Tag: behavior disorders

The benefits of ‘body doubling’ when you have ADHD, according to experts | CNN

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CNN
 — 

Once a week, ADHD coach Robin Nordmeyer joins a Zoom meeting with other coaches while she writes blogs, does administrative tasks or works on content for presentations she has been putting off.

Nordmeyer, who has ADHD, isn’t necessarily using the meeting to collaborate with others — she just needs their presence as a motivator to help her get things done.

“I run a business, and I have to balance lots of different areas of the business,” said Nordmeyer, cofounder and managing director of the Center for Living Well with ADHD-Minnesota, an ADHD coaching group near Minneapolis serving all ages.

“Some of those things come very easy — like, they’re in my wheelhouse, they energize me, I can’t wait to get to them,” Nordmeyer said. “And some of those things are a little more tedious, or I have some resistance around them.”

What Nordmeyer does to get through those tougher tasks is sometimes known as “body doubling,” a productivity and self-help strategy that involves working with another person around to help improve motivation and focus. It has been popular for some time among people with ADHD — attention-deficit/hyperactivity disorder — especially during the pandemic.

“The idea is that the presence of another is essentially a gentle reminder to stay on task,” said Billy Roberts, clinical director of Focused Mind ADHD Counseling in Columbus, Ohio. “For folks (with) ADHD whose minds tend to wander and get off task, the body double somehow works as an external motivator to stay on task.”

Body doubling isn’t just for people with ADHD, but like many “coping strategies, something that can be helpful for anybody is more central and important for folks with ADHD,” said J. Russell Ramsay, professor of clinical psychiatry at the University of Pennsylvania’s Perelman School of Medicine and codirector of the university’s ADHD Treatment and Research Program.

A neurodevelopmental disorder commonly diagnosed in childhood but lasting into adulthood, ADHD stems from underdeveloped or impaired executive function and self-regulation skills, according to Harvard University’s Center on the Developing Child. Those skills help us to plan, focus attention, remember instructions and multitask. Symptoms of ADHD include inattention, hyperactivity and impulsivity — so people with this disorder might have trouble concentrating, staying organized, managing their time or controlling their impulses, which can affect both their work and personal lives, Roberts said.

If people with ADHD have no intrinsic interest in a task, Roberts said, they typically struggle with a lack of internal motivation to complete it or even to get started. Body doubling provides that motivation, experts said.

“It also draws on our social selves,” Ramsay said. “A lot of people with ADHD will say, ‘I have a hard time getting started on this if I’m doing it for myself, but if I know somebody else is relying on me, if somebody else is waiting outside for me to show up to go for our walk, I’m more likely to go and be there because I don’t want to let them down.’”

There doesn’t appear to be extensive research on body doubling for productivity, according to Roberts and other experts. “But I do know that the idea of externalizing motivation is a long-standing, evidence-based mechanism for managing ADHD,” Roberts said.

In theory, the method is pretty straightforward, but there a few factors to keep in mind to make the most of it.

Body doubling can help with pretty much any task you’re having a hard time getting done — whether that’s work, chores, exercise, schoolwork or paperwork. The other person doesn’t have to be doing the same thing as you, unless the activity you need body doubling for — such as exercising — requires that assistance.

Be choosy about whom you ask to be your body double. The person should be as committed to you completing your work as you are, Roberts said — not distracting you with conversation or anything else. Choose someone who usually makes you feel comfortable and safe, and who can encourage you when necessary.

“It’s important to keep a body double session focused on its purpose,” Nordmeyer said. If conversations do come up, table them for later, perhaps during a break or dinner.

Asking someone to be your body double might feel awkward, but Roberts said the best approach is often a straightforward one. You could say, “It’s something I heard can help with productivity. Would you mind just being around me while I work on this? Maybe you have something you could work on, too.”

You could also barter with them, in a sense, by making an offer such as, “You help me organize my garage on Saturday; I’ll help you organize your home office on Sunday,” Ramsay said.

Those small first steps of seeking a partner and setting up the session get you started and keep you going, he added.

Scheduling regular body doubling sessions is one option, Nordmeyer said, or just ask whenever the need arises. How transparent you are about why you need a body double is up to you, as is whether you have more than one body double.

“It depends on the individual,” Roberts said. “If it turns into a distraction more than mindfulness, accountability or behavioral support, then you just want to rework things. You can kind of tinker with things until you find what works.”

If you don’t have a friend or colleague to be your body double, you aren’t out of luck.

Some TikTok users, such as Allie K. Campbell, regularly go live while they’re working so others can use them as a virtual body double. There are also body doubling or coworking platforms or apps such as Flown, Focusmate or Flow Club.

In virtual sessions, “most body doubles ask you to share your camera, and a lot of people are real nervous about being visible,” Nordmeyer said. “The purpose of that is to make sure you’re still in your chair working. … But there might be other ways you can create that accountability through a chat feature.”

The benefits of body doubling are likely why some people like working on things in coffee shops, libraries or coworking spaces — which can be sources of passive body doubling if you don’t have someone to ask, Roberts said.

“Some people work better with community support and just the awareness of other people around them,” he added. “You saw that a lot with the pandemic, like people learning more about the kinds of structure they needed.

“We all think and work differently, and there’s nothing wrong with that,” Roberts said.

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ADHD medication abuse in schools is a ‘wake-up call’ | CNN

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CNN
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At some middle and high schools in the United States, 1 in 4 teens report they’ve abused prescription stimulants for attention deficit hyperactivity disorder during the year prior, a new study found.

“This is the first national study to look at the nonmedical use of prescription stimulants by students in middle and high school, and we found a tremendous, wide range of misuse,” said lead author Sean Esteban McCabe, director of the Center for the Study of Drugs, Alcohol, Smoking and Health at the University of Michigan in Ann Arbor.

“In some schools there was little to no misuse of stimulants, while in other schools more than 25% of students had used stimulants in nonmedical ways,” said McCabe, who is also a professor of nursing at the University of Michigan School of Nursing. “This study is a major wake-up call.”

Nonmedical uses of stimulants can include taking more than a normal dose to get high, or taking the medication with alcohol or other drugs to boost a high, prior studies have found.

Students also overuse medications or “use a pill that someone gave them due to a sense of stress around academics — they are trying to stay up late and study or finish papers,” said pediatrician Dr. Deepa Camenga, associate director of pediatric programs at the Yale Program in Addiction Medicine in New Haven, Connecticut.

“We know this is happening in colleges. A major takeaway of the new study is that misuse and sharing of stimulant prescription medications is happening in middle and high schools, not just college,” said Camenga, who was not involved with the study.

Published Tuesday in the journal JAMA Network Open, the study analyzed data collected between 2005 and 2020 by Monitoring the Future, a federal survey that has measured drug and alcohol use among secondary school students nationwide each year since 1975.

In the data set used for this study, questionnaires were given to more than 230,000 teens in eighth, 10th and 12th grades in a nationally representative sample of 3,284 secondary schools.

Schools with the highest rates of teens using prescribed ADHD medications were about 36% more likely to have students misusing prescription stimulants during the past year, the study found. Schools with few to no students currently using such treatments had much less of an issue, but it didn’t disappear, McCabe said.

“We know that the two biggest sources are leftover medications, perhaps from family members such as siblings, and asking peers, who may attend other schools,” he said.

Schools in the suburbs in all regions of the United States except the Northeast had higher rates of teen misuse of ADHD medications, as did schools where typically one or more parent had a college degree, according to the study.

Schools with more White students and those who had medium levels of student binge drinking were also more likely to see teen abuse of stimulants.

On an individual level, students who said they had used marijuana in the past 30 days were four times as likely to abuse ADHD medications than teens who did not use weed, according to the analysis.

In addition, adolescents who said they used ADHD medications currently or in the past were about 2.5% more likely to have misused the stimulants when compared with peers who had never used stimulants, the study found.

“But these findings were not being driven solely by teens with ADHD misusing their medications,” McCabe said. “We still found a significant association, even when we excluded students who were never prescribed ADHD therapy.”

Data collection for the study was through 2020. Since then, new statistics show prescriptions for stimulants surged 10% during 2021 across most age groups. At the same time, there has been a nationwide shortage of Adderall, one of the most popular ADHD drugs, leaving many patients unable to fill or refill their prescriptions.

The stakes are high: Taking stimulant medications improperly over time can result in stimulant use disorder, which can lead to anxiety, depression, psychosis and seizures, experts say.

If overused or combined with alcohol or other drugs, there can be sudden health consequences. Side effects can include “paranoia, dangerously high body temperatures, and an irregular heartbeat, especially if stimulants are taken in large doses or in ways other than swallowing a pill,” according to the Substance Abuse and Mental Health Services Administration.

Research has also shown people who misuse ADHD medications are highly likely to have multiple substance use disorders.

Abuse of stimulant drugs has grown over the past two decades, experts say, as more adolescents are diagnosed and prescribed those medications — studies have shown 1 in every 9 high school seniors report taking stimulant therapy for ADHD, McCabe said.

For children with ADHD who use their medications appropriately, stimulants can be effective treatment. They are “protective for the health of a child,” Camenga said. “Those adolescents diagnosed and treated correctly and monitored do very well — they have a lower risk of new mental health problems or new substance use disorders.”

The solution to the problem of stimulant misuse among middle and high school teens isn’t to limit use of the medications for the children who really need them, McCabe stressed.

“Instead, we need to look very long and hard at school strategies that are more or less effective in curbing stimulant medication misuse,” he said. “Parents can make sure the schools their kids attend have safe storage for medication and strict dispensing policies. And ask about prevalence of misuse — that data is available for every school.”

Families can also help by talking to their children about how to handle peers who approach them wanting a pill or two to party or pull an all-night study session, he added.

“You’d be surprised how many kids do not know what to say,” McCabe said. “Parents can role-play with their kids to give them options on what to say so they are ready when it happens.”

Parents and guardians should always store controlled medications in a lockbox, and should not be afraid to count pills and stay on top of early refills, he added.

“Finally, if parents suspect any type of misuse, they should contact their child’s prescriber right away,” McCabe said. “That child should be screened and assessed immediately.”

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Adderall users struggle with ongoing shortage while reason — and resolution — remain uncertain | CNN

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CNN
 — 

Clara Pitts has always strived for perfection.

The 17-year-old Utah native has been named a 2023 National Merit Scholarship finalist. And she heads to Brigham Young University as a freshman this fall.

But despite all of her achievements, Clara has one thing weighing on her mind: What if she fails?

Clara was diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 10th grade, during the summer of 2020, after months of digital schooling had started to take its toll.

“For the first time, I started struggling with getting my homework done [and] having a set schedule that I had to do myself,” Clara said. “It was because of online school.”

So along with her mother, Rebekah, she made the decision to try medication.

“I didn’t realize just how much my ADHD was inhibiting me from acting the same way as all of my friends until I had that experience of leveling the playing field,” Clara said.

By December 2020, Clara was prescribed 10 milligrams of Adderall, a formulation of amphetamine mixed salts, to be taken twice a day. Immediately, she noticed a difference.

“It seemed like the logical course of action, like something that shouldn’t have been happening in my brain was being fixed,” Clara said. “Naturally, my brain goes really, really fast, and I don’t even notice it because it’s what I’ve grown up with, and it’s the only mind I’ve ever experienced. But once I started having a different experience mentally, I felt a lot calmer.”

For the two years that followed, Clara was finally able to lead what she called a normal life, managing school, extracurricular activities and social life – all with the help of Adderall.

But in October 2022, Clara’s sense of calm was stripped away when the US Food and Drug Administration announced a shortage of Adderall and its generic counterparts.

“I hadn’t heard anything about a shortage,” she said. “I didn’t really take it seriously at first until later that week – maybe three or four days later – when I started to hear news about the shortage, and it really started to sink in.”

CNN first spoke with Clara and her mother, Rebekah, about a month after the FDA’s announcement. At the time, Clara had eight Adderall pills left in her prescription bottle – enough to last her four days.

“Initially, I was just very surprised when I tried to refill the prescription and they would not [refill it],” Rebekah says. “Very quickly, I went from surprised to afraid.”

On October 24, Rebekah texted Clara the bad news. The shortage had finally affected them, and their pharmacy could not refill Clara’s medication due to the shortage.

“They wouldn’t put you on a waiting list,” Rebekah texted her daughter. “I’m just sitting here crying because I can’t get you these meds.”

Rebekah says she called eight local pharmacies, and each one turned up empty.

“I felt really emotional about it in that first week or two … like I had failed my child, even though it wasn’t my fault,” Rebekah said. “I felt scared for what that would mean for her as a senior.”

The FDA announced a shortage of Adderall on October 12. The agency noted that it was in communication with all manufacturers of amphetamine mixed salts and that one of those companies, Teva, was “experiencing ongoing intermittent manufacturing delays.” Although other manufacturers continued to produce the drug, the agency said, “there is not sufficient supply to continue to meet U.S. market demand through those producers.”

Jim McKinney, a spokesperson for the agency, told CNN that the manufacturing delay has been resolved and that the shortage is now “demand-driven.”

Data from the analytics and research company IQVIA shows that the demand for Adderall has risen nearly 27% in recent years, with prescriptions jumping from 35.5 million in 2019 to 45 million last year.

On its website, the FDA lists eight manufacturers that have reported Adderall shortages to the agency. The website lists the shortage reason for some versions of the drug, such as “demand increase” or “shortage of active ingredient,” but for other versions, it just says “other” or lists no reason at all.

Each year, the Drug Enforcement Administration tracks and sets a limit on production of amphetamine, one of the key ingredients in Adderall. It says that for the past three years, manufacturers didn’t expend all of the ingredients that were available for their use.

“DEA is committed to ensuring that all Americans can readily access needed medications,” an agency spokesperson told CNN in a statement. “We are aware that the pharmaceutical industry is claiming that there is a quota shortage for the active ingredients in ADHD drugs. Based on DEA’s information – which is provided by drug manufacturers – this is not true.”

CNN reached out to the eight manufacturers that reported shortages to the FDA.

Teva Pharmaceuticals, Epic Pharma and Rhodes Pharmaceuticals did not respond. Alvogen, SpecGX and Sunrise Pharmaceutical declined to comment.

Sandoz said it had enough product to meet current customer orders. Lannett also said it had enough to meet current customer orders but added that it did not have enough to fulfill increased demand.

McKinney, the FDA spokesperson, said supply is increasing.

“The FDA recognizes the potential impact that reduced availability of certain products may have on health care providers and patients and is working closely with numerous manufacturers and others in the supply chain to understand, mitigate and prevent or reduce the impact of intermittent or reduced availability of certain products,” he said.

McKinney clarified that although the FDA is working with manufacturers, the agency does not make drugs and “cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug.”

Dr. Yoram Unguru, a pediatric hematologist and oncologist with joint faculty appointments at the Herman & Walter Samuelson Children’s Hospital at Sinai and the Johns Hopkins Berman Institute of Bioethics, studies drug shortages.

He says a lack of transparency about details – how big the shortage is and how much drug each company is making – is hindering solutions.

“Pharmaceutical manufacturers are not required to disclose the reason for disrupted supply. Knowing the exact reason for a given shortage is always challenging,” Unguru said. “It’s really difficult to be able to anticipate and let alone come up with meaningful solutions if you don’t know what the problem is.”

Clara ultimately went without Adderall for two and half months as she coped with the stresses of senior year. She began taking a different ADHD medication, Vyvanse, in mid-January.

Rebekah says she hopes Adderall will be an option for Clara again one day, adding that she doesn’t have the emotional stamina to keep searching for the medication.

“I would like her to have medication as an option and for it to be reliable, because college will probably be the hardest journey for her with ADHD.”

Clara says that life without Adderall is like trying to see the world vividly while wearing smudged glasses.

“You go around with dirty glasses. You get used to it, and you don’t realize that they’re dirty. But when you clean them off, having that extra bit of clarity makes a world of difference.”

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