The CEO of Deeley Harley Davidson Canada, Don James has been trying to give a 3 million dollar donation for a desperately needed children and adult BC ADHD clinic. For 3 years. Incompetent BC medical bureaucrats have ignored him. Repeatedly.

This is disgraceful.

Pamela Fayerman, the Vancouver Sun’s medical reporter wrote an excellent investigative story on this. Check out her Blog Medicine Matters, Twitter  Facebook. But unfortunately, her 1675 word investigative story complete with a staff photographer photograph that looks like it’s written for the print edition is posted instead in her blog, not the print edition.

Why? Was it spiked? Blog spiked? It’s a great story. Did it offend the powers that be at the Vancouver Sun? Their connected friends or organizations? Vancouver Sun managing editor Harold Munro apparently made the decision. Please ask Harold why an excellent story like this is not in the print edition? Here’s his email address hmunro@vancouversun.com ADHD gets ignored or stigmatized in BC far too much.

Don James, CEO of Deeley Harley Davidson Canada explains why he offered the generous donation for a much needed BC adult and children’s ADHD clinic.

We’ve had some experience with ADHD in our family,” he said. “My wife Ruth, and I, wanted to ensure that children treated there aren’t suddenly dropped as patients when they transition to adulthood,” he said, noting that in 2009, a B.C. Medical Association report drew attention to the need for more services for ADHD patients of all ages.

I wish there were more people like Don James in BC.

James approached various mental health experts at the Provincial Health Services Authority (PHSA), the BC Mental Health Foundation as well as experts at BC Children’s Hospital. Although there was initial interest, no one got back to him with a plan or promise to use the money, he said.

This is disgraceful.

As an Adult ADHD coach who runs the Vancouver Adult ADD Support group, I get people emailing me on a daily basis, asking for people who can diagnose ADHD in children and especially in adults. I’ve heard far too many horror stories by people who suffered because they didn’t get diagnosed and treated for ADHD.

Many BCers wait months on wait lists to get diagnosed for ADHD IF they can find someone who is actually knows ADHD well enough to give a proper diagnosis. Most medical professionals in BC have no training in ADHD. UBC medical students only get one hour of training on ADHD.

Don James says

If they weren’t interested in our donation, they should have had more respect by referring us elsewhere because we weren’t talking about an insignificant amount of money. We weren’t given the straight goods.

People were protecting their turf and not thinking about all the patients out there who aren’t getting proper treatment. We were handled in an incompetent, unprofessional manner

So adults and children with ADHD in BC who are severely lacking in resources for diagnosis and treatment HAD someone out there willing to fund the services they so desperately needed but didn’t get them because incompetent medical bureaucrats decided fighting ego turf wars was more important than helping ADHD patients?

Or did they just have contempt for people with ADHD? I know people who work in the mental health field who’ve went public at work with their ADHD and experienced discrimination by doctors and psychiatrists because of it.

Dr. Jana Davidson, a psychiatrist and head of mental health at BC Children’s and Women’s Hospital and Health Centre, admitted that, as one of those tasked with handling the pledge, she dropped the ball and left James and his wife dangling for three years.

“I feel badly. These were incredibly generous, well-meaning people, intent on trying to improve services for those living with the negative effects of ADHD. “The responsibility fell on my shoulders. I should have done a better job, especially in the formal communication with them,” Davidson said.

The BC Liberal govt closed down the only public adult ADHD clinic in BC 5 years ago after having a politically embarrassing 12-14 month wait list for an entire year. Still closed. I asked then NDP health critic Adrian Dix‘s (now BC NDP leader) office if they’d do something about it, but just got a lot of empty promises and nothing in the end.

Why hasn’t health minister Mike De Jong done something about this? What will he do about this badly botched multimillion dollar donation? Email mike.dejong.mla@leg.bc.ca Phone: 250 953-3547

I asked BC Premier Christy Clark at her town hall meeting 8 months ago if she would reopen the BC Adult ADHD clinic the BC Liberals closed. Her answer is on my blog post with the audio, she said “I’m Absolutely Committed To Working With You On It”. CKNW and CBC did a story on it. But nothing’s happened.

“James said he made several overtures to experts, including Leslie Arnold, president of BC Mental Health and Addictions Services, a PHSA (Provincial Health Services Authority) agency that has a mandate for ADHD services based at Children’s Hospital.

When James first approached BC Children’s in 2008, the hospital was about to stop accepting adult patients because waiting lists were too long. Even after dropping adult patients, waiting lists for pediatric patients — and their parents who may be taught new parenting skills —are still long. At present, new patients must wait five months to be seen. ”

James said he’s incredulous he’s only recently learned more about the dithering on his pledge. And he’s especially disturbed he discovered about it through a Vancouver Sun journalist (this writer), not from hospital officials.

“No one ever told us they couldn’t use our money or why. We offered money and they simply ignored us.”

Dr. Margaret Weiss head of the BC ADHD clinic, and world renowned authority on ADHD resigned in part over this. She’s worked there for 20 years. This is a big loss.

The Don James donation debacle played a role in the resignation from BC Children’s Hospital of Dr. Margaret Weiss, one of the world’s leading authorities on ADHD. Weiss had practised psychiatry at the hospital for 20 years and had led the ADHD program for about the last half of them until she left a few months ago. The McGill and Harvard University-educated psychiatrist is now seeing ADHD patients and conducting research in her North Shore home office.

She’s one of the world’s most prolific authors of ADHD studies published in prestigious medical journals. She also advises health systems around the world how to provide ADHD treatment programs. Weiss said the diversion of the James donation, coupled with the BCCH policy to stop accepting patients after their 19th birthday, was devastating news to her and her patients. It was one of the reasons she resigned, she said

If you ever wanted to do something about getting back an adult ADHD clinic in BC now’s the time.

“Someone else should do it” rarely really happens in real life. Many non ADHD people don’t even think ADHD is real let alone care about us.

People with ADHD don’t get services in part because far too often many in the media, the govt, and the medical bureaucrats don’t think it’s real, or a real problem. If we want services, we need to tell them why we need them.

Here are a few ways you can help:

Please read the story and pass it on to people you know who might be interested in it and facebook/twitter, consider commenting on Pamela’s blog post or writing a letter to the editor, if you do, ask them why the article is not in the print edition of the Vancouver Sun.

Please call your MLA and demand they reopen the BC adult ADHD clinic and ask them to do an inquiry on why a much needed $3 million dollar donation for BC adult and children’s ADHD clinic got ignored for 3 years.

Here’s how to find your MLA’s contact info

Also please consider politely (cursing gets deleted) explaining to these people why adults and children with ADHD need a BC adult and children clinic. If they don’t think we need resources they won’t give us it. Lots of other groups want the limited resources.

If the PHSA Provincial Health Services Authority won’t help adults and children with ADHD, they should give the resources to VCH Vancouver Coastal Health Authority to do so

1. Lynda Cranston, President and CEO of the PHSA. Provincial Health Services Authority lcranston@phsa.ca

2. Lorna Howes, Director of Mental Health Services for VCH. Vancouver Coastal Health Authority  lorna.howes@vch.ca

3. Mike De Jong. Minister of Health. Email mike.dejong.mla@leg.bc.ca Phone: 250 953-3547

4. Mike Farnworth BC NDP’s Health critic. Email  Mike.Farnworth.MLA@leg.bc.ca
Phone: 250 387-3655

Other ideas?

Children with ADHD have nearly a four times higher risk of suicide attempts and depression according to a new study in Archives of General Psychiatry.

12% of children & teens with ADHD said they had a specific suicide plan at least once during this time period vs 1.6% of the non ADHD kids.

Do you think a 4 times higher risk of suicide attempts and depression in ADHD children will finally get the medical system, governments and the media to stop stigmatizing ADHD families and start taking ADHD more seriously? Will they start demanding proper training for doctors, psychiatrists and psychologist on ADHD, and parent training programs for parents of ADHD children? ADHD meds are useful, but they won’t magically teach skills.

For example, here in Vancouver BC, UBC medical school students only get one hour of training on ADHD & the BC govt closed the only public Adult ADHD clinic in BC because an embarrassing long 1 year wait list. Also, ADHD is 80% genetic, if the kids have it usually 1 or more of the parents do too and should be screened for adult ADHD. If you haven’t learned methods to manage your own ADHD, it will be a lot harder to manage your child’s ADHD.

With ADHD, comorbidity or  co-existing conditions are the norm, not the exception. People with ADHD have higher rates of depression, dysthymia, anxiety, drug and alcohol abuse, bipolar, anxiety disorders, personality disorders, anorexia, bulimia, binge eating, oppositional defiant disorder, conduct disorder, gambling addiction, learning disabilities, and higher rates of incarceration etc.

But, properly managed, ADHD can be a competitive edge, like the billionaires that attribute their success to ADHD, and a MENSA ADHD group with 600+ members.

Here’s what the prospective follow-up study on children with ADHD and depression and suicidal ideation and attempts during adolescence measured and found out.

PATIENTS: A cohort of 125 children who met DSM-IV criteria for ADHD at 4 to 6 years of age and 123 demographically matched comparison children without ADHD were prospectively followed up in 7 structured diagnostic assessments of depression and suicidal behavior in assessment years 6 through 14, spanning 9 through 18 years of age.

MAIN OUTCOME MEASURES: DSM-IV criteria for depressive disorders and suicidal behavior.

RESULTS: Children with ADHD at 4 to 6 years of age were at greatly increased risk for meeting DSM-IV criteria for major depression or dysthymia (hazard ratio, 4.32) and for attempting suicide (hazard ratio, 3.60) through the age of 18 years relative to comparison children. There were marked variations in risk for these outcomes among children with ADHD, however. Within the ADHD group, children with each subtype of ADHD were at risk but for different adverse outcomes. Girls were at greater risk for depression and suicide attempts. Maternal depression and concurrent child emotional and behavior problems at 4 to 6 years of age predicted depression and suicidal behavior.

CONCLUSIONS: All subtypes of ADHD in young children robustly predict adolescent depression and/or suicide attempts 5 to 13 years later. Furthermore, female sex, maternal depression, and concurrent symptoms at 4 to 6 years of age predict which children with ADHD are at greatest risk for these adverse outcomes. Identifying high-risk young children with ADHD sets the stage for early prevention trials to reduce risk for later depression and suicidal behavior.

It’s no secret among those of us who work with ADHD that children and adults have much higher rates of depression, dysthymia and suicide. If you look at some of the symptoms of ADHD in children or in adults and you don’t find ways to manage them effectively, it’s pretty logical to see how they could easily lead to depression.

According to WebMD, Dr. Alec L. Miller,  professor of clinical psychiatry says

Some youth with ADHD, especially when undiagnosed or when poorly managed clinically, exhibit difficulties in academic, social, and familial functioning and significant and persistent impairment in these domains naturally can contribute to depression.

Dr Stephen Grcevich, a child and adolescent psychiatrist points out

Parents should make sure that their kids are getting proper treatment for ADHD so that these functional impairments don’t escalate to the point that they put kids at greater risk for depression.

Proper treatment is multiple methods of treatment. USNews has an article called ADHD, Depression, and Suicide: How Parents Can Keep Children Safe that you might want to look at.

The Vancouver Sun celebrated ADHD Awareness week by stigmatizing ADHD on it’s front page, & sharing it Canada wide via the Canwest 2.0 / PostMedia News network.

Update 2: The Vancouver Sun actually ran a story on the same study nearly a month earlier, August 18th with the title One million children may be misdiagnosed with ADHD: Study.

Vancouver Sun 1st article on Elder ADHD Study on August 18th, 2010

They ran it as a news piece without the 3 comments by people who do not diagnose ADHD in children and are not ADHD experts. So please explain to me why a story The Vancouver Sun (a daily newspaper) covered on August 18th 2010 was also their front lead news story on Sept 13th 2010?

Update:

See: The 2 blog posts Vancouver Psychologist Dr. Jim Roche who diagnoses ADHD and works with ADHD children has written on the Vancouver Sun ADHD stigma article.

1. Vancouver Sun doesn’t get the point about ADHD Diagnosis and Treatment

2.ADHD: Science-Based Medicine and Psychology

Monday Sept 13th 2010 was the 1st day of the 7th annual ADHD Awareness week in the US. Sadly, Canada, which is quite backward in understanding and dealing with ADHD, has yet to have a 1st one. BC is more backwards on ADHD than some other provinces like Alberta, Ontario and Quebec.

The Vancouver Sun has done some great articles on depression and biploar in the past. That’s one reason why it was so disappointing on the 1st day of ADHD Awareness week to read their front page lead article stigmatizing ADHD and promoting myths about ADHD instead of exposing the stigma and myths about ADHD. Their Sept 13th A1 headline by reporter Tracy Sherlock was

“One in five hyperactive children possibly misdiagnosed, report finds”

I’m an adult ADHD coach who has ADHD and I don’t have a problem with the actual findings of the study, which talks about children who are younger than their peers in classes being more likely to be misdiagnosed with ADHD. When you consider that ADHD is often considered a developmental delay, and that ADHD isn’t taken seriously enough by the government, healthcare system and the media let alone the general public (for example the BC govt closed the only public Adult ADHD clinic after it had an politically embarassing 1 year wait list ) and that many doctors are unfortunately not provided with proper training on diagnosing and treating ADHD, it was not that surprising for those of us who know ADHD. You can see the full study in PDF format here

It’s the rest of the Vancouver Sun article that’s the problem. Worse, it got picked up by PostMedia News (Canwest 2.0) so they promoted ignorance and stigma about ADHD across Canada in outlets like the Vancouver Province, Victoria Times Colonist, Edmonton Journal, Ottawa Citizen, Montréal Gazette, Global TV, etc.

Too bad the Vancouver Sun didn’t do a more responsible, non stigmatizing article on the diagnosing ADHD in children study like the one The National Post (a sister PostMediaNews paper) did 3 weeks earlier written by a doctor that actually diagnoses ADHD in children, Dr. Yoel Abells.

This post has 3 sections

1. Six Problems with the Vancouver Sun’s coverage of the ADHD story (there are more but I’ll limit it to six).

2. Some thoughts on the implication of the study.

3. Some possible actions you can take at the end of this post.

Here are 6 problems with the Vancouver Sun’s coverage

1. It’s OLD news for a daily newspaper.

Nearly a month old. Yet, it was published as a front page lead story in a “daily” newspaper. It ran in Macleans and many other print media sites on August 17th vs Vancouver Sun’s September 13th.

2. The article mentions a study on diagnosing ADHD in children, quotes 3 local people in the article and NONE of them:

1. Actually diagnose ADHD in children or adults.

2. Are recognized experts in ADHD.

Would the Vancouver Sun do an article on diagnosing liver disease and quote 3 locals on it and not have at least one of them someone who actually diagnoses liver disease? How did this slip by the editors? Or was it a deliberate decision to slant the story from the beginning to stigmatize people with ADHD and use them as bait for more readers?

3. The only quote highlighted is a stigmatizing quote demonstrating ignorance of ADHD

This is the only pull quote in the text that’s been bolded to draw attention to it

There is no blood test for ADHD — it’s very subjective and this study makes that very clear,” MacDonald said. “I’ve long suspected that our attitude toward rambunctious behaviour influences whether we perceive that children have ADHD. Barry MacDonald

Where do I begin?

Barry Mcdonald is a RCC, registered clinical counselor, not a psychologist. RCC’s don’t diagnose ADHD.

“There’s no blood test for ADHD”

Of course there’s no blood test for ADHD. There’s no blood test for depression or schizophrenia either. Does that invalidate/minimize/trivialize/stigmatize the diagnosis of depression or schizophrenia?

There are NO blood tests for ANY mental health condition. That’s the most basic point of diagnosing ANY mental health condition. Why doesn’t the Vancouver Sun reporter Tracy Sherlock or any of her editors know this? No one expects them to be experts on every medical condition, but surely shouldn’t there be some baseline knowledge? In an editor at least, if not a reporter?

It was the lead front page story. Shouldn’t there be at least a few editors around with a very basic understanding of physical and mental health conditions? Especially when you see how many editors there on the Vancouver Sun’s contact page?

Does the Vancouver Sun need someone like Psychiatrist Dr. Margaret Weiss, head of the BC ADHD clinic to come in to educate the Vancouver Sun staff on some basic factual knowledge on ADHD and other mental health conditions?

If you want to learn what’s involved in diagnosing ADHD, or let your doctor know, the CADDRA (Canadian ADHD Resource Alliance) Canadian ADHD Practice Guidelines will tell you. CADDAC, CHADD Canada, TotallyADD and my 130 page ADHD resource website are some other good Canadian websites on ADHD.

The second part of the quote, “I’ve long suspected that our attitude toward rambunctious behaviour influences whether we perceive that children have ADHD.” is another common myth used to stigmatize ADHD, i.e. the old “it’s not really ADHD, its just boys being boys/active”, or “Only people who have massively off the chart behavior problems have ADHD, there’s too many boys being boys diagnosed with it” BS meme. The subtext is trying to push the it’s not a real condition/ only extreme off the chart cases are ADHD, etc. There’s a huge difference between believing something and having a solid clinical diagnosis by someone who really understands ADHD. Trouble is not enough doctors do.

Why does the Vancouver Sun decide to highlight one paragraph, this one? Why highlight ignorance and stigma? Shouldn’t the job of a newspaper be to expose ignorance and correct ignorance and stigma? Versus make it most prominent part of the story and syndicate it nationwide?

4. Study Author Todd Elder also talks about the under diagnosis of ADHD in the study that the media ignored.

Although recent headlines from his research have focused on the possibility that nearly 1 million children in the U.S. may have been misdiagnosed with ADHD, Elder tells WebMD that there may also be a substantial amount of under diagnosis among older kids.

but Vancouver Sun also ignores that. Wonder why? Doesn’t fit their biased narrative?

ADHD is misdiagnosed, overdiagnosed and underdiagnosed. Underdiagnosis is the biggest problem, especially in adults, and ignorance & stigma against ADHD is one of the reasons for this. This will continue to happen until people start demanding medical schools and the BC College of physicians and surgeons starts properly training doctors and psychiatrists on ADHD. Maybe start by contacting your local BC MLA or or contact BC’s Minister of Health Services Kevin Falcon

5. ADHD is not just Hyperactive

Headline is “One in five hyperactive children possibly misdiagnosed, report finds”. Not all children with ADHD are hyperactive, many girls, and some boys have the inattentive form of ADHD, AND often don’t get diagnosed because people aren’t aware of it. That’s why the actual report and other media used the term ADHD.

6. Most obvious question ignored.

Wouldn’t an obvious question from the study be: given the findings, are BC doctors, psychiatrists and psychologist adequately trained enough in ADHD to be able to properly diagnose and treat ADHD in children? Let alone adults, given there are more adults with ADHD than children, since ADHD is 80% genetic (fathers usually stay in denial longer than mothers) How come that question is never asked? Would it harm the biased narrative?

Go to the end of this post if you want some ideas on responding to the Vancouver Sun and Post Media New’s ignorance and stigmatization of ADHD

Implications of the study

If the study is indeed accurate and SOME medical professionals are overdiagnosing younger children and underdiagnosing older children in those numbers or even near that, it should be a wake up call to the public, the healthcare system, and the media. Too bad the media is sleeping through the alarm clock.

BC Parents shouldn’t have their child diagnosed with ADHD when they don’t have it or not diagnosed with ADHD when they do have it.

BC doctors, psychiatrists and psychologists are NOT adequately trained on ADHD; this is what many of them have told me. Many of them have said they weren’t trained on ADHD during medical school. There ARE some people like Dr. Margaret Weiss of the BC ADHD Clinic at Children’s Hospital and Dr. Gabor Mate who has ADHD and wrote a book on it, Scattered Minds who are world-class experts in ADHD here in Vancouver, but they learned about ADHD on their own.

UBC medical students only get one hour of training on ADHD during their entire program.

Is that enough to diagnose and treat a complex condition like ADHD where there are many co-existing condition with it, and they’re the norm, not the exception? If not what is being done to change that?

One reason the media keeps stigmatizing ADHD is not only the lack of properly trained medical professionals who know ADHD, but many people with ADHD don’t go public with the condition because of the ignorance and stigma surrounding ADHD, which the Vancouver Sun and PostMedia News (Canwest 2.0) perpetuates.

I’ve done an anonymous survey for adults who’ve been diagnosed with ADHD and haven’t gone public asking them what it would take for them to go public.

Of course not everyone should and there are many dangers and benefits to doing this and it should not be done impulsivly. I’ve got 100+ answers so far, some amazing powerful stories, and am working on analyzing it for a media release and a series of blog posts.

But some of the common answers I’ve found from my survey was that when they talked to their families, friends and medical professionals about having ADHD, they often were told ADHD isn’t a real condition. They also had families, friends, and medical professionals insulting, shaming, and stigmatizing ADHD and them for having it.

Here’s one quote from part of one person’s answer.

I am very careful about revealing to people about having ADHD. In conversations, they would say things like “Oh ADHD does not exist” or “it is just laziness.” Someone said “everyone has it these days.” When I hear people mention things like this, I just decide not to reveal anything to them. My mother still yells at me and tells me that I am just being lazy and disorganized on purpose.

What can you do about this?

1. Contact these people and politely tell them your thoughts about their Sept 13th front page lead article stigmatizing ADHD.

Patricia Graham, Editor-in-Chief, Vancouver Sun
Phone: 604-605-2318 pgraham@vancouversun.com

Kirk LaPointe, Managing Editor, Vancouver Sun
Phone: 604-605-2033 klapointe@vancouversun.com

Alex Beer, Editor-in-Chief Postmedia New
Phone: 289-396-2066 abeer@canwest.com

or the editor of the local paper that approved and syndicated this article

2. Share your thoughts about this article on twitter, facebook, your blog, or email it to others that might be interested in it.

3. Express your thoughts in the comment section of this blog post

4. Ask the Vancouver Sun and PostMedia News to do an article on ADHD that dispels the myths and stigma surrounding ADHD instead of promoting them. Perhaps by interviewing people who actually know ADHD well enough to properly diagnose ADHD and people who actually have expertise in ADHD

5. Contact your local BC MLA or or contact BC’s Minister of Health Services Kevin Falcon and ask them why aren’t they making sure BC’s Doctors, Psychiatrists and Psychologists are properly trained on diagnosing and treating ADHD in children and adults? BC Parents shouldn’t have their child diagnosed with ADHD when they don’t have it or not diagnosed with ADHD when they do have it.

6. Other ideas?

This is from someone I coached. Thought some of you might find it helpful.

Pete

What Has Helped Me with Adult ADD

Hi,

I don’t know if you have adult ADD or ADHD (I have ADD), but I sure feel for you. I was diagnosed this summer, shortly before I was fired for the second time. Looking back I realize it’s been going on for 10 years. It’s caused huge financial and family turmoil that we’re still working through. I was doing good work on individual projects, but missed I appointments, was late on important documents, and felt mentally cloudy – like I was in a shower with fogged up glass around me. In some ways the worst part was that I never felt that I accomplished enough of the items on my To Do list, and felt panicky and like a failure – even when I was being productive.

The good news: Now that I’ve been diagnosed and taken action, I would say I have my ADD about 80% controlled. At this point I probably fall into the category of “occasionally absent minded” rather than a mess. This means the things I’m really good at stand out rather than being dragged down by glaring mistakes. I’m pretty confident I’ll keep the next job – I feel entirely different, haven’t missed an appointment, project deadline, paid a bill late, or missed freeway off ramps since then.

People get ADD under control in individual ways. I’ll tell you in a bit what worked for me – but you should see it a menu, not a concrete guide to what you should do. Here are the resources I turned to:

• Get an ADD coach + maybe a personal organizer: I like the ADD coach I used very much – he’s low key, with lots of good ideas. He’s in Vancouver but we worked well together over the phone and by email. Here he is – if you use him, tell him I sent you: Pete Quily
• I also used a local professional organizer. She came over and helped me organize my home office – how I should organize my desk and filing cabinets, filing system and so on. Find someone local in the phone book or online. Get someone who has worked with ADD clients
• The nicest thing she said to me was: “You can get organized, and be successful – you just have to do it differently than most people, because the usual organizing tips don’t work for people w ADD”
• ADD-Friendly Ways to Organize Your Life, by Judith Kolberg and Kathleen Nadeau. By far the best book on adult ADD I looked at – in fact I bought it. It’s filled with practical tips on how to get ADD under control; many of the others talk more about ADD as a disability but don’t give you concrete tips on taking action
• Psychiatrist + medication: Find a good psychiatrist who’s familiar with adult ADD. I’m sure my Mom can help you. I got lucky; mine is terrific. There are different meds to use, but he put me on the lowest dose (30 mgs) of Vyvanse, basically it’s like a strong cup of coffee that lasts all day. My mind cleared up amazingly within 2 hours of when I took my first dose. He told me that Vyvanse is somewhat more effective than Ritalin, which is used more commonly – but that’ll be up to your psychiatrist
• Go to: ADDitude Magazine- good site with lots of helpful articles, plus you can sign up for a free online newsletter. Some good stuff on nutrition in there – for example fish oil is supposed to be helpful
• Here’s what I’ve come up with as a system that works pretty well for me. I have to be strict about following these rules – when I don’t, I mess up pretty quickly. It took me several months to really get into these habits. Again, it may not work for you

Steve’s 10 ADD Disciplines

• Ask the right people for help: Not everyone can be helpful to you, but don’t hesitate to reach out to those who can. This is a disability just like a broken arm – no shame in it
• Stop and listen to the quiet voices inside your head – they often tell me when I’m wasting time on something that’s not a priority
• Ask the right people for help: Not everyone can be helpful to you, but don’t hesitate to reach out to those who can. This is a disability just like a broken arm – no shame in it
• Stop and listen to the quiet voices inside your head – they often tell me when I’m wasting time on something that’s not a priority
• Strict AM routine: I’ve developed a routine that I go through every morning: Create a to do list every morning that you look at during the day and check off what’s done. My list is: Look at my calendar – what do I have to do today? Check emails if case there’s something important. Look at yesterday’s Action list, and create a new one for today. Prioritize what important, not just what’s urgent
• A place for everything and everything in its place: For example, when I go out my cell phone is in my right front pocket, my keys are in my left front, and my wallet is in my back left pocket. Same with your home
• OHIO: Only handle it once. Good for emails, bills, and so on. Don’t let things pile up
• Take small bites (I don’t mean food): When I have a big project that looks hard; just do a little piece of it. Fold half of your laundry – you’ll feel better and eventually get stuff done
• Prepare first thing for appointments: If I have a meeting today, even if it’s in the afternoon, I prepare for it first thing in the morning so if things get rushed I’ll still be able to leave on time. I even take a shower and lay my clothes out
• Leave twice as much travel time as you think it will take to get somewhere, and take something to read or do if you’re early. Sometimes you need all that time, and you’ll be more relaxed
• When it’s good enough, stop: I tend to try to make things better and more perfect than they need to be – big waste of time. Only make things really great if they need to be
• Do your best, and forgive yourself when you mess up. Don’t beat yourself up when you make ADD mistakes – it’s going to happen. Figure out when went wrong, and change the system so it won’t happen again

I hope this is helpful. I believe that you CAN control ADD and improve your life. I have.

Best of luck,

Steve

Dr Charles Parker has a good article about sleep and ADHD where he provides

specific treatment considerations for any ADHD symptoms associated with sleep disturbance. Untreated each of these issues aggravates symptoms of ADHD.

Many adults and children with ADHD have sleep problems, it’s almost a diagnostic sign of ADHD. ADDers often have problems with sleep in a few areas.

• Going to sleep. Actually getting off the computer/TV etc and getting into bed
• Getting to sleep.
• Staying asleep. not waking up during the night and staying up.
• Waking up.

here’s a few of his 10 tips

Untreated ADHD or other Comorbid Psychiatric Problems: The most frequent cause of Level 1 sleep issues is untreated ADHD and/or depression associated with worry and prefrontal cortical dysregulation. Comorbid major depression, mood disorder, and other psychiatric problems may also interfere with all three levels of sleep.

Assess Lifetime Duration of Sleep Problems: Many live for years with sleep issues and only in middle age begin to show the significant wear. Just because someone has previously done well with 4 hr of sleep and naps doesn’t help the defragmentation process that takes place in a 8 hr sleep at night. Sleep treatment for these challenges usually results in excessive sleep for days to weeks until the body sets a new calibration.

Excessively Treated ADHD: If stimulant [or other psychiatric] medications are adjusted inappropriately high, and duration of effectiveness of the stimulant medications is not properly adjusted, medications will interfere with sleep on many levels. Paradoxically, when stimulant medications are well adjusted, and comorbid depression is corrected, often sleep medications are not necessary. Always dose psychiatric medications according to the principles of the Therapeutic Window noted in my other articles here.

Sleep deprivation can look like ADHD and can be gasoline on ADHD symptoms. Ideally you want to get of the electronic stimulation boxes (surfing the net, playing video games, watching TV) at least an hour before bedtime in order to allow your racing ADHD brain to slow down enough to get to sleep. Not always easy I can say from personal experience, but very useful. Sleep hygiene is also important. Just use your bed for sleeping and sex, nothing more, try go to bed at the same time 7 days a week etc. Sometimes melatonin can be useful.

What things have helped you to deal with sleep problems?

There are many ways how to manage or deal with Adult Attention Surplus Condition, aka Adult Attention Deficit Hyperactivity Disorder. Here are a few.

Top Ten Ways to Manage Adult ADHD

1. ADHD Coaching. More for adults than children. Pills can be useful but pills don’t teach skills, they’re not designed to. They can, however, put you in a better place to learn them through ADHD coaching or therapy.

Once you stop using ADHD meds, their effectiveness is gone. Learned skills from ADHD coaching last longer.

See the 26 benefits of adult ADHD coaching. Adult ADHD Coaching focuses on practical day to day ways to manage adult ADHD more effectively at work and at home. Generally speaking therapy is more focused on the past, and coaching is more focused on the present and the future. Adult ADHD Coaches work on helping you learn to more effectively manage the challenges of ADHD and identifying and developing the strengths of having ADHD. They work over the phone for 3-4 sessions per month. Most of us adult ADD coaches offer a free sample sessions of ADD coaching so you can try before you buy.

2. ADHD Medication. Not the tool of the devil, not the magic cure all. Just a useful tool that has been studied more than probably 98% of any medications that you’ve taken, and stimulants have been used for 70 years. Talk to people who’ve actually taken medications for ADHD and a doctor that’s experienced in dealing with adult with ADHD before you make up your mind. Here’s some articles on ADHD medications, lists of companies making ADD medications and detailed clinical pdf’s on ADHD meds and ways to deal with side effects (scroll down to chp 10). If you do try ADD meds, at least give them an honest try, it takes a while to find the right med(s) and the right dose. Keep in mind meds are a partial solution, even ADHD drug companies don’t say they’re a complete solution

3. Cognitive Behavioural Therapy by someone that knows about Adult ADD. The knowing ADD part is crucial whether its a therapist or coach. Just like coaching it’s also crucial to have a good fit with the therapist. Therapy is useful in uncovering, understanding & dealing with things from your past that aren’t resolved and interfere with your present functioning. Some people, especially men, view going to a therapist as a sign of weakness. I view it as a sign of strength and courage. That you have the guts to look inside yourself instead being too weak and afraid to do so. So if you need to go to one, go, don’t be a wuss.

4. ADHD Support Groups. There’s a lot of info on the net about Adult Attention Deficit Hyperactivity Disorder. I have a 130+ page website on Adult ADHD and believe learning about Adult Attention Deficit Disorder is important, but it can be really useful to meet other ADDers in person. They’ll all “get” Attention Deficit Disorder, you don’t have to explain what it is to them, it’s helpful to meet others with the same problems & gifts, plus we’re not boring people:) I have a list of Canadian ADHD support groups by province and a list of US ADHD support groups and International ADHD support groups. If you’re in Vancouver come visit the group I lead, the Vancouver Adult ADD Support Group. If there’s no group in your area, create your own like I did, check out the section on how to start, run and promote a support group.

5. Adequate Diet. Keeping the race car brain running smoothly. Feeding your ADHD brain with a good diet, especially adequate dopamine building protein in the morning, and Essential Fatty Acids are important. Adders often forget meals and water. Starving your brain doesn’t make you smarter.

6. Exercise boosts the 3 main neurotransmitters associated with Adult ADHD. Dopamine, serotonin, norepinephrine and the feel good beta-endorphins and relieves stress. Exercise is the number one non medical way to deal with ADHD, depression, anxiety and stress. Make sure you chose exercise that’s interesting to you vs. what you think you “should” do. Not everyone likes the gym.

7. Learning to Slow down and Stop. So you don’t crash. Take regular, short, non electronic breaks or your brain will slow down/shut down/or distract/procrastinate out, all very common problems with ADHD Adults. This is the #1 way to be more efficient at work. Especially when you’re “too busy” to take a break.

8. Meditation. Think deep mental refreshment. Why do those Buddhist monks always look so chilled out? Race car ADHD brains need pit stops and tune ups or they burn out. If you’re a beginner, start with active forms of meditation first, NOT passive ones (i.e., don’t start staring at the wall and thinking of nothing). Active forms of meditation involve your senses, i.e., body, breath, voice, ears, or fingers, so it’s easier for ADHD Adults to focus and avoid getting distracted and helps to calm the monkey mind. Check out UCLA’s research on mindfulness and ADHD

• So try out Yoga, Tai Chi, Qigong, breathing meditations, walking meditations, guided meditations on CD, mantras, chanting, using mala‘s / prayer beads, or Eckhart Tolle’s concept of being present, being in the now.

• Would you expect to go from not running to trying to run for 30 minutes the first time? Then don’t expect to meditate 15-20 minutes at the beginning. Try 2-3 minutes at first everyday and slowly work up.

9. Tutors or Educational Psychologists that know about ADHD. See this section on teaching students with ADHD, or this one.

10. Professional Business and Personal Help. Professional Organizers that know about ADHD, bookkeepers, virtual assistants, secretarial help, cleaning services etc. Smart, successful people delegate what they don’t like, or aren’t good at. Especially if you have your own business, hiring someone to do the paperwork should be the first thing you pay for, it can make the difference between success and constant struggle and frustration. In Canada try Professional Organizers of Canada, and in the US try Napo.

What are some ways you manage your ADHD?

Just a reminder for those that don’t usually do well with New Year’s resolutions. There is an alternative. A New Year’s Theme.

Have a Merry Christmas and a Happy New Year. And a happy Hanukkah, Kwanza and Akemashite Omedetoo Gozaimasu.

ADD Resources has a great list of links to dozens of ADHD related CME’s (continuing medical education) courses for medical professional and available to the general public as well. They also have links to podcasts and videos.

Next time you hear your Doctor/Psychologist/Psychiatrist say “I don’t know enough about ADD to diagnose or treat it”, show them this webpage.

One way to fight ignorance and stigma against ADHD in the medical profession and the media is knowledge about the condition, diagnosis and treatment.

Sometimes ADHD Adults and parents of ADHD kids need to help educate their Doctors/Psychologists/Psychiatrists about ADHD, since it still isn’t covered very well by medical schools (according to many doctor’s well versed in ADHD that I’ve talked to, who tend to be self educated).

Another great place to go for free clinical information on ADHD is CADDRA’s (Canadian ADHD Resource Alliance) Canadian ADHD Practice Guidelines for 2007-8. It has quite an extensive amount of free information to teach medical professionals how to diagnose and treat ADHD in children, adolescents and adults including various rating scales, how to manage medication side effects, etc.

It’s designed for ADHD clinicians but should also be read by people with ADHD and parents of children with ADHD. Or anyone that wants to learn more about ADHD.

Here’s a list of the subjects that the ADD Resources CME’s cover:

* ADHD Diagnosis
* ADHD Treatment for Adults
* ADHD Treatment for Children
* Medicines
* Depression and Comorbid ADHD
* ADHD and Comorbidities in Adults
* ADHD and Comorbidities in Children
* ADHD and Substance Abuse
* Quality of Life Issues in Adults with ADHD
* Quality of Life Issues in Children with ADHD
* General Topics
* Research

Here’s a link to a quick Adult ADHD screener test by Harvard, NYU and the WHO.

Here’s a link to 34 Articles & Ebooks and Manuals on Teaching Students with ADD.

The term Fisking, or to Fisk, is blogosphere slang describing detailed point-by-point criticism that highlights errors, disputes the analysis of presented facts, or highlights other problems in a statement, article, or essay.

Karin Klein an LA Times editorial staff writer wrote an editorial in the August 20th, 2007 issue entitled “Pens, Pencils and Meds”, which I thought just piled more unneeded stigma on people with ADHD. It unfortunately got picked up by many other newspapers, websites and blogs, further spreading the stigma and ignorance. I recently got an email from her saying she was on the Pulliam Fellowship, so she can work full time on an in-depth project in ADD and asked me to help her find mothers with ADD to interview. Being the curious type, I googled her and found this editorial Karin Klein wrote last August. I wrote back saying I declined and citing her article and made a few point about the stigma against ADDers it created, and that I didn’t want to help her create more stigma against ADDers.

However Gina Pera, a journalist and mental-health activist, did a much more thorough job than me rebutting Karin Klein’s editorial, and with her kind permission I’m reprinting Gina’s rebuttal. Karin Klein’s editorial is in blockquotes, Gina Pera’s comments are in regular text.

If you think that this sort of content stigmatizing people with ADD doesn’t belong in the LA Times you might want to let her editor Jim Newton jim.newton@latimes.com know how you feel.

Enjoy.

Pencils, Pens, Meds

As kids head to class, pharmaceutical companies ramp up their drug marketing — and it works.

It works because too many parents don’t realize their children have ADHD — and their doctors don’t, either — until they get to school! It works because many parents themselves have undiagnosed ADHD, and they do not recognize it as such in their children. It works because our society is in massive denial about ADHD and sometimes the most effective method is appealing directly to the people who know that it is real – and it is significant.

By Karin Klein

August 20, 2007
Back-to-school season is in full swing. Time to pick out a backpack, sneakers and a stimulant medication for attention-deficit hyperactivity disorder.

Disgusting lead. Cheap, cheap shot.

Nearly 2 million children in the United States are diagnosed with ADHD, which is marked by poor concentration, lack of self-control and/or hyperactivity. Besides time off from school, many kids with ADHD get a summer “vacation” from the prescription medications that help them focus in class.

That is outmoded thinking. Experts today recommend no medication “holidays” because ADHD impairments extend far beyond “focusing in class.” They include deficits in social skills and driving/sports safety and vulnerability to substance use, promiscuous sex, STDS, unplanned pregnancies, and many other risky behaviors.

So, not only is she reinforcing old ideas — that there are medication holidays and that medication is used solely for focusing the classroom — but she is also implying that all children receive stimulant medication callously. Instead, for the vast majority of parents that I know, it is a very painful process of coming to accept the medical nature of their child’s difficulties—-usually after a long process of trying every other alternative–and finding the best way to help them. They don’t need Ms. Klein heaping ignorant blame on their heads.
(Full disclosure: I have no children, and if I did, I know this would be a tough decision. But I have met many, many parents who have helped their children immensely by seeking medical treatment for them. For many, family life can still be quite tough. These parents deserve all the support we can muster, not fear-mongering.)

So August has become a prime time to market the idea that a change in drug for the new school year (Concerta to Adderall?) might help the kids focus better, keep them going longer or have fewer side effects. Direct-to-parent marketing of ADHD drugs — most of which are stimulants — has grown pervasive over the last few years, despite a United Nations treaty banning most of it. Use of such medications increased by more than 60% from 2001 to 2005, according to the International Narcotics Control Board.

Why does Ms. Klein not cite the studies showing that general practitioners aren’t comfortable with their ability to accurately diagnose or treat ADHD — hence the need for the advertisements in the first place?

At least here she does give one useful piece of information, though accidentally, I’m sure: Some people do respond much better to one class of stimulant over another. And, what does she mean.,..”keep them going longer,” as if these parents are trying to create little Energizer bunnies? That is preposterous.

This month’s homemaker-targeted magazines, such as Family Circle, Woman’s Day and Redbook, feature advertising spreads for Vyvanse, Shire US Inc.’s new entry in the growing stable of ADHD medications. The ads show “Consistent Kevin through the day, even through homework,” picturing a well-groomed boy smiling as he wields his pencil through a work sheet, and “Consistent Sarah,” who even at 6 p.m. contentedly pecks away at the piano keys.

Homemaker???? What decade is she living in?

Ms. Klein might deride the benefits of a child being “consistent,” but for many children it is their dearest wish. Instead, they think it is their failing that they cannot be consistent. Consistently do as well as they know they can. Consistently make and keep friends.

Ms. Klein obviously has an agenda. With her education in psychology and linguistics, perhaps she is of the mindset that these children are being forced into mindless conformity. She can’t be bothered with good old shoe-leather reporting. She’s making this up as she goes.

ADDitude magazine, published for people with ADHD, has ads for four medications. One ad touts a flavored, chewable form of methylphenidate with the slogan, “Give me the grape.” (Methylphenidate is best known under the trade name Ritalin, which is not among those drugs advertised.)

Many people with ADHD have sensory sensitivities, including one that precludes swallowing pills. How else do you suggest getting sensory-defensive children surrounded by stigma to adopt a more comfortable relationship with taking a medication?

And, are not children’s eyeglasses made in appealing styles, so that children feel less stigma about wearing them? (And adults’ eyewear as well?) But in truth, this type of flavored medication is in the minority. Again, she is cherry-picking to suit her biased purposes.

Ads for candy-flavored methylphenidate are a far cry from the vision set forth in 1971 by the Convention on Psychotropic Substances. So far, 159 countries, including the U.S., have agreed to ban consumer-targeted marketing of psychotropic medications — which all these ADHD drugs are — that carry the potential for addiction or dependency. For decades, pharmaceutical companies abided by its provisions.

Since when is grape a candy? But, finally a news peg, such as it is. Why not just focus on that, instead of the preceding diatribe? Because that would not suit her bias?

The fact is, in 1971, we knew very little about the brain or that medical disorders related to the brain might not be obvious. Perhaps the true point of the story should be the need for revising this musty convention. There are all kinds of forgotten laws on the books, ones that no longer apply to modern life.

I would have to see which 159 countries want to ban such marketing. Perhaps their worst fear is an educated populace — one that would learn about the possibilities of medication and then start demanding it. How odd that a journalist would be promoting censorship.

But in 2001, one company began buying ads in the September issue of women’s magazines in the U.S. to draw attention to Metadate CD, a long-acting form of methylphenidate. Other companies quickly followed suit.

Called on the carpet by the U.S. Drug Enforcement Administration,

that great arbiter of neuroscience and mental health.

lawyers for the drug companies vowed to defend themselves under the umbrella of 1st Amendment speech rights. According to former DEA officials, the Department of Justice was unwilling to test this one in court.

Perhaps with good reason.

Six years later, the results are dramatic. Doctors and therapists increasingly see parents seeking to change their child’s medication or coming in with their own diagnosis of ADHD and suggestions for medications they have seen advertised. Many of the companies offer coupons for a free trial supply.

HOGWASH. Critical thinking, please! Research, please! Ms. Klein is drawing a clear correlation between ads and an increase in diagnosis? I should tell that to the thousands of volunteers that I know who have worked doggedly to get this issue on the map — and are still doing so: “Folks, it’s nothing you’ve done. It’s all the ads! Gee, we could have all relaxed and gone to the beach.”

Ms. Klein needs to learn the first rule of science ( I think I learned this in journalism school): CORRELATION IS NOT CAUSATION.

Children in the U.S. are 10 times more likely to take a stimulant medication for ADHD than are kids in Europe. In fairness, children in Europe are also somewhat less likely to be diagnosed with ADHD because of a stricter set of criteria. But that doesn’t nearly account for the difference in prescription rates. The U.S., the only nation to violate the U.N. treaty, consumes about 85% of the stimulants manufactured for ADHD.

Well, I’m glad she’s trying to be “fair.”
In the UK alone, alcoholism rates are through the roof—just one of the presumed side effects of untreated ADHD. Reports from fellow volunteers throughout the rest of the world absolutely bemoan the lack of medications in their home countries and the ignorance of their national health systems. The ones who can afford it come here, load up on medications, and fly home. The ones who don’t suffer. Does Ms. Klein know about this? Or does it not fit her paradigm – or the hypothesis for her book?

The medications are very expensive. NHS usually doesn’t want to pay for them. You want stories of the pain and loss of human potential this causes? I can supply them in spades. People in other countries are in awe of our medical advances; they are envious.

Though the drugs do not appear to be habit-forming in children with ADHD, there’s a rising black market for methylphenidate and similar drugs. A report last year by the National Institute on Drug Abuse found that teenage abuse of prescription stimulants was rising.

It is no surprise, when papers like yours stigmatize the use of medication — and the very idea of ADHD — that many people go undiagnosed and instead go “underground” with their need for stimulant medication. Don’t even get me started on the methamphetamine connection to undiagnosed ADHD in our nation’s rural areas.

But again, what is Ms. Klein’s point? That the ads are causing this stimulant abuse? Again, hogwash. In my college days, students abused speed or No-doz.

Drug companies would argue that increased production and use of ADHD drugs are the result of better diagnosis and treatment.

Many medical and epidemiological experts would argue that, too. And as for the people with ADHD, they cheer on Big Pharma, because they know that novel medications and delivery systems mean that each person has a better chance of finding a medication that works best for them.

But the International Narcotics Control Board holds advertising responsible. In a report earlier this year, the board noted that from 2001 — when the ads first appeared — to 2005, medical consumption of methylphenidate increased by 64%.

The International Narcotics Control Board????? You’ve got to be kidding. Is that the best Ms. Klein can do? This is supposed to be some big scoop? Who cares what this “quasi-official” body thinks? Why don’t you talk to our own National Institute for Drug Abuse (NIDA), where the brilliant scientist Dr. Nora Volkow could set you straight about the ADHD, the brain and substance abuse.

This just gets worse and worse.

“That large increase was mainly a result of developments in the United States, where the substance is advertised in the media, directly to potential customers,” according to the report.

By continuing to cite this report from this very controversial body, she is giving more credence to it. Yet, she has not quoted one authoritative medical expert. Time to enter the 21st Century, Ms. Klein.

Ms. Klein accepted this grant to be an editorial writer at the LAT with this statement, sounding more like a psychodynamic-oriented psychologist with an agenda than a journalist:

“I am so very grateful to the Society of Professional Journalists and the Sigma Delta Chi Foundation for the opportunity to pursue a project that has been of enormous interest to me. The Pulliam Fellowship will allow me to extend our understanding of a population that has in large part been quietly struggling, and to probe our own, unexplored attitudes about normalcy, differentness and isolation,” said Klein.

Back to Karin Klein’s piece

The Food and Drug Administration should move forward with rules to bring the U.S. into compliance — in conjunction with the Justice Department. There’s legitimate debate about Americans’ rush to diagnose and medicate children who fall problematically outside the norm. In some cases, the drugs are the only thing that keeps a child from being expelled for aggressive behavior, or falling into the foster-care system, or believing that he is an impossibly bad or stupid kid. Yet other countries are making do with far less of the medications.

Making do? Making do? People aren’t making do. They are hobbling through – and suffering tremendously. What is Ms. Klein arguing for? Dumbing down the medical care in this country to meet the low standards of the rest of the world?

Oh, and there’s her throw-away line — just so no one can accuse her of being totally ignorant about ADHD. Sorry, that’s not nearly enough to get her off the hook and convince anyone that she has a modicum of knowledge on this condition, especially not coming on the heels of so much drivel.

Powerful psychotropic medications should be an option of last resort and uninfluenced deliberation, not another brand-name product to add to the back-to-school shopping list.

As if that is how parents make this decision? They most certainly don’t, but Ms. Klein will do her best to make them ashamed of their action and reconsider it — against all good reason.

And deliberation uninfluenced by what? Scientific evidence? Medical opinion? A desire for a happy, self-actualized life?

And why a last resort? On whose authority? Should people be denied eyeglasses unless they can’t see but two feet in front of them? Who the heck is she to decide how much access someone has to his or her brain? Does she have any clue about the comorbid physical conditions often accompanying untreated ADHD? Does she know about the health risks from on-the-job accidents, and all the rest?

Oh, please. This is an embarrassment to a large daily newspaper. Please do better.

Is it Depression? Is it ADHD? Is it both?

Some people who get diagnosed with ADHD do so because they’ve been undergoing therapy and antidepressant medication for Depression or Dysthymia (chronic low level depression, a condition that is very often missed) for years with little improvement. They finally start asking about ADHD and see someone that is actually trained in diagnosing and treating ADHD (unfortunately, far too few medical professionals), get a diagnosis of ADHD.

Then they start managing their ADHD by ADHD medication, adult ADHD coaching or therapy, exercise, lifestyle changes, greater self awareness and participation in Adult ADD support groups, and the grey fog of depression starts to lift.

Eventually there’s no more depression, just ADHD.

If you look at the symptoms of ADHD and you don’t find some way to manage them relatively effectively, its not to hard to see that they can easily lead to other conditions like Depression, Dysthmia or Anxiety Disorders.

I personally know 3 8 women with ADHD who underwent therapy for depression for a decade and even suggested to their therapist that they might have ADHD and that possibility was quickly dismissed. Later they found someone that understood ADHD, got diagnosed and sought help and now are no longer depressed. I’ve unfortunately heard and read far too many other similar stories.

You could also think you might have ADHD and it’s just depression or dysthmia since some of the symptoms are similar.

You could have ADHD and experience a divorce, death in the family, lose your job and develop depression from those events, unrelated to ADHD.

This is why a good diagnosis by a professional that understand ADHD and Depression is crucial. You don’t want to waste years of your life because you’re treating a secondary symptom of the problem and not the root cause