ADHD in the News

As I have written about here before, I do extensive work assessing for and diagnosing ADHD.  One area I have particularly focused upon is Adult ADHD which normally gets far less media coverage than childhood ADHD.  I thought it was interesting therefore that on msn.com an article was posted seemingly in the spirit of Valentine’s Day, yet focused upon the relational aspect of being married to a partner with ADHD.  It is an interesting take for the partner of an adult with ADHD to write of her experiences with the diagnosis through the relationship she has with her husband.  The article can be found at: http://health.msn.com/health-topics/adhd/adult/articlepage.aspx?cp-documentid=100253978&gt1=31001

Enjoy,

Dr. Jared Maloff

(310) 712-5480

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New Addition!

I want to announce a new addition to my practice, and let everyone know that now my office can conduct psychological and psychoeducational testing in Spanish as well as English.  I am excited about this new development as we now have the capacity to assess for a wide variety of educational, developmental and psychological issues between the ages of 2 and 102!  This new addition will enable us to broaden the scope of our services while still providing quality care for myriad issues that can arise throughout the life span.

Dr. Maloff

(310) 712-5480

Testing Accommodations

Testing Accommodations

As the nation’s economy continues to struggle to create job growth, more and more American adults are returning to school.  In these economic times, earning a college degree no longer ensures that a good job is soon waiting on the horizon.  Obtaining graduate level degrees is more important than ever to help secure one’s future in the workforce.  This cultural shift is definitely being evidenced within my practice. I devote approximately 50 percent of my time to conducting therapy and 50 percent of my time conducting psychological and psychoeducational testing. More people than ever are now contacting me to attempt to qualify for testing accommodations on exams such as the LSAT, MCAT, GMAT, GRE and DAT.  The ages of these clients seems to be trending older as more and more people who have lost their jobs, or have failed to find good jobs straight out of college, are needing to succeed on these ever more competitive tests that essentially serve as entrance exams to law school, business school, medical school and dental school.

Some believe that testing accommodations unfairly skew results in favor of those who obtain them, thus leaving those who do not have accommodations at a major disadvantage.  The reality however is much different.  Those with disabilties (i.e. learning disabilities, ADHD) are negatively impacted in academic situations, standardized testing situations and other major domains of life such as work and interpersonal relationships.  By definition a disability places the suffering individual at such a disadvantage over non-disabled individuals that accommodations such as extended time, private room testing, extended breaks between sections and paper and pencil exam forms are essential in order to ‘level the playing field’.  The Americans With Disabilities Act of 1990 protects ALL people with disabilities not just from discrimination in society and at work but ALSO on standardized tests such as the SAT, LSAT, GMAT, MCAT, and the Bar Exam.

Most laypeople think of the disabilities as a set of symptoms that can easily be seen and identified.  The insignia representing the notion of a disability even depicts a person in a wheelchair, but psychiatric diagnoses and psychoeducational diagnoses DO qualify as serious disabilities that are protected by the Americans with Disabilities Act.  Though ADHD and learning disabilities are not readily apparent to the average observer, their symptoms can be extremely difficult for the sufferer to manage.  Standardized testing exacerbates the impact of these diagnoses rendering those with these diagnoses at significant disadvantages.

In order to apply for testing accommodations, a diagnosis from a doctor past or present is not by itself enough to qualify.  Even receiving accommodations in the past does not ensure a successful petition for testing accommodations.  In order to qualify one must be tested by a qualified professional with experience in testing accommodations.  On average, a comprehensive report is 15-20 pages long not including educational and clinical records.  Such reports must fully explain the testing results as well as provide clear rationale for the necessity of current accommodations on a specific exam.  For someone with ADHD or learning disability, testing accommodations can make an enormous difference in scoring which of course aids admission to higher quality schools.

With more people than ever returning to school, entrance to graduate programs has become even more competitive than in the recent past.  With this trend continuing, those who suspect they may have diagnoses such as ADHD or a learning disability should not hesitate to be assessed by a qualified professional as admission to graduate school is now more than ever an important stepping stone on the path to success.

Dr. Jared Maloff

(310) 712-5480

www.BeverlyHillsPsychologist.com

50 Percent Increase in Autism in Past 2 years? Think Again.

In today’s L.A. Times an article ran that advertised what seems to be a disturbing trend.  According to the CDC the proportion of 8 year olds diagnosed with an Autism Spectrum Disorder has increased 50% in the past 2 years.  Essentially this means that previously 1/150 children were diagnosed with the disorder while currently that number has increased to 1/100.  Even more startling is the fact that 1/58 boys are now diagnosed with an Autism Spectrum Disorder.  This is truly a staggering number. 

Autism Spectrum Disorders refer to Autism and Asperger’s Syndrome which some researchers believe to be a milder form of Autism.  In my clinical practice however, it is my belief that Asperger’s is a seperate entity from Autism.  There are similarities in the two disorders but Asperger’s also has a lot in common with another highly diagnosed condition amongst boys; ADHD.  Rather than believe that 8 year olds of 2009 are 50% more likely to be Autistic than in 2007, the research merely indicates that the diagnosis of Autism and Asperger’s Syndrome are being levied much more frequently. 

For properly trained psychologists who understand child development Autism is hard to miss.  It is estimated that around half of Autistic children are also mentally retarded.  Also, Autistic children do not meet the developmental milestone of talking on time.  Some are never able to communicate verbally at all.  For those who can verbalize and are not mentally retarded, the tell tale signs of Autism are severe delays in speech as well as disinterest and inability to functionally participate in social relationships.  Asperger’s is a bit harder to spot because this diagnosis is NOT co-morbid with mental retardation or major problems in speech.  Instead the diagnostic criteria is mainly based upon difficulties with social relationships, immaturity, rigidity, concrete thinking and difficulty taking on anyone else’s perspective but their own.  These criteria are much more subjective and the symptoms sound general.  If one were to just use these symptoms alone to make their diagnosis, many of our friends and acquaintances would be labelled with this syndrome inaccurately. 

Unless a psychologist has experience with assessing these kinds of disturbances in child development they should not be offering such diagnoses.  Autism and Asperger’s are life-long developmental disabilities and their diagnosis carries a great deal of weight.  Just because the media is covering these issues more as of late does not qualify all mental health practitioners to diagnose these disorders.  This is why we end up with these inflated numbers that are sure to scare all perspective parents.  It is my belief that children are being diagnosed with Asperger’s Syndrome when they actually may have other diagnoses that share some similar symptoms.  ADHD and Oppositional Defiant Disorder are two other commonly diagnosed disorders of childhood that may now be getting labelled as Asperger’s by clinicians who have Asperger’s on the brain more than ever due to enhanced media coverage. 

Due to the severity of Autism and Asperger’s diagnoses I would encourage all parents who have doubts about their child’s diagnosis to seek at least a second opinion from a clinical psychologist who specializes in assessment and is highly familar with these disorders.  If everyone sought such second opinions I am certain that the rapid increase in these diagnoses over the past 2 years would be discovered to be spurious.

Dr. Jared Maloff

(310) 712-5480 

Adult ADHD

There is a myth that is quite prevalent among both laypeople as well as mental health professionals that ADHD is primarily a disorder of childhood.  While the diagnosis is generally made in childhood and symptoms first begin to develop prior to age 7, ADHD is a pervasive psychobiological disorder that people experience into adulthood. While many adults figure out how to manage their symptoms in such a manner so as to minimize the negative impact upon their life, others cannot either due to the severity of the disorder, or their lack of treatment.

My practice is 33% comprised of clients with Adult ADHD, and approximately 75 percent of calls from new clients are those seeking treatment for this diagnosis.  I believe that as society evolves and technology becomes more and more easily accessible, it becomes ever more difficult to live with Adult ADHD.  There seem to be far too many distractions available for those already prone to inattentiveness.  The days of unplugging the TV in order to focus on work are over because now one would have to remove themselves from their computers and phones as well in order to eliminate distraction, something we as a society all seem loathe to do.  We live in an age of immediacy where the expectation is to be entertained at every free moment.  This value will only exacerbate the symptoms of ADHD and make it even harder for those with this diagnosis to calm their hyperactive, sensory seeking behavior. 

Due to economic factors adults who previously who have not been interested in returning to school are doing so and finding difficulties sitting through long lectures attentively.  Even those adults with ADHD who had been able to find a career that they could manage given their symptoms are feeling like kids again as they realize their symptoms may not be as under control as they had believed.  Due to these societal factors of the convergence of high technology within this period of economic turmoil, I believe more adults will be diagnosed with ADHD than ever before as they switch careers or return to school. 

Adults who experience symptoms such as forgetfulness, disorganization, losing or misplacing important things, feel the need to be constantly entertained and stimulated, lose their place while reading, tune out others who are speaking to them, or feel fidgety may have ADHD.  Though this diagnosis can range between milder and more severe cases, it is important to seek treatment in order to learn the most effective methods of managing their symptoms. 

Dr. Jared Maloff

(310) 712-5480

New Year’s Resolutions

40 to 45% of American adults make one or more New Year’s resolutions. Studies have shown that the most common things we want to change about ourselves are: lose weight, exercise more, stop smoking, save more money , and get out of debt.

The following shows how many of these resolutions are maintained as time goes on:
– past the first week: 75%
– past 2 weeks: 71%
– after one month: 64%
– after 6 months: 46%

While a lot of people who make new years resolutions do break them, research shows that making resolutions is useful. People who choose to explicitly make a resolution and tell others about it are 10 times more likely to follow through than people who keep their goals to themselves, and don’t officially give it the “New Year’s Resolution” label.

As with all goal setting, telling important people in our lives about it, and writing the goal down are important because it makes us feel accountable. These small acts instill a feeling that the goal is now bigger than just ourselves, and enhances the possibility of following through over the long term.

Another aspect of goal setting that has been known to lead toward ultimate follow through is specificity. For instance, if a person wants to lose weight, they should identify the amount of weight they want to lose, thus making the goal concrete. While concretizing the goal, another equally crucial part of the plan is moderation. Someone who wants to lose 20 lbs, or get out of debt should NOT strive to complete these tasks in a short period of time. The pressure of restricting spending to the bare minimum to get out debt quicker will ultimately make the task overbearing and impossible to keep up over the long haul. Same with weight loss. Losing all the weight one needs to lose in a month is unrealistic and would involve a far too restricted diet to be able to continue past the 6 month milestone where a full 54 percent of us abandon our resolutions. The same even goes for stopping smoking. This is probably the hardest of the most common resolutions to follow through on. While ‘cold turkey’ works for some people, I recommend a plan of moderation here as well. Learning to reduce the amount of cigarrettes week by week to eventually get down to none is a very slow but steady manner of stopping. Also using the nicotine patches and even talking to one’s doctor about medication options to stop smoking will make the goal much more managable. Also, many people who smoke do so to reduce stress, and oftentimes addressing one’s underlying depression with therapy can help reduce thisstress ina non-destructive manner. This can also aid one to stop smoking in 2009.

Setting moderate, even easy to accomplish goals for the first 6 months of ’09 will help enable us to get into a routine of success where we know we can accomplish our goals, and furthermore, EXPECT to accomplish our goals. Learning to expect success, and making our goals do-able and realistic can help ensure that in 2010, we aren’t making the exact same resolutions of 2009.

Dr. Jared Maloff

(310) 712-5480

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Financial Fear

It doesn’t take a psychologist to notice that Americans today are extremely anxious and on edge. The fear is fueled by the news and media coverage of the poor economy that we are all experiencing. This is a topic on the tips of our collective tongue these days. Naturally it comes up within the therapies of many clients, but I also notice that friends and relatives who never seemed to give much thought to their overall financial state suddenly begin to panic. Certainly more people are out of work today than a year ago, but of all the talk and financial panic expressed by those I know, the vast majority of these friends, relatives and acquaintances are actually not in a financially precarious position. So why the panic?

Humans normally carry anxiety within the deep recesses of their minds, and most prefer to keep it there, outside of conscious awareness. This type of deep seated anxiety is related to our knowledge of our own mortality and the frailty of being just one person in a big world where many of the things we regularly deal with are out of our loci of control. Thus, when much attention becomes focused on a real life crisis such as terrorist attacks, natural disasters and this current financial meltdown, this anxiety that we regularly carry unconsiously actually becomes projected onto the current crisis of the day the way a movie projector displays a film on a blank screen. It is times like these when logical thinking and level headedness become difficult to maintain, and the panic snowballs.

Rather than focus on the TV pundits however to tell us when to be worried and when not to be, it is important for all of us to be able to sort out how much ofour own panic is truly related to the external crisis at hand, and how much of it is connected to the generalized anxiety that many people tend to carry within the unconscious aspects of their mind. Until one can actually identify all of the triggers to their panic, it is very important to hold off on making quick, impulsive decisions to try to reduce anxiety. For instance, it won’t help to make an impulsive financial decision given the current state of the economy when much of one’s anxiety is related to their inner, unexpressedfeelings of inadequacy.

In short, external stressors make all of us much more aware of our feelings of inner unrest. So before panicking about the state of the economy, it actually makes much more sense for all of us to attempt to understand and cope with our internal anxiety. Only after these internal fears are managed can one make any reliable, solid and sober decisions regarding the economy and their own financial situations.

Dr. Jared Maloff

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Inherent in life is the presence of frustration, and its manifestation; stress. The essence of frustration is not being able to get what we want, how we want it, when we want it. It may sound selfish, but all of ourminds are wired to seek out the gratification of these urges. Freud called them id impulses, and they dominate during childhood years. As we grow into mature adults, these impulses are moderated by what he called the super ego, and its socially acceptable face that we put forth into the world, the ego. Though on the surface, it is usually quite important to keep a veneer over this id vs superego battle, internally we all have to cope with life’s daily, inherent frustrations. In Los Angeles the major daily frustration is the traffic and the fact that many times, we cannot get to where we want, when we want, how we want. Though I’m quite certain that anyone who has ever been in traffic has fantisized about all the other cars disappearing and to not have to share the road with anybody else, obviously reality dictates otherwise. Thus we are left with frustration, the strain of the id clashing up against the harsh superego. What defines psychological wellbeing is not the absence of frustration, but how we cope with the frustration. How do we continue to keep life’s speedbumps in perspective when our current, immediate needs are not being met?

This question seems particularly poignant given the stark realities that have unfolded within the past month and week. The devastation inflicted by the gulf coast hurricanes, the derailment of a Los Angeles Metrolink train and the seeming collapse of the country’s financial markets are weighing heavily on many people’s minds these days. The traumatic nature of these current events has a way of bringing to the surface of one’s mind, manyprimative fears and inadequacies. Essentially the perception of stress, the true experience of not getting what we want or need in the moment, brings up a very primal fear of not being able to survive. Thisof course is the root of most anxiety. So how can we cope?

The experience of fear is exacerbated by the unknown. Not being able to tell the future incidentally is also inherently frustrating. One element of combatting fear is understanding what can be known, and what cannot be about a given situation. Once parsing these two concepts, gaining as much knowledge as is reasonable about the element that can be known can help reduce anxiety. Another factor that can reduce anxiety, paradoxically, is actually facing the feared variable. The depth of one’s anxiety is usually connected at its roots to a fear of death, or being utterly humiliated, and since when facing a fear one of these two options does NOT occur the vast majority of times, it is customarily a very safe bet to say that when facing a fear, the worst possible scenario imaginable will not actually happen. Thus when looking fear in the face, we tend to come out ahead, feeling stronger, more capable and essentially more well equipped to deal with future frustration and trauma.

Courage is not defined by the absence of fear, rather the ability to face one’s fears in the face of feeling uncomfortable. When it comes to natural disasters and a plunging stock market, one cannot control these factors anymore than a surfer can control the tide, but our ability to manifest courage will breed a future sense of capability and calm despite the unpredictability of the storms that each day has to offer each of us. The alternative to facing fears, hiding from one’s fears only serves to severely exacerbate the fears. The internal monologue one utilizes when avoiding fears usually sounds something like this: “I feel safe because I am avoiding ‘X’. As long as I avoid ‘X’, I will be ok. ‘X’ must be really scary, and thats why I try so hard to avoid it. If I ever had to deal with ‘X’ I’m not sure I could survive.” One’s ability to prove that they can survive when dealing with their personal demon(s) is absolutely essential to building more confidence, or as Freud would term it ‘ego strength’. It thus should become all of our collective responsibility to not strip ourselves of the chance to prove our own internal strength and resourcefulness.

Dr. Jared Maloff

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Managing Anxiety

Life is inherently stressful, and what separates those who genuinely feel relaxed versus those in a consistent state of anxiety and panic is the ability to acknowledge life’s stressors, tolerate the discomfort, and attempt to control that which can be controlled, and not worry about controlling that which cannot be.

An example of something we can all control are the decisions that we make, the relationships we choose to pursue and cultivate, and how we spend our time. Those who find themselves becoming upset at the traffic, the weather, or even what others are thinking about them may find that they are generally anxious and live in a state of fear. Perfectionism, or essentially the assumption that we as individuals can control all or even most of the elements of our lives including other people will be destined to be self-critical and let down by their own lofty and irrational expectations.

Make no mistake though, not worrying about what others must be thinking, or not being frustrated by the traffic is definitely easier said than done. That being said, it is important for all of us to be mindful of our own tendencies to expect ourselves to be able to control our social environments. Generally it is this expectation which is a major cause of stress and anxiety. Individual therapy can be a great help at reducing this type of stress, and other interventions that people can do on their own can also be helpful. Exercise for example is a good way of releasing pent up anxiety, or aggression, and there are also things that millions of people do every day that unwittingly contributes to their own stress.

Two activities that are part of millions of Americans daily routine actually exacerbate stress while their intended use seems to be to relieve stress. Smoking cigarettes and drinking caffeinated beverages can both pomote anxiety and even trigger panic attacks. Smoking interferes with breathing and reduces oxygen flow to the brain which causes more rapid breathing and faster beating of the heart. This is a physiological reaction which mimics some of the symptoms of panic, “hyperventilating, and tachycardia.”

The stimulant effect of caffeine can also promote anxiety in much the same way. Stimulants activate the body’s central nervous system which mediates the body’s response to stress or danger. So, for people who may be susceptible to stress and anxiety, (i.e. Type A people and perfectionists) avoiding smoking and caffeine and while exercising regularly can promote a healthier lifestyle and reduce overall anxiety.

If you feel overwhelmed by anxiety, stress or self-doubt, Dr. Maloff can be reached for consultation at (310) 712-5480.

Identifying Depression in the Elderly

Depression is a condition that impacts children and adults of all ages, though in elderly populations, depression often goes untreated. In part, this is likely due to the misperception that depression is a ‘normal’ part of the aging process. The fact is, that depression is a serious issue within elderly populations, and as with other age groups, it is often highly treatable. Studies indicate that 1-5% of elderly people living within the community are clinically depressed. Twelve percent of elders who are hospitalized are depressed, compared with 14% of those who require in-home assistance for a health problem. Thirty-nine to 47% of elders who live in nursing homes are depressed. Depression in the elderly can be triggered by the challenges of old age, such as the loss of physical abilities or the loss of a spouse and peers.

If depression within the elderly population is left untreated, which seems to be the norm, the liklihood of developing health problems and disabilities is increased. Also, the risk of suicide increases with age. White men over 85 represent the highest rate of suicide in the United States. Depression can be harder to diagnose in the elderly than it is in younger populations. Elderly people may present with a different constellation of symptoms than younger adults, and yet still be depressed nonetheless. Symptoms of depression in the elderly often masquerade as somatic (physical) symptoms. The following symptoms when noted in the elderly population could be illustrative of Major Depressive Disorder:

1. Heart Palpitations

2. Restlessness

3. Fatigue

4. Tremors

5. Body Aches and Pains

6. Nausea

7.Shortness of Breath

8. Heavy Perspiration

9. Memory Problems

10. Difficulty with Concentration

If physical conditions are ruled out, and an elderly person presents with several of these symptoms, they should be assessed by a mental health professional for depression. Many elderly patients however resist the notion of seeing a therapist as many grew up in an era when emotional problems were stigmatized. For this reason, many depressed elderly patients first end up in their general practitioner’s office or in the Emergency Room. There is a strong connection between the body and the mind, and any clinical mood disorder can worsen one’s physical condition. This is particularly worrisome in elderly populations where health is a prime concern. For this reason, as well the opportunity to lead a happier, richer life, it is important for the prospect of depression to not be overlooked when evaluating the overall health of an elderly patient.