The AAMFT Blog

Understanding ADHD in Children

Most of us have heard of attention deficit hyperactivity disorder, or ADHD, and from time to time, we may refer to ourselves as having it when feeling distracted, impulsive, or lacking focus. Daily life can be stressful, and one can feel easily overwhelmed by various demands. Now, more than ever, we live within a culture that values achievement rather than prioritizing balance and ability. Children and young adolescents are often over-scheduled with activities.

What does this mean for someone who is not "neurotypical," someone whose neural wiring results in behavior that works against our cultural values.? Children with ADHD experience the world in an "atypical" way. It is both a blessing and a curse for those whose natural way of being doesn't allow them to still and focus for an extended or even short period of time.

For children who experience the symptoms of ADHD, life in a world that often requires sitting still and having focus becomes challenging. They may exhibit behaviors that are pervasive and persistent, causing difficulties in all areas of their life. For example, children must go to school. When they are toddlers, and in kindergarten, ADHD may not be seen at all since children are often spirited, creative, and on the go. All of these behaviors are view as "normative" from young ones. But as children grow and develop, expectations change, and different skills are required, especially when it comes to successful academics.

ADHD in children presents differently for each person. Some are more distracted, others more energetic, and some experience both. Most often, the symptoms of ADHD show up before the age of 12. 

Subtypes and Symptoms

The Children and Adults with Attention Deficit Disorder (CHADD) website lists three presentations of ADHD—Predominantly Inattentive, Hyperactive-Impulsive, and Combined. The symptoms for each are adapted and summarized below.

ADHD (predominantly inattentive presentation)

• Fails to give close attention to details or makes careless mistakes
• Has difficulty sustaining attention
• Does not appear to listen
• Struggles to follow through with instructions
• Has difficulty with organization
• Avoids or dislikes tasks requiring sustained mental effort
• Loses things
• Is easily distracted
• Is forgetful in daily activities

ADHD (predominantly hyperactive-impulsive presentation)

• Fidgets with hands or feet or squirms in chair
• Has difficulty remaining seated
• Runs about or climbs excessively in children; extreme restlessness in adults
• Difficulty engaging in activities quietly
• Acts as if driven by a motor; adults will often feel inside as if a motor drives them
• Talks excessively
• Blurts out answers before questions have been completed
• Difficulty waiting or taking turns
• Interrupts or intrudes upon others

ADHD (combined presentation)

• The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.

These symptoms can change over time, so children may fit different presentations as they get older.

When to Seek Help From a Marriage and Family Therapist 

If you are noticing multiple symptoms of ADHD that are keeping your child from meeting expectations at home and school, a marriage and family therapist can help. MFTs are mental health professionals who look at behaviors in the context of various relationships. The focus of therapy for a child with ADHD is to build skills and confidence. MFTs take a holistic approach when helping their clients. And while the system we work in requires a diagnosis, we mustn't label children. Labels hurt self-perception and understanding. It limits the potential to embrace the gifts that accompany the more challenging aspect of ADHD. On the flip-side of impulsiveness, and hyperactivity, you will also find many strengths. Creativity, intelligence, humor, curiosity, empathy, compassion, honesty, and kindness are just a few. We can modify challenging behaviors while also emphasizing these wonderfully abundant strengths.

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References:

Diagnosis in Adults - CHADD 

UC Davis Mind Institute Mint Study ADHD Resource Guide 

About ADHD - NSADHD CHADD Group

Medicare Coverage for Opioid Use Disorder Treatment Services

A new Medicare benefit that goes into effect in January will benefit many Medicare beneficiaries and will positively impact MFTs who work in Opioid Treatment Programs (OTPs).

In 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act was signed into law. Among other things, this law creates a new Medicare Part B benefit beginning in 2020. Under this new law, Medicare beneficiaries will be able to receive opioid use disorder treatment services furnished at one of the 1,700 or so OTPs located throughout the country that are certified by SAMHSA.

AAMFT closely monitored the SUPPORT Act, as well as other opioid-related legislation, through the legislative process. Under this law, these opioid disorder treatment services include “substance use counseling by a professional to the extent authorized under State law to furnish such services” and “individual and group therapy with a physician or psychologist (or other mental health professional to the extent authorized under State law).” To help ensure MFTs were indeed eligible to participate in this Medicare-funded program, AAMFT submitted comments during the rule-making process after the legislation had been passed into law.

On November 1, the Centers for Medicare and Medicaid Services (CMS) released its final rule pertaining to Medicare coverage for opioid use disorder treatment in OTPs. A summary of this final rule can be found here. Under both the statute and final rule, LMFTs employed in OTPs would be allowed to provide substance use counseling and therapy to Medicare beneficiaries receiving opioid use disorder treatment services in these programs. This new law does not allow LMFTs to be recognized as providers able to bill Medicare; however, OTPs would contract directly with Medicare. Under this new benefit, LMFTs working in OTPs would be able to provide necessary therapy and substance abuse counseling to Medicare enrollees.

This new benefit will help many Medicare enrollees who have an opioid use disorder.  If you’re an MFT currently working at an OTP, please feel free to contact us at [email protected] if you’d like to share your story. If you have any questions about this new law, please also feel free to email [email protected].

How to Create a Private Practice Facebook Business Page

This content is provided by Brighter Vision, an affinity partner of AAMFT. This information is not necessarily the views of AAMFT and should not be interpreted as official AAMFT policy.

While Facebook marketing is an important tool for private practice owners and individual therapists alike, the many moving parts of it all can often make it seem much easier said than done. One classic hurdle for new therapists just starting their online marketing journey is setting up a Facebook Page for their business. With a little help, setting up your practice’s Facebook Page can be a quick and easy task that will pay off big time in the long run.

Having an active presence on Facebook allows you to take advantage of the platform’s superior ability to target your ideal local clients. Creating an official Facebook Page gives your practice a sense of authority, providing your potential clients with a place to learn more about your business and the services you provide.

In this post, we’ll walk you through all the necessary steps to set up your private practice’s Facebook Page properly. Then we’ll turn our focus to fine-tuning your Facebook Page to make your practice stand out from the rest.

4 Steps to Set Up Your Facebook Business Page

1. Create Your Facebook Business Page Using Your Personal Account

One important thing to know about your new business page is that you’ll manage it through your personal Facebook account, so you’ll need to log into that account before we go any further.

Next, you’ll simply navigate to the top of the Facebook homepage and click the “Create” button, which will create a drop-down menu. From that drop-down menu, you’ll select the “Page” option. And you’re on your way!

Polyamory 101: What Every Therapist Needs to Know

Polyamory is in the news, in the movies, and in the therapy room. As media attention for this open relationship style grows, more and more people are giving it a try. In this webinar, Martha will provide an introduction to polyamory from a therapist's perspective, including explaining why she loves working with this population and thinks you will too. You will learn how challenges specific to polyamory present in therapy, and how to handle them with skill. There will be ample time for Q and A, so you can get the specific information you need in order to feel confident working with polyamorous clients in your practice.

Learn more and register for this webinar here.

Presenter: Martha Kauppi, LMFT, CST-S
Martha Kauppi, LMFT, is an AASECT-certified sex therapist and supervisor, and AAMFT-approved supervisor. She has a private practice in Madison, Wisconsin, specializing in relational therapy and a broad variety of sex-related concerns including alternative sexualities and marginalized populations. Martha trains therapists from all over the world to work effectively with sex issues through online trainings and in-person workshops. She blogs regularly about relational therapy, differentiation, attachment, sexuality, and polyamory. You can find her course offerings and blog at www.instituteforrelationalintimacy.com

2020 Leadership Symposium: Registration Now Open

Let AAMFT help you meet your personal and professional goals in 2020! The Leadership Symposium is an exceptional resource for MFTs who have leadership aspirations, or who simply want to expand their skills and practice to advance both their career and the profession.

The 2020 Leadership Symposium is in Phoenix, Arizona, from March 12-14. Register early for the lowest pricing.

Highlights:

• Keynote speakers who lead their fields and will provide higher-level insight and inspiration on topics of decisive actions, going from good to great, intersectionality, and reaching new generations.
• Expanded breakout sessions, submitted through an abstract and invitation process, ensure that there are more opportunities to hear from MFT experts, allowing you to tailor your experience.
• 13.5 hours of continuing education as an option for attendees while maintaining the highest value and lowest cost per hour available.
• Networking receptions and dining options to connect with MFTs at every level of experience and background.
• Approved Supervisor Refresher Course available as an add-on for those who need to renew their designation.
• Located in Phoenix, Arizona, a sunny city that unites the beauty of the desert with sophisticated urban amenities.

Visit the Leadership Symposium website to learn more about this event. 

Understanding and Treating Insomnia

It is not uncommon to have a restless night's sleep. In fact, it happens to most people about once a year. Everyone has concerns and normal worries that creep into their sleep cycle. It is part of life and virtually impossible to avoid. 

But what happens when one restless night follows another, then another, and so on? It is one thing to have a few days of interrupted sleep, but another to have chronic sleep disturbances. Most commonly, sleep irregularity known as insomnia. Chronic insomnia can become a health concern. It is marked by difficulty falling asleep and staying asleep, or by waking up too early.

Insomnia manifests and presents in different ways. People who have insomnia find it difficult to fall asleep, frequently awaken in the middle of the night and have trouble going back to sleep. They also wake up too early in the morning and feel tired when they get up. Daytime fatigue and low energy are commonly experienced, along with a lack of focus, poor memory, and reduced coping skills. 

If it takes someone more than 30 minutes to fall asleep, or if you are awake 30 minutes or more during the night at least three times a week – for a month or more – you are most likely suffering from insomnia. 

According to the Center for Disease Control and Prevention, approximately 50–70 million Americans have sleep-wake disorders. The impact can be devastating for its sufferers. Insomnia can interfere with mind-body regulation. Most notably, mood and judgment are affected, and it can also be a symptom of anxiety and depression. 

Insomnia is the result of multiple factors. The primary reason for sleep-wake disturbance is stress. However, some physical conditions and medications can interfere with our sleep rhythm. These include conditions such as sleep apnea, overactive thyroid, and gastrointestinal problems like gastroesophageal reflux.

Additionally, the sleep-wake cycle is affected by lifestyle choices. A lack of physical activity or excessive substance abuse, for example, will knock our sleep off-kilter. Other factors to consider when it comes to sleep disturbance include shift-work, jet lag, caffeine and alcohol consumption, vitamin D deficiency, and keeping the bedroom temperature too warm at night.

For marriage and family therapists, it is crucial to assess sleep-wake patterns in clients. Insomnia significantly affects mood and can be a trigger for depression and anxiety. And while medication may offer temporary relief, it is not a long-term solution. 

The systemic approach that is a hallmark of how MFTs think and work with clients offers an integrative and holistic way to develop a treatment plan. 

Here are some tips that an MFT may suggest to help manage your insomnia: 

• Schedule a visit with your primary care physician to rule out any underlying physical causes like sleep apnea. 
• Develop a routine that promotes healthy sleep habits. The use of "sleep hygiene" techniques can positively impact sleep-wake cycles by shifting any negative patterns that support poor sleep. 
• Cognitive-behavioral therapy (CBT) helps target the thoughts and actions that disrupt sleep. CBT may include relaxation techniques, as well as establishing a sleep schedule that restricts the time one spends in bed awake. 
• Developing and implementing the practice of self-care positively correlates to better sleep habits. Mindfulness and meditation, for example, are holistic tools that help reduce anxiety and depressive thoughts. Regular exercise, reducing your caffeine intake, staying hydrated, and eating well is essential to overall well-being, which includes meeting our sleep needs.

Treating insomnia is critical to staying healthy. If you are struggling with sleep, seek professional help. Rest is an integral part of self-regulation, both emotionally and physically. In short, a good night's sleep is a contribution to our happiness bank and well worth the investment. 

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