In a recent Washington Post Magazine article called "Scattered," Brigid Shulte deals with an important topic: attention deficit hyperactivity disorder (ADHD) among women. The subject is important for many reasons. First, although most people associate ADHD with schoolchildren, the condition often persists into adulthood. Second, ADHD is extremely common in adults, affecting, according to one Harvard study, an estimated 4.4 percent of adults (or 8 million people between ages 18 and 44), the vast majority of whom don't even know that they have the condition. About 40 percent of these people are women. Third, because ADHD results in all sorts of performance problems (disorganization, failure to meet deadlines, and absenteeism, to name just a few), the condition is estimated to cost the U.S. $75 billion per year in lost productivity. Finally, there are all sorts of secondary problems that people with ADHD have to contend with, including more motor vehicle accidents and other psychiatric conditions -- depression, anxiety and addiction to cigarettes and other substances.
The problem Schulte outlines in her article is all too familiar to me in my psychiatric practice in the D.C. metropolitan area. Often I end up treating the mothers of schoolchildren (mostly boys), who have been referred to me for all the expected difficulties that such young people have at school. But often it falls upon their mothers to help organize them in the numerous activities expected of schoolchildren these days -- getting their homework done, delivering it on time, juggling their extracurricular activities. For a mother with two or more children, a few pets, a husband who expects her to have a meal ready at the end of the day, and a house to maintain, such a juggling act is an accomplishment even for those without ADHD. And this doesn't take into account the growing number of women who also hold jobs or pursue careers outside of the home.
Even a casual analysis of the problem makes it clear that these women are under tremendous stress, which creates a vicious cycle. The stress creates anxiety, which compounds the ADHD, and that, in turn, makes life more stressful. How, then, can this vicious cycle be broken?
Luckily, several treatment approaches are available to help people with ADHD, but unfortunately no one treatment is a panacea. For example, the drugs that are widely used for ADHD (usually stimulants, like Ritalin or Dexedrine) often help these people stay more focused and avoid distractions. They are less helpful, however, for problems with disorganization that are often part of the condition. As my colleague Mary Lou Sullivan, a popular coach in the Northern Virginia, will attest, in addition to medications, people with ADHD need a great deal of help with organization, and encouragement to prevent demoralization.
To this mix of medications and coaching, I would respectfully like to suggest a third component to the treatment program -- some form of stress reduction. One of the most potent forms of stress reduction that I know is the Transcendental Meditation (TM) technique. So potent is TM as a stress reducer that it has reliably been shown to reduce blood pressure, can reverse early stage blood vessel disease, and can actually boost longevity, according to two controlled studies. I suggest that the same de-stressing powers may be invaluable to an adult (or child) struggling with both ADHD and a lifestyle of rushing, running and juggling that is conductive to ADHD.
A young psychiatrist friend of mine has been diagnosed with ADHD and is on medications to treat it. She has a full-time practice, a baby to take care of and a husband with a high-powered career of his own. She is careful to restrict her use of stimulant medications because they can raise blood pressure and, if used late in the day, prevent her from getting to sleep. She relates how on one recent afternoon, she was tired, scattered and had her day's charting still to complete. Feeling quite inadequate to the task and dreading it, she sat down to meditate for 20 minutes. On emerging, her mind was clear and she proceeded to tackle the charts with no difficulty. In her words, "Twenty minutes of meditation helped me accomplish what no drug could have done."
Although there are at this time no controlled studies that support the benefits of TM for ADHD and its associated problems, my friend is just one of many examples I could offer from my experience interviewing many people who practice TM. My colleague, Bill Stixrud, arguably the foremost neuropsychologist in the Washington, D.C. area, agrees, and he has conducted a small, encouraging pilot study of TM in children with ADHD in addition to learning difficulties.
Transcendental Meditation involves sitting comfortably for 20 minutes twice a day, while thinking a mantra (a word-sound) in a specific way that you learn from a qualified teacher. One might ask, "Where can someone who is already scattered find the extra time needed for TM?" But when you consider the time lost as a result of being scattered, you can imagine how a de-stressing program might easily save time. For example, one woman in Schulte's article mailed her pocket book twice by mistake, while another forgot to feed the dogs, who spilled the garbage on the kitchen floor.
In summary, I would like to reinforce the importance of diagnosing and treating women with ADHD, most of whom continue to suffer without proper care. In addition, I would like to suggest that therapists consider innovative approaches that go beyond standard stimulant treatment. One such approach might be to reduce the stresses that compound the scatter that occurs both in the condition of ADHD and in the lives that so many of us lead.
Norman E. Rosenthal, M.D. is a Clinical Professor of Psychiatry at Georgetown Medical School and the author of "Transcendence: Healing and Transformation Through Transcendental Meditation" (Tarcher Penguin, 2011).
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