Do you believe these happiness lies ?

By David Joel Miller

Happy child

Happy child

Most of us have some lies we tell ourselves every day. You may have been told these lies by others. Some are little ones and keep up hope. The big ones can make you miserable unless you face them.

  1. Once X happens then I will be happy.

More money, a new relationship or finally reaching a goal all sounds like things that should make you happy. The truth is more like, if you are not happy while traveling to this place you will not be happy when you get there.

Learn to be happy while you are working to earn that money and then you can enjoy the happiness and the money. If you are miserable on the way to the money you will still be miserable when you arrive.

  1. Once you become a success nothing bad will happen

One thing people in recovery learn is that life keeps happening. You work hard on your issues and then life gets better. But then something else happens and things get tough again. Successful people still get sick. Their families break up and their children get in trouble.

Plenty of highly successful people develop addictions or get arrested. There is no thing out there you can get that grantees permanent happiness unless maybe that thing is a proper attitude towards life.

  1. Life is fair or someone should make it fair.

Life is not always fair. Bad things happen to good people. No one can make life be fair. What you can do is learn the skills to get through hard times and how to keep a positive attitude when things look darkest.

  1. There is something you can do to guarantee safety

You can be constantly on the lookout for danger and still it can overtake you. It is reasonable to take precautions and watch out for danger, but do not fall into the trap of thinking that there are things you can do that will assure your safety. Insurance does not stop accidents it just pays you money to compensate for your losses. Excessive work about what might happen robes you of the happy moment now.

  1. Not taking chances will keep you safe

Everything in life requires a measure of risk. Apply for a job and you may not get it. Avoid falling in love and you will not have to go through a break up. You will also never know the joys of being in love.

If you want to have the good you need to accept the risk of things not always going the way you want them to.

  1. You are in control of everything

The great illusion of control takes many forms. One is the belief that if you work hard enough and insist loudly enough you can get control over everything and everyone in your life.

No one ever has control of life. It rains whether you want it to or not. Weather happens. People in your family get sick ether you eat the right foods or not. No matter how hard you try to control your children some of them will turn out well and some will not.

  1. You are in control of anything

No matter what thing you believe you have reduced to your control that control is probably temporary. The only thing that may in fact yield to your control is your attitude towards the uncontrollable.

  1. You are not good enough

You are plenty good enough. We all can do better but do not tell yourself that the fault is that you are inherently defective. This belief is just a sneaky way of letting yourself off the hook and allowing you to stop trying.

  1. The whole world is no good

There are good people and bad people. Sometimes good people do bad things and bad people do good things. Things keep changing. There is good all around if you look for it. The most beautiful flower may have some dead leaves. Even a weed can have beautiful blooms.

Believe in your worthwhileness and accept yourself scars and all.

10. The future will never be any better

There will always be another tomorrow. Some of those will be better and some few may be worse. Do not create a negative future by only looking for the defective. You will find what you are seeking but only if you believe that happiness is out there just waiting for you to find it.

11. You are the only one with this problem or issue

Hang out in any recovery program and you begin to swear those people were following you around recording your story. Troubles seem to come at one point or another to most of us. Listen for the ways in which others have struggled and you may decide that you are not so different from others.

12. You should not have to tell others what you need

People stay hungry or unloved because they don’t talk up. No matter how hard you try you will not always know what others around you need and want. They will not be able to read your mind Give yourself permission to ask for what you need. Telling those in your support system what your needs are helps them to be able to feel the joy of knowing how to help you.

13. You can’t take any more or can’t stand this situation.

If you say you can’t – you won’t. Most of us can take more than we think. Tell yourself that this too shall pass and much more becomes bearable. If your situation is intolerable take action to change it. Can’t change all of your life obstacles? Work on the changes you can make first and then reevaluate.

13. Your happiness depends on people, places or things

Happiness is an inside job. You can be happy no matter where you are if you permit it. You may wish things were different. You might prefer them to be different, but your ability to find happiness does not depend on having the right things or places in your life. No matter how much you miss someone who was in your life and is now gone out of it, do not let that absence rob you of the good times that you had. Do not let the loss of one person cheat you out of the relationship with the other people who could enrich your life.

Some other posts on finding and keeping a happy life are listed below

5 mandatory skills for a happy healthy life

16 Ways to create a happy life

17 Habits of unhappy people

Pretending to be happy?

How to be Happy

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books  

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What causes Attention Deficit Hyperactivity Disorder – ADHD?

By David Joel Miller

What do were really know about who gets ADHD and why?


Photo courtesy of Flickr ( Life Mental Health)

Developmental Psychopathology is the discipline that studies why one person gets a mental illness and another does not. This discipline also looks at how a disorder develops over the life time. Developmental psychopathology has a lot to tell us about who gets ADHD and why.

The picture, when it comes to ADHD and most other disorders is not a clear as we would wish. With all the people currently taking meds for ADHD you would think that professionals would know what ADHD was and what was causing it.

Both of these questions are fuzzy.

Developmental psychopathology tells us that there are two primary ways of behaving. Some people internalize and hold it all in. They are prone to depression and anxiety.

Other people externalize and let it all out. They are likely to get in trouble, get labeled oppositional defiant, conduct disordered or even anti-social.

People with ADHD may internalizes, externalize or do both.

What we call ADHD is in essence three different problems and those problems can occur in multiple combinations. First the three problems and then the possible causes.

1. Impulsivity – poor behavioral inhibition is the defining characteristic

Poor impulse control is prominent feature of most children. It also affects many adults both with and without ADHD. So if you find it hard to control your impulses you are at risk of getting an ADHD diagnosis.

This makes ADHD hard to differentiate from bad behavior or criminal behavior for that matter. Some have argued that most people in prison are there because they have ADHD. I find that hard to believe.

But when we see the way addicts and alcoholics struggle to not drink and use, then that feature of loss of behavioral control seems to fit a lot of socially unacceptable behavior.

Impulsivity looks a lot like acting out or externalizing behavior.

2. Inattention

Paying attention, in my view, is a skill that people can learn or improve. We believe, partly based on the existence of the ADHD diagnosis that there are some people who have difficulty focusing their attention when they try to do that.

Impulsive people have more difficulty sustain their attention because they keep getting distracted by other things that catch their attention.

Inattention or impaired ability to sustain attention is a characteristic of internalizing disorders. When you are depressed you can’t pay attention. Neither can the anxious person. So professionals need to be very careful to not call depression or anxiety by the wrong name – ADHD.

3. Hyperactivity

This is a problematic criteria some of the time. What is hyper or excessive activity is in the eye of the beholder. The child who will not sit still in class looks hyperactive, when they are in class. The child who sits quietly in their seat looks normal.

But put these two children out on the soccer field and the child that sits down and watches rather than plays looks underactive and the child that runs after the ball for long periods of time, they become the star player.

Increase the amount of exercise and the child that is hyperactive may calm down and sit still. This running to cure ADHD is the precise opposite of the fall-behind-in-your-work and you lose your recess approach.

All three of these factors, poor inhibition of impulses, inattention and hyperactivity can occur in varying amounts and combinations in any one person. This makes us wonder about causes of ADHD.

Is there one cause of ADHD or many?

A number of things have been identified as risk factors for ADHD. There are also protective factors.

1. Genetics play a role in who gets ADHD

Up to 75% of the risk of getting ADHD can be accounted for by various genetic factors. Wish this explained something. There are at least 7 different genetic mutations affecting two different neurotransmitter systems that increase the risk. This 7 genes in all the possible combinations results in up to 5,000 different combinations of genes that may increase the risk. But this risk factor does not guarantee you get ADHD and there are other risk and protective factors.

These genes are not specific to ADHD so they may be causing other mental illness and these illnesses maybe risks for ADHD.

2. Environment, especially parenting is a risk factor that may explained the other 25% of ADHD

For most people parents provide both genetics and environment which makes it hard to disentangle the effects of the two.

One thing we find that helps solve this puzzle is that if a parent has two of the symptoms of ADHD, say dad has ADHD and is inattentive and impulsive, there is a high chance that his son will not only have ADHD, but will also be inattentive and impulsive.

The children of parents that have ADHD have a high incidence of the same form of ADHD the parent had.

Things would be simpler if people had one and only one disorder. But most people with ADHD have two, three or more.

Almost half of all children with ADHD also have a diagnosis of Anxiety disorder. This complicates treatment for children with ADHD. In adults one thing we are told to recommend to our clients is to reduce their intake of caffeine and other stimulants, like amphetamine. But for kids with ADHD and anxiety disorder the treatment is to put them on a prescribed amphetamine.

I find this confusing. If it makes you wonder, talk with your prescribing psychiatrist about your or your child’s meds. (Yes there are non-stimulant ADHD meds but they do not get prescribed all that often.) Side effects of prescribed medications can look like a mental illness. If you have confusion, depression or anxiety and are taking prescribed medication discuss your emotional problems with your doctor and see if your meds could be causing some of your symptoms.

A second disorder that coexists with childhood ADHD is a substance use or abuse disorder. Occasionally the ADHD child is doing drugs but a lot of the time it is mom that is on drugs and this increases the risk of the child having ADHD even if mom does not start drugs until after the child is born. Yes having a mother who is using increases childhood ADHD.

Having a depressed or anxious mother also is a risk factor for developing ADHD.

There have been even more studies on dad than mom in the ADHD area. If dad had any acting out problems as a child there is at high risk that the child, boy or girl, will also act out and get in trouble at school and with the law.

We do know that the ability to pay attention develops over time and that there are ways to increase your ability to pay attention other than taking meds. It also appears that the brain circuits that control attention also overlap those for emotional regulation. More on these topics in posts to come.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books  

Top Ten Life mistakes you need to avoid.

By David Joel Miller

Top ten life mistakes to avoid.

Mistakes to avoid

10 Mistakes to avoid
Photo courtesy of Flickr (opensourceway)

When you are rushing through life there are things that look important and things that look like you can put them off. Eventually you need to stop and take another look at your life. Avoid these life mistakes if you can. If you have already made some of these change and do better. There is no time like the present to improve your life in these areas.

1. Do not live your life for someone else

A well lived life is lived by doing the things that you want to do. There is nothing wrong with a life of service, service to God or to your fellow-man. Just make sure you are doing this because it brings you joy.

Do not waste time being and doing what a parent, friend or partner wanted from life unless that is truly what you wanted also. Live in a way that leaves few or no regrets.

2. Don’t put your dreams on hold till someday

Someday never comes. It is always today. Live each day the best you can. Do not delude yourself that someday you will do this or that. Enjoy the trip from here to there. If you live your life off in someday you will miss out on today.

Keep working towards realizing your dreams. Small steps taken one after another keep you moving in the right direction.

3. Never rush into relationships

Do not think that you need to settle for someone who will accept your love. Look for someone you can love over the long haul. Do not settle for Mr. or Miss Good enough.

Take your time getting to know people. Invest your time in positive relationships. Some people will be friends for the moment and some will be friends though the ups and downs of life.

4. Do not rushing out of relationships

Do not believe that the problems in a relationship are faults that always are caused by the other person. Change partners and you change problems. Every friend comes with defects of character. Think carefully about which of the problems in the relationship are because of things about the other person you can’t accept. Which of your relationship problems are about you?

Hang in there and work on your ability to create a good relationship until you become totally convinced that there is no way to make this relationship work.

5. Stop thinking that things equal happiness

Twenty years from now your children will remember the things you did together more than the things you paid for. Buying more things fills up your trashcan not your happiness.

More things does not equal more happiness. Take a miserable person and give them a lot of things and as soon as the novelty of the new things wears off you will have a miserable person with a lot of used miserable things.

6. Avoid using drugs and alcohol to change the way you feel

Medications can heal. Medication can help you to live a healthy life if you take them for the right reasons and precisely as prescribed by a good doctor. Street drugs change the way you feel in another way. You take them and you temporarily feel better or more likely you feel less.

Eventually the drugs stop working. You need more and more to feel just normal and the happy feeling you were chasing moves farther and farther away.

If you become dependent on using a drug to feel happy that feeling will require more and more drugs. We call this illusion – addiction.

7. Not saving enough is a mistake

It is easy to say that you do not have enough income to save. The more you make the more your expenses. In the beginning you are too poor not to save. Save a nickel or a dime and eventually those coins will be dollars.

Especially save so that the wolf will stay away from the door. Most people spend when they have it and then go without when they are broke. Having a few dollars set aside will reduce a lot of emergencies to manageable problems.

8. Not spending enough time with your family and friends

The currency of friendships is time and shared interests. Do things and spend time with those you want to keep close in life.

9. Not investing in yourself

Don’t believe that you can’t afford the time or money for education. Learning the hard way is more expensive. A person with an education earns more over their lifetime than someone who did not invest in self-development.

Not all education comes in classrooms. Read things that will help you improve your game. Talk with people who know how to do the things you aspire to do. Allays be curious and make lifetime learning part of your life.

10. Not developing more friendships

Friendships and family are the support systems that help you get through rough times. Do not make the mistake of believing you can do everything alone. Growing friendships requires that you plant a lot of seeds, invest time in nurturing them and weed out the ones that are holding you back.

Make cultivating your friendship garden a priority.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books  

How many kinds of attention are there?

By David Joel Miller

You need more than one kind of paying attention skill

Attention Sign

Attention Sign
Photo courtesy of Flickr (fs999)

One kind of paying attention skill is not enough. From the first day of life you had to pay attention. As you grew and developed you needed to learn other attention skills. There are reasons why you may have found one kind of paying attention more difficult than another.

In a previous post we looked at ADHD and how people get the ADHD diagnosis because of behavior. That behavioral deficit gets blamed on the attention paying part. Turns out that we are not all taking about the same thing when we say “pay attention.”

Starting from the day you were born here are the paying attention skills humans need to learn.

1. Alert attention – recognize that there is something out there

From that first day babies begin to attend to physical sensations. They recognize and respond to hunger and thirst, hot and cold and all the other physical needs.

You will never stop paying attention to those feelings of hunger or the startle response to loud noises.

Many people have their alert attention volume set to high. The result is that a nose in the next room causes them to jump out of their skin. This can result in an anxiety disorder. Some people get ADHD diagnosis because of anxiety not any lack of attention. The just respond to and attend to sights, sounds or smells in an excessive manner. They can’t seem to ignore these Alert attention cures.

Life experiences, single or complex traumas, can increase this startle response form of “paying attention.”

2. Orienting attention

By three months of age a baby not only alerts to a stimulus but tracks that stimulus. You hear a sound, you jump. Then you look intently for where this is coming from. You stare at the stimulus. In the mean time you have forgotten all about what you were doing and thinking about.

This tracking, attending behavior draws you away from what you were attending to in the first place. This easily distracted form of attention tracking can keep you safe if something dangerous is going on but it can be annoying to other people, notably adults, if the child stopped paying attention to the adult to attend to tracking this sudden stimuli.

3. Sustained Attention

This paying attention skill cause the most problems for most people who end up in therapy. Too much or two little of this attention paying skill, gets you and ADHD diagnosis.

In sustained attention you need to keep you attention on one thing while ignoring all others. So the teacher tells you to read your story book for the next ten minutes. Sustained attention keeps you reading.

People who find that they are paying attention to alerts have problems sustain attention. Someone in the back of the class starts talking you turn around to listen and you get in trouble for “not paying attention.”

If you are good at tracking attention you might see someone walking by the class room window and you track their progress. You might even get up and walk over to the window to see where they are going. This gets you in trouble for “not paying attention” to your reading despite the fact that you are getting really good at tracking attention.

Too much sustained attention is a bad thing.

After the ten minutes your teacher tells the class to stop reading it is now time for math. You, having mastered sustained attention, do not hear her and continue to read. You are now attending to the story and it is interesting. The result is you get in trouble for “not paying attention” to what the teacher is saying.

There is a related phenomenon we see in substance abusers. When under the influence of a stimulant drug, methamphetamine in particular, they have excessive sustained attention. They refer to this as “getting stuck.” The person may begin to clean the kitchen floor and two days later is till down on their knees cleaning the cracks in the tile with a tooth-brush. They have become stuck and can’t shift their attention.

This makes me wonder if some of the benefits of stimulant ADHD medications are the result of “Stuck attention” in which the person can sustain the attention for long periods of time but may not be able to use the other forms of “paying attention.”

What you needed at this point is the next form of attention “Executive attention.”

4. Executive attention is the ability to move your attention around as needed.

With good executive attention you can attend to what you want to or should be attending to. Sometimes as in the last example these two attention demands are in conflict. You want to continue reading but you need to shift your attention and take out your math book. This attention issue is one you will continue to develop across your life time.

Remember your first grade teachers demands for attention when you are retired and your spouse asks “where you listening to me?”

5. Selective attention

Most attention researchers list three kinds of attention. The trouble is they do not list the same three types. Some researchers include selective attention under executive attention others under sustained attention.

What happens is that over time you develop personal rules for how you decide what you will pay attention to. This may have to do with your interests. It may also have to do with how hard you get hit if you do not select the form of attention an adult is expecting.

Worth noting is that problems with selective attention overlap almost all known forms of mental, emotional or behavioral disorders. Defects in selective attention processes are linked to autism spectrum disorders, depression, bipolar disorders, anxiety, psychosis, ADHD, learning disorders, behavioral and conduct disorders.

This makes me wonder if ADHD, or selective attention defects specifically, is a cause of symptoms in these other disorders or is it a symptom of another problem that is not getting recognized until much later in life? You can have ADHD, Anxiety, depression and a substance abuse problem. But which is causing which is another topic.

Stay tuned for more posts on the subjects of attention, ADHD and how you might learn skills to improve your attention.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books  

What do you do if you are allergic to smoke?

By David Joel Miller

How do you work around smokers if you are allergic to smoke?

Cigarette Smoking

Cigarette Smoking
Photo courtesy of Flickr (Iqbal Osman1)

This question originally came to me as an email from a counselor who is allergic to smoke. While they love the work, it its difficult being around people who are heavy smokers. This problem also applies to those who have allergies to perfume or other strong scents. I thought I would pass this along for whatever it is worth. If any of you out there have other ideas feel free to leave a comment or contact me.

This is an extra problem, I believe, for anyone who works in mental health or substance abuse treatment areas. The comments also apply to those who work with the homeless or in social service agencies.

Smoke also affects the family members and children of the smokers. When there are children involved we suggest that the smoker refrain from smoking not only when the children are around but also suggest that they not smoke in areas that their children will be.

See the post on Third Hand Smoke to find out more about the lingering effects of having a smoker in a room where others later go.

As an ex-smoker, this is less of an issue for me. I often do not notice the scent of smoke but others may. I am not suggesting anyone take up smoking to reduce the issues they have with being around others who smoke.

I have written previously about how tobacco (nicotine) is the drug of choice among the homeless. See: What is the Drug of choice among the homeless?

Heavy smoking is common among those with serious and persistent mental illnesses, substance abusers and the homeless. Smoking is not the only reason that these clients may have a strong odor. Lack of hygiene facilities makes the problems worse and so do illnesses like depression that make it overwhelming for many people to do their activities of daily life.

The conventional wisdom used to be that smoking calmed down people with psychosis or emotional issues. So if you were trying to treat someone hearing voices or abusing street drugs why make then give up tobacco at the same time?

Today, more and more places, treatment facilities and self-help meetings are going smokeless. What we have found is that helping people give up tobacco does not hamper their recovery from other substances and may help improve their mental health symptoms.

Increasingly stop smoking programs are finding their place in the treatment of people with mental illness and substance use disorders.

Here are some thoughts to help those of you who find yourself around smokers who are triggering your allergies.

What do you do if you are allergic to smoke?

This is a serious challenge. I would hate to think that anyone would need to give up their profession because of allergies.  This is a server challenge for people with allergies since so many clients are heavy smokers and the smoke smell lingers long after they have put that cigarette out. Heavy smoking is common in people with psychosis, schizophrenia, substance use disorders and so on. I did have a colleague who had severe allergies and even someone wearing perfume or having flowers in their office set off their attacks.

Six suggestions for coping with smoke:

  1. See your doctor, especially an allergist. Untreated this is only likely to get worse. Taking medication may help prevent the allergies getting worse.
  2. Consider a fan or air purifier for your office
  3. Try to work in larger offices or rooms where the smell may be less overwhelming.
  4. See if you can do some distance counseling work. We have a law here (California) that helps people who are in rural areas, shut-in’s etc. see their therapist via the internet. Other professionals may be able to do more of their contacts via phone.
  5. See if you can get assigned to a school based program or work with children. Their parents may smoke but you will have less smell on your clients.
  6. See if you can work in an inpatient facility that has a no smoking policy

Not sure if those suggestions will help you but that is the ones I have thought of so far.

If any of you readers come up with any other solutions let me know.  Let’s see what blog readers can come up with.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books  

Ways to take care of yourself.

By David Joel Miller

You deserve to be well cared for.

Tender loving care

Tender loving care
Photo courtesy of Flickr (hehaden)

Did anyone teach you how to take care of yourself? Did they tell you that taking care of yourself is being selfish? Don’t listen to that kind of talk.

Taking good care of yourself is not being selfish. You can’t give others something you do not have. How can you expect your children and others around you to take care of themselves when you do not set a good example?

Having the guts and determination to keep on pushing forward despite the obstacles is an admirable quality. But eventually even the supper heroes need to rest and relax. Living your life as if the objective is to see how much you can suffer and push yourself is no way to live.

You are only here for one life. Try to get the most out of that life by living a life full of self-compassion.

Here are a list of simple to do self-care acts that can make you a more self-compassionate person.

1. Let yourself rest when tired – sleep

This one is at the top of the list for a reason. Sleep is not unproductive time. You do not get more accomplished by sleeping less. When needed you can probably get by on less sleep for a few days or even weeks but eventually that lack of rest catches up with you.

Sleep is the time when your brain cools down, increases blood flow and cleans out all the waste products. Your brain and nerves heal and memory’s get consolidated during sleep.

Fail to get enough sleep and your daily performance will decline. You may even damage that computer in your head and there are no replacement parts for the model brain you are using.

2. Take care of your body

Eat healthy and get some exercise. If you are too busy to eat well or exercise you are too busy. Eventually parts of the body get worn. You need good nutrition and some physical exercise to keep the machine you call your body working well.

Pushing yourself long hours on poor quality fuel results in excessive wear on your body and a shortened lifespan.

Want to get the most done in your career or home. Keep yourself in good shape for the whole journey.

3. Respect how you feel

Do not ignore your feelings. If something is bothering you attend to it before it becomes a major problem. Talk that issue through with a trusted friend or professional. If the issue is between you and your spouse then your partner is the one you need to be talking with.

Having healthy supportive relationships keeps you mentally, physically and emotionally healthy.

If you emotions are running rough do not ignore the feelings. Take yourself in for an emotional tune up if needed. Most people think that seeing a counselor or therapist is something you do after you have nervous breakdown. Get emotional help in the early stages and there may be no breakdown.

4. Schedule time for you

Never have any time for yourself? Then you are giving too much of your life away.  Make time for yourself, your interests and enjoying life.

You are the only you there will ever be. Enjoy every minute you spend with yourself. Being alone some of the time should not equal being lonely. Balance the time around others with the time you spend in solitude.

5. Pause to take stock of where you are in life – have goals

One good habit to get into is a periodic review of your life. Businesses take inventory at least one a year. Are there things in your life that are obsolete? Have a clearance sale and get those activities that are taking up your time but providing no value out of your life.

Are your activities taking you where you want to go? Review you goals and the strategies and tactics you are using to get to those goals.

6. Reward your hard work

Make sure you build in rewards for the hard work you do. What special rewards will you give yourself when you reach a goal?

7. Challenge yourself to build a sense of accomplishment

People have comfort zones. When you step just a little outside that zone you feel some anxiety but when you try on a new behavior and are successful you get used to this new area. Keep moving just a step outside that comfort zone and you will stretch out the area of things that you can comfortably do.

8. Give yourself a round of applause for things well done

Be your most enthusiastic cheerleader. Make sure you notice the things that you do and give yourself a round of apples every time you are able to master a new skill or challenge.

Accept compliments when offered. Do not reject those compliments with a self-depreciating “It was nothing.” A simple thank you to the party that offered you the praise will go a long way in building your self-esteem and theirs.

9. Invest time and money in yourself

You have a set amount of time each week. You can spend that time wisely or foolishly. Budget those hours and include an investment in yourself as part of that budget. Take a class, read something that interests you.

There is a difference between spending money and time for momentary pleasure and investing in yourself for the long run. Investments in yourself in learning new skills or expanding your experiences pay dividends down the road.

What other ways have you found that help you take care of yourself?

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books  

What is causing the ADHD epidemic?

By David Joel Miller

What is Attention Deficit Hyperactivity Disorder (ADHD) and why is it on the rise?


Photo courtesy of Flickr ( Life Mental Health)

ADHD appears to be everywhere. It is spreading faster than obesity. In my therapy practice most of my adult clients tell me that they were diagnosed with ADHD at some time in the past. Most of them have children with an ADHD diagnosis. It is common for the young people who come to see me to have, as their first diagnosis, ADHD.

ADHD is now something everyone gets. Over a nine-year period the number of girls diagnosed with ADHD increased 600% (Robinson et al., 2002.) It is no longer exclusively a diagnosis of children as adults and even senior citizens are receiving the diagnosis.

One author tells us that if the current trend continues, within 20 years, half of all children will be on an ADHD med (paraphrased from Shannon, 2009.)

Why is ADHD so common and what is fueling its spread?

To answer this question there a number of factors we need to look at. What is ADHD? Even more basic, what is Attention and what is hyperactivity? We also need to know is attention abilities something you are born with or does it develop over time? Are there things you can do to improve your attention or is this just the way you are? Are there alternatives to taking stimulant meds and do those alternative really work?

The relationship with other mental emotional and behavioral disorders is also important. There is a lot of overlap between having ADHD and having Autism, depression, anxiety and substance use disorders.

There are also cultural factors in ADHD. Certain population groups are more likely to get the ADHD diagnosis than others. Who gets diagnosed also is affected dramatically by who does the “testing” and who gives out the diagnosis.

There has been a lot of research on ADHD and its treatment recently. As I am able to read that research I want to report back to you what I find out and how you may be able to apply these ideas to your life or the life of someone you care about.

From the day a child is born there is pressure to behave in certain ways. Some children are more active than others. Some from day one have better abilities to “pay attention” but genetics is not the whole story of why some people are diagnosed with ADHD and others are not.

Regardless of age a person can learn skills to improve their ability to “pay attention.” We can also learn skills to reduce or increase out behavior. Let’s begin out review of the ADHD phenomenon.

ADHD is not one thing but several

We professionals used to have two separate diagnosis for these issues, Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD.) If you go back farther in the psychiatric literature these issues had other names.

The idea was that some people, mainly children, where not good at “paying attention.”  Mostly we thought that this was a lack of effort on their part and that they just needed to listen better. Most people with a predominantly inattentive issue did not cause anyone any problems and so did not get noticed until they were much older and came asking for help. Sometimes this inability to “pay attention” was written off as low intelligence or a learning disability. Sometimes those things were factors but often they were not.

We have studied attention a lot and it turns out there are a number of different skills that we call “paying attention” and that those skills develop with time and can be learned. More on the subject of what attention is and how it develops in upcoming posts.

Most ADHD diagnosis are about Behavior!

Most ADHD diagnosis come about because the child’s behavior is upsetting an adult. The child does not stay in their seat, talks to much and generally disrupts the class rom. Some parents tell us that their children are “hurricanes” and are always in motion. So if the child does not stay in one place, moves a lot and causes problems for adults, this gets them evaluated and probably diagnosed.

Hyperactivity is very situational. If a child runs all through the soccer practice and is fast at running around the track, they get A’s from the coach and may become track stars or pro soccer players. That same child who is never in their seat in the class room will get in trouble and probably placed on meds.

To avoid this ADHD diagnosis the child needs to develop the ability to regulate his behavior. A whole lot of factors, like diet and opportunities for physical activity can affect a child’s ability to sit still. When most people lived on farms and in rural communities there were more opportunities to “work off” that energy. Now most people on planet earth live in cities and they stay inside a lot more.

Some of my clients have told me they are not allowed to go outside because of the gangs and the drive-bys. Their parents tell me they are scared to let the kids out of the house. One client has two bullets in him from drive-bys. Any questions why his kids never leave the house?

One theory is that ADHD, the hyperactivity part, is a failure of human evolution to keep up with our changing environment. This may also be true of the inattentive part as we will talk about in the future.

ADHD also coexists with depression and anxiety

Many children’s first diagnosis is ADHD. They are then placed on a stimulant medication to treat this hyperactivity on the premise that the behavior problems are caused an inability to “pay attention” meaning a failure to do what the adult says.

It does not stop there. Before long, because their behavior is causing adults problems, we change this diagnosis to “Disruptive Behavior Disorder.” Eventually this may run the gamut of “bad child diagnoses” to Oppositional Defiant Disorder or even Conduct Disorder.

In the teen years or adulthood we then discover that this person was depressed or had an anxiety disorder all this time.

One treatment for anxiety disorders in adults is to tell them to avoid caffeine or other stimulants. This is a conflict if they are talking stimulant meds for their “ADHD.”

I fully believe that there are children who warrant the diagnosis of Disruptive Behavior Disorder, Oppositional Defiant Disorder or even Conduct Disorder. They and the others in their lives need help. Just saying that we professionals and society need to be looking for depression and anxiety issues also.

So next stop would need to be this area of attention. What is the ability to “pay attention” how much are we born with and how does it develop.

The day you were born you had some ability to “pay attention.” In the next attention post let’s look at this day-one ability and how your attention abilities change and develops over time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books