Prefrontal Cortex

Brief Definition
The prefrontal cortex (PFC) is the cerebral cortex covering the front part of the frontal
lobe. This brain region has been implicated in planning complex cognitive behavior,
personality expression, decision making, and moderating social behaviour. The basic
activity of this brain region is considered to be orchestration of thoughts and actions in
accordance with internal goals. The most typical psychological term for functions
carried out by the prefrontal cortex area is executive function. Executive function
relates to abilities to differentiate among conflicting thoughts, determine good and bad,
better and best, same and different, future consequences of current activities, working
toward a defined goal, prediction of outcomes, expectation based on actions, and social
“control” (the ability to suppress urges that, if not suppressed, could lead to socially
unacceptable outcomes). The frontal cortex supports concrete rule learning, while
more anterior regions along the rostro-caudal axis of the frontal cortex support rule
learning at higher levels of abstraction. (adapted from Wikipedia – see below for a more
complete explanation)

Prefrontal cortex of left cerebral hemisphere. Shown in red. Polygon data were
generated by Database Center for Life Science(DBCLS)[2]. – Polygon data are from
BodyParts3D[1]
 The Science of Psychotherapy Podcast
Clinical Relevance In Brief:
 Reduced volume and interconnections of the frontal lobes with other brain
regions has been observed in people diagnosed with mental disorders; those
subjected to repeated stressors; suicides; those incarcerated; criminals;
sociopaths; those affected by lead poisoning; and daily cannabis users.
 Feeling guilt or remorse, and to interpret reality, may be dependent on a well-
functioning prefrontal cortex.
 The size and number of connections in the prefrontal cortex could relate directly
to sentience, as the prefrontal cortex in humans occupies a far larger percentage
of the brain than any other animal.
 The left and right halves of the prefrontal cortex appear to become more
interconnected in response to consistent aerobic exercise.
 Practicing mindfulness can enhance prefrontal activation, which is correlated with
increased well-being and reduced anxiety.

Frontal Lobe Brain Anatomy. Image decade3d/[Link]

Frontal lobes
The frontal lobes are probably of most interest to psychotherapy interventions such as
CBT because they are home to the PFC, an area vitally involved in executive functions
such as concentration, organization, judgement, reasoning, decision-making, creativity,
emotional regulation, social–relational abilities, and abstract thinking—in other words,
all the functionality we rely on for healthy relationships with ourselves and others. We
will look at the PFC separately because of its special importance to psychotherapy;
however, the frontal lobes in general regulate voluntary movement, the retention of
non-task-based memories that are often associated with emotions, dopamine-driven
attention, reward motivations, and planning, to name just a few.

Prefrontal Cortex
The PFC is the part of the cerebrum that lies directly behind the eyes and the forehead.
More than any other part of the brain, this area dictates our personality, our goals, and
our values. When we have a long-term goal, for example, which we are pursuing with
value-congruent action, we maintain a neural representation of that goal so as to not
be distracted or influenced by competing goals or alternate values (Grawe, 2007). If the
PFC is damaged, it affects our personalities and the ability to orient our behaviour in
line with our values and goals. The PFC is vital to the sense of self and others necessary
for healthy interpersonal relationships and decision making.
As in the case of so many discoveries in neuroscience, we often learn what a brain area
can do when it becomes damaged in some way. Phineas Gage was a young, reflective,
determined, and goal-oriented man who, despite his youth, had been promoted to
foreman on an American railroad construction project. But in an unfortunate accident
on September 13, 1848, an explosion drove a tamping rod up through the left side of
his face and out the top of his head. The rod passed through and destroyed much of his
left PFC. Amazingly, Gage survived, and was even speaking within minutes of the
accident. He was still conscious and talking to a physician about half an hour later,
having introduced himself saying, “Doctor, here is business enough for you.” Following
his recovery, an early observation of a change in Gage’s personality was noted by Dr.
John Harlow:
The equilibrium or balance, so to speak, between his intellectual faculties and animal
propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times
in the grossest profanity (which was not previously his custom), manifesting but little
deference for his fellows, impatient of restraint or advice when it conflicts with his
desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many
plans of future operations, which are no sooner arranged than they are abandoned in
turn for others appearing more feasible. A child in his intellectual capacity and
manifestations, he has the animal passions of a strong man. Previous to his injury,
although untrained in the schools, he possessed a well-balanced mind, and was looked
upon by those who knew him as a shrewd, smart business man, very energetic and
persistent in executing all his plans of operation. In this regard his mind was radically
changed, so decidedly that his friends and acquaintances said he was “no longer
Gage”. (Harlow, 1869, pp. 13-14)
 1868 diagram of Phineas Gage’s skull and the damaged caused by the tamping rod – by John M. Harlow
Clearly, some important functions of Gage’s personality had been altered by his
injuries, although he did become more functional and socially adaptable as the years
went on. Given a structured environment in which clear sequencing of tasks was part of
the rehabilitation, Gage managed to retrain his brain to regulate itself in reference to
values and goals.
The left and right sides of the PFC have different biases, with the left side oriented more
toward approach, positive goals, and emotions, and the right side specialized more in
avoidance and negative emotions. It is also worth noting that the left side of the PFC
hosts more dopamine receptors/activity (associated with motivation and reward), while
the right has greater norepinephrine activity (associated with anxiety). Individuals who
appear to have a bias toward positive emotions may have a more activated left PFC,
whereas right PFC activation is correlated with more negative emotional experiences.
Any suggestion of a clear binary division is an oversimplification, as the experience of
positive or negative emotions does not hinge purely on left/right PFC activation, but
there is nonetheless evidence of a strong correlation.
In studies of the neural correlates of depression, it has been found that left PFC activity
is underactive relative to right PFC activity. It seems that less access to the positive
bias of the left PFC may make it more difficult for the depressed individual to engage in
positive goal-oriented thought and behaviour. Similarly, the left PFC is more responsive
to rewards than the right PFC, which is more responsive to punishment. Studies have
found that the depressed individual is generally more sensitive to what may be
perceived as punishment and does not respond as well to rewards. Moreover, the
relative underactivation of the whole PFC in depressed individuals could account for
them having less motivation for planning, problem solving, creativity, and so forth.
In depression, not only is there underactivation of the PFC, but its volume has been
found to be reduced as well. A depressed person with an underactive PFC of reduced
volume is not going to demonstrate the rational problem solving abilities of someone
without such deficits—the neural integrity to support such resilience is simply not there.
This is where the active, approach-oriented and positively biased PFC of a therapist can
be of great value to the depressed client. We will discuss the supportive right brain-to-
right brain activity of therapy further when we address specific psychopathologies.
The PFC has been divided into a number of functionally distinct regions,
described below.
Dorsolateral prefrontal cortex (DLPFC). The DLPFC is the topmost part of the PFC
and is considered to have overall management of cognitive processes such as planning,
cognitive flexibility, and working memory. This is an area specialising in problem
solving and how to direct and maintain attention to a task. When we are focused on
what is happening now, our working memory is engaged with the DLPFC and
connecting with the hippocampus for the retrieval and consolidation of long-term
explicit memories. A dysfunction in this area may lead to problems with working
memory, processing in the hippocampus, and long-term memory, as well as the
integration of verbal expression with emotions. Such memory deficits have been
associated with PTSD due to an underactive left DLPFC. Other DLPFC deficits can
manifest as a lack of spontaneity and affect (flat rather than negative), and attention
deficit—due to an inability to maintain sufficient attention to see a task through to
completion. In obsessive–compulsive disorder (which we will consider separately in a
later section the DLPFC plays an important role in strengthening attentional skills to
momentarily break the compulsion circuit and give the orbitofrontal cortex a chance to
inhibit the runaway activation of the amygdala. As with many brain regions, there are
significant hemispherical differences within the dorsolateral prefrontal cortex, the
left DLPFC being associated with approach behaviours and the right with more avoidant
behaviours.

The ventromedial prefrontal cortex helps us make decisions based on the bigger picture gathered from
connections to the amygdala, temporal lobe, ventral segmental area, olfactory system, and the thalamus.
Orbitofrontal cortex (OFC). The OFC, like the DLPFC, is involved in the cognitive
processing of decision making; however, because of its close connection with the limbic
system, it is particularly associated with our ability to make decisions based on
emotional information. The OFC also plays a major role in forming social attachments
and regulating emotions. This region can be thought of as a convergence zone for
sensory and emotional information, effectively integrating external and internal worlds.
Social information is processed and used to guide us in our perceptions and
interactions, and the OFC plays an important role in the interpretation of these complex
social interactions, including, for example, the ability to understand a joke.
The OFC may help us predict the reactions of others and modulate our behaviour
accordingly. When there is a dysfunction in the orbitofrontal cortex, the normal cortical–
subcortical modulation is not optimal—as is likely the case in borderline personality
disorder (Schore, 2012). As with other areas of the PFC, the OFC has hemispherical
differences. The left OFC is associated with positive emotions, while the right OFC is
associated with more negative emotions.
Ventromedial prefrontal cortex (vmPFC). This part of the PFC helps us make
decisions based on the bigger picture gathered from connections to the amygdala,
temporal lobe, ventral segmental area, olfactory system, and the thalamus. It is very
well connected, receiving and sending a lot of information that influences many brain
regions, including the amygdala. The vmPFC plays an important role with the OFC in
regulating our emotions, especially in social situations. It is also vital for personal and
social decision making and the ability to learn from our mistakes. Our capacity to make
judgements and allow our emotions to assist in decision making is mediated by this
region of the brain. Activation of the vmPFC is also associated with courage,
suppression of negative emotions, compassion, shame, and guilt.

Executive Function & Self-Regulation

Executive function and self-regulation skills are the mental processes that enable us to plan,
focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air
traffic control system at a busy airport safely manages the arrivals and departures of many
aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set
and achieve goals, and control impulses.
When children have opportunities to develop executive function and self-regulation
skills, individuals and society experience lifelong benefits. These skills are crucial for
learning and development. They also enable positive behavior and allow us to make healthy
choices for ourselves and our families.
Executive function and self-regulation skills depend on three types of brain function:
working memory, mental flexibility, and self-control. These functions are highly interrelated,
and the successful application of executive function skills requires them to operate in
coordination with each other.

Each type of executive function skill draws on elements of the others.

 Working memory governs our ability to retain and manipulate distinct pieces of
information over short periods of time.
 Mental flexibility helps us to sustain or shift attention in response to different demands
or to apply different rules in different settings.
 Self-control enables us to set priorities and resist impulsive actions or responses.
Children aren’t born with these skills—they are born with the potential to develop
them. Some children may need more support than others to develop these skills. In other
situations, if children do not get what they need from their relationships with adults and the
conditions in their environments—or (worse) if those influences are sources of toxic stress—
their skill development can be seriously delayed or impaired. Adverse environments resulting
from neglect, abuse, and/or violence may expose children to toxic stress, which can
disrupt brain architecture and impair the development of executive function.
By focusing on real-life daily situations such as bedtime and mealtime, the Ready4Routines intervention
seeks to strengthen executive function skills in adults and children, while also increasing predictability
within young children’s lives.
Providing the support that children need to build these skills at home, in early care and
education programs, and in other settings they experience regularly is one of society’s
most important responsibilities. Growth-promoting environments provide children with
“scaffolding” that helps them practice necessary skills before they must perform them alone.
Adults can facilitate the development of a child’s executive function skills by establishing
routines, modeling social behavior, and creating and maintaining supportive, reliable
relationships. It is also important for children to exercise their developing skills through activities
that foster creative play and social connection, teach them how to cope with stress, involve
vigorous exercise, and over time, provide opportunities for directing their own actions with
decreasing adult supervision.

Overview - Cognitive behavioural therapy

(CBT)
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems
by changing the way you think and behave.
It's most commonly used to treat anxiety and depression, but can be useful for other mental and physical
health problems.
How CBT works
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are
interconnected, and that negative thoughts and feelings can trap you in a negative cycle.
CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down
into smaller parts.
You're shown how to change these negative patterns to improve the way you feel.
Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on
issues from your past.
It looks for practical ways to improve your state of mind on a daily basis.
Uses for CBT
CBT has been shown to be an effective way of treating a number of different mental health conditions.
In addition to depression or anxiety disorders, CBT can also help people with:
 bipolar disorder
 borderline personality disorder
 eating disorders – such as anorexia and bulimia
 obsessive compulsive disorder (OCD)
 panic disorder
 phobias
 post-traumatic stress disorder (PTSD)
 psychosis
 schizophrenia
 sleep problems – such as insomnia
 problems related to alcohol misuse
CBT is also sometimes used to treat people with long-term health conditions, such as:
 irritable bowel syndrome (IBS)
 chronic fatigue syndrome (CFS)
 fibromyalgia
 chronic pain
Although CBT cannot cure the physical symptoms of these conditions, it can help people cope better with
their symptoms.
What happens during CBT sessions
If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2
weeks.
The course of treatment usually lasts for between 6 and 20 sessions, with each session lasting 30 to 60
minutes.
During the sessions, you'll work with your therapist to break down your problems into their separate
parts, such as your thoughts, physical feelings and actions.
You and your therapist will analyse these areas to work out if they're unrealistic or unhelpful, and to
determine the effect they have on each other and on you.
Your therapist will then be able to help you work out how to change unhelpful thoughts and behaviours.
After working out what you can change, your therapist will ask you to practise these changes in your
daily life and you'll discuss how you got on during the next session.
The eventual aim of therapy is to teach you to apply the skills you have learnt during treatment to your
daily life.
This should help you manage your problems and stop them having a negative impact on your life, even
after your course of treatment finishes.
Pros and cons of CBT
Cognitive behavioural therapy (CBT) is effective in treating some mental health problems, but it may not
be successful or suitable for everyone.
Some of the advantages of CBT include:
 it can be completed in a relatively short period of time compared with other talking therapies
 the highly structured nature of CBT means it can be provided in different formats, including in
groups, self-help books and online
 it teaches you useful and practical strategies that can be used in everyday life, even after the
treatment has finished
 it focuses on the person's capacity to change themselves (their thoughts, feelings and behaviours)
 it can be as effective as medicine in treating some mental health problems and may be helpful in
cases where medicine alone has not worked
Some of the disadvantages of CBT to consider include:
 you need to commit yourself to the process to get the most from it – a therapist can help and advise
you, but they need your co-operation
 attending regular CBT sessions and carrying out any extra work between sessions can take up a lot
of your time
 it may not be suitable for people with more complex mental health needs or learning difficulties
 it involves confronting your emotions and anxieties – you may experience initial periods where
you're anxious or emotionally uncomfortable
 it does not address any wider problems in systems or families that may have a significant impact on
someone's health and wellbeing
Some critics also argue that while CBT addresses current problems and focuses on specific issues, it does
not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
How to find a CBT therapist
You can get psychological therapies, including CBT, on the NHS.
You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from
a GP.
Find an NHS psychological therapies service (IAPT)
Or your GP can refer you if you prefer.
If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions
varies. It usually costs £60 to £100 per session, but lower rates may be available to those on lower
incomes.

Borderline personality disorder

Borderline personality disorder is a mental health disorder that impacts the way you think and
feel about yourself and others, causing problems functioning in everyday life. It includes self-
image issues, difficulty managing emotions and behavior, and a pattern of unstable
relationships.
With borderline personality disorder, you have an intense fear of abandonment or instability,
and you may have difficulty tolerating being alone. Yet inappropriate anger, impulsiveness and
frequent mood swings may push others away, even though you want to have loving and lasting
relationships.
Borderline personality disorder usually begins by early adulthood. The condition seems to be
worse in young adulthood and may gradually get better with age.
If you have borderline personality disorder, don't get discouraged. Many people with this
disorder get better over time with treatment and can learn to live satisfying lives.
Symptoms
Borderline personality disorder affects how you feel about yourself, how you relate to others and
how you behave.
Signs and symptoms may include:
 An intense fear of abandonment, even going to extreme measures to avoid real or imagined
separation or rejection
 A pattern of unstable intense relationships, such as idealizing someone one moment and then
suddenly believing the person doesn't care enough or is cruel
 Rapid changes in self-identity and self-image that include shifting goals and values, and seeing
yourself as bad or as if you don't exist at all
 Periods of stress-related paranoia and loss of contact with reality, lasting from a few minutes to a few
hours
 Impulsive and risky behavior, such as gambling, reckless driving, unsafe sex, spending sprees, binge
eating or drug abuse, or sabotaging success by suddenly quitting a good job or ending a positive
relationship
 Suicidal threats or behavior or self-injury, often in response to fear of separation or rejection
 Wide mood swings lasting from a few hours to a few days, which can include intense happiness,
irritability, shame or anxiety
 Ongoing feelings of emptiness
 Inappropriate, intense anger, such as frequently losing your temper, being sarcastic or bitter, or
having physical fights
When to see a doctor
If you're aware that you have any of the signs or symptoms above, talk to your doctor or a
mental health provider.
If you have suicidal thoughts
If you have fantasies or mental images about hurting yourself or have other suicidal thoughts,
get help right away by taking one of these actions:
 Call 911 or your local emergency number immediately.
 Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline,
available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and
confidential.
 Call your mental health provider, doctor or other health care provider.
 Reach out to a loved one, close friend, trusted peer or co-worker.
 Contact someone from your faith community.
If you notice signs or symptoms in a family member or friend, talk to that person about seeing a
doctor or mental health provider. But you can't force someone to seek help. If the relationship
causes you significant stress, you may find it helpful to see a therapist yourself.
Diagnosis
Personality disorders, including borderline personality disorder, are diagnosed based on a:
 Detailed interview with your doctor or mental health provider
 Psychological evaluation that may include completing questionnaires
 Medical history and exam
 Discussion of your signs and symptoms
A diagnosis of borderline personality disorder is usually made in adults, not in children or
teenagers. That's because what appear to be signs and symptoms of borderline personality
disorder may go away as children get older and become more mature.
Treatment
Borderline personality disorder is mainly treated using psychotherapy, but medication may be
added. Your doctor also may recommend hospitalization if your safety is at risk.
Treatment can help you learn skills to manage and cope with your condition. It's also necessary
to get treated for any other mental health disorders that often occur along with borderline
personality disorder, such as depression or substance misuse. With treatment, you can feel
better about yourself and live a more stable, rewarding life.
Psychotherapy
Psychotherapy — also called talk therapy — is a fundamental treatment approach for borderline
personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The
goals of psychotherapy are to help you:
 Focus on your current ability to function
 Learn to manage emotions that feel uncomfortable
 Reduce your impulsiveness by helping you observe feelings rather than acting on them
 Work on improving relationships by being aware of your feelings and those of others
 Learn about borderline personality disorder
Types of psychotherapy that have been found to be effective include:
 Dialectical behavior therapy (DBT). DBT includes group and individual therapy designed
specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you
how to manage your emotions, tolerate distress and improve relationships.
 Schema-focused therapy. Schema-focused therapy can be done individually or in a group. It can
help you identify unmet needs that have led to negative life patterns, which at some time may have
 been helpful for survival, but as an adult are hurtful in many areas of your life. Therapy focuses on
helping you get your needs met in a healthy manner to promote positive life patterns.
 Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify your own
thoughts and feelings at any given moment and create an alternate perspective on the situation.
MBT emphasizes thinking before reacting.
 Systems training for emotional predictability and problem-solving (STEPPS). STEPPS is a 20-
week treatment that involves working in groups that incorporate your family members, caregivers,
friends or significant others into treatment. STEPPS is used in addition to other types of
psychotherapy.
 Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP
aims to help you understand your emotions and interpersonal difficulties through the developing
relationship between you and your therapist. You then apply these insights to ongoing situations.
 Good psychiatric management. This treatment approach relies on case management, anchoring
treatment in an expectation of work or school participation. It focuses on making sense of emotionally
difficult moments by considering the interpersonal context for feelings. It may integrate medications,
groups, family education and individual therapy.
Medications
Although no drugs have been approved by the Food and Drug Administration specifically for the
treatment of borderline personality disorder, certain medications may help with symptoms or co-
occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may
include antidepressants, antipsychotics or mood-stabilizing drugs.
Talk to your doctor about the benefits and side effects of medications.
Hospitalization
At times, you may need more-intense treatment in a psychiatric hospital or clinic. Hospitalization
may also keep you safe from self-injury or address suicidal thoughts or behaviors.
Recovery takes time
Learning to manage your emotions, thoughts and behaviors takes time. Most people improve
considerably, but you may always struggle with some symptoms of borderline personality
disorder. You may experience times when your symptoms are better or worse. But treatment
can improve your ability to function and help you feel better about yourself.
You have the best chance for success when you consult a mental health provider who has
experience treating borderline personality disorder.

Psychotherapy
Psychotherapy is a general term for treating mental health problems by talking with a
psychiatrist, psychologist or other mental health provider.
During psychotherapy, you learn about your condition and your moods, feelings, thoughts and
behaviors. Psychotherapy helps you learn how to take control of your life and respond to
challenging situations with healthy coping skills.
There are many types of psychotherapy, each with its own approach. The type of
psychotherapy that's right for you depends on your individual situation. Psychotherapy is also
known as talk therapy, counseling, psychosocial therapy or, simply, therapy.
Why it's done
Psychotherapy can be helpful in treating most mental health problems, including:
 Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder or post-
traumatic stress disorder (PTSD)
 Mood disorders, such as depression or bipolar disorder
 Addictions, such as alcoholism, drug dependence or compulsive gambling
 Eating disorders, such as anorexia or bulimia
 Personality disorders, such as borderline personality disorder or dependent personality disorder
 Schizophrenia or other disorders that cause detachment from reality (psychotic disorders)
Not everyone who benefits from psychotherapy is diagnosed with a mental illness.
Psychotherapy can help with a number of life's stresses and conflicts that can affect anyone.
For example, it may help you:
 Resolve conflicts with your partner or someone else in your life
 Relieve anxiety or stress due to work or other situations
 Cope with major life changes, such as divorce, the death of a loved one or the loss of a job
 Learn to manage unhealthy reactions, such as road rage or passive-aggressive behavior
 Come to terms with an ongoing or serious physical health problem, such as diabetes, cancer or
long-term (chronic) pain
 Recover from physical or sexual abuse or witnessing violence
 Cope with sexual problems, whether they're due to a physical or psychological cause
 Sleep better, if you have trouble getting to sleep or staying asleep (insomnia)
In some cases, psychotherapy can be as effective as medications, such as antidepressants.
However, depending on your specific situation, psychotherapy alone may not be enough to
ease the symptoms of a mental health condition. You may also need medications or other
treatments.
Risks
Generally, there's little risk in having psychotherapy. But because it can explore painful feelings
and experiences, you may feel emotionally uncomfortable at times. However, any risks are
minimized by working with a skilled therapist who can match the type and intensity of therapy
with your needs.
The coping skills that you learn can help you manage and conquer negative feelings and fears.
How you prepare
Here's how to get started:
 Find a therapist. Get a referral from a doctor, health insurance plan, friend or other trusted source.
Many employers offer counseling services or referrals through employee assistance programs
(EAPs). Or you can find a therapist on your own, for instance, by looking for a professional
association on the Internet.
 Understand the costs. If you have health insurance, find out what coverage it offers for
psychotherapy. Some health plans cover only a certain number of psychotherapy sessions a year.
Also, talk to your therapist about fees and payment options.
 Review your concerns. Before your first appointment, think about what issues you'd like to work on.
While you also can sort this out with your therapist, having some sense in advance may provide a
good starting point.
Before seeing a psychotherapist, check his or her background, education, certification, and
licensing. Psychotherapist is a general term rather than a job title or indication of education,
training or licensure.
Trained psychotherapists can have a number of different job titles, depending on their education
and role. Most have a master's or doctoral degree with specific training in psychological
counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe
medications as well as provide psychotherapy.
Examples of psychotherapists include psychiatrists, psychologists, licensed professional
counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses,
or other licensed professionals with mental health training.
Make sure that the therapist you choose meets state certification and licensing requirements for
his or her particular discipline. The key is to find a skilled therapist who can match the type and
intensity of therapy with your needs.
What you can expect
Your first therapy session
At the first psychotherapy session, the therapist typically gathers information about you and
your needs. You may be asked to fill out forms about your current and past physical and
emotional health. It might take a few sessions for your therapist to fully understand your
situation and concerns and to determine the best approach or course of action.
The first session is also an opportunity for you to interview your therapist to see if his or her
approach and personality are going to work for you. Make sure you understand:
 What type of therapy will be used
 The goals of your treatment
 The length of each session
 How many therapy sessions you may need
Don't hesitate to ask questions anytime during your appointment. If you don't feel comfortable
with the first psychotherapist you see, try someone else. Having a good fit with your therapist is
critical for psychotherapy to be effective.
Starting psychotherapy
You'll likely meet in your therapist's office or a clinic once a week or every other week for a
session that lasts about 45 to 60 minutes. Psychotherapy, usually in a group session with a
focus on safety and stabilization, also can take place in a hospital if you've been admitted for
treatment.
Types of psychotherapy
There are a number of effective types of psychotherapy. Some work better than others in
treating certain disorders and conditions. In many cases, therapists use a combination of
techniques. Your therapist will consider your particular situation and preferences to determine
which approach may be best for you.
Although many types of therapies exist, some psychotherapy techniques proven to be effective
include:
 Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and
behaviors and replace them with healthy, positive ones
 Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you handle stress,
manage your emotions and improve your relationships with others
 Acceptance and commitment therapy, which helps you become aware of and accept your
thoughts and feelings and commit to making changes, increasing your ability to cope with and adjust
to situations
 Psychodynamic and psychoanalysis therapies, which focus on increasing your awareness of
unconscious thoughts and behaviors, developing new insights into your motivations, and resolving
conflicts
 Interpersonal psychotherapy, which focuses on addressing problems with your current
relationships with other people to improve your interpersonal skills — how you relate to others, such
as family, friends and colleagues
 Supportive psychotherapy, which reinforces your ability to cope with stress and difficult situations
Psychotherapy is offered in different formats, including individual, couple, family or group
therapy sessions, and it can be effective for all age groups.
During psychotherapy
For most types of psychotherapy, your therapist encourages you to talk about your thoughts
and feelings and what's troubling you. Don't worry if you find it hard to open up about your
feelings. Your therapist can help you gain more confidence and comfort as time goes on.
Because psychotherapy sometimes involves intense emotional discussions, you may find
yourself crying, upset or even having an angry outburst during a session. Some people may feel
physically exhausted after a session. Your therapist is there to help you cope with such feelings
and emotions.
Your therapist may ask you to do "homework" — activities or practices that build on what you
learn during your regular therapy sessions. Over time, discussing your concerns can help
improve your mood, change the way you think and feel about yourself, and improve your ability
to cope with problems.
Confidentiality
Except in rare and specific circumstances, conversations with your therapist are confidential.
However, a therapist may break confidentiality if there is an immediate threat to safety (yours or
someone else's) or when required by state or federal law to report concerns to authorities. Your
therapist can answer questions about confidentiality.
Length of psychotherapy
The number of psychotherapy sessions you need — as well as how frequently you need to see
your therapist — depends on such factors as:
 Your particular mental illness or situation
 Severity of your symptoms
 How long you've had symptoms or have been dealing with your situation
 How quickly you make progress
 How much stress you're experiencing
  How much your mental health concerns interfere with day-to-day life
 How much support you receive from family members and others
 Cost and insurance limitations
It may take only weeks to help you cope with a short-term situation. Or, treatment may last a
year or longer if you have a long-term mental illness or other long-term concerns.
Results
Psychotherapy may not cure your condition or make an unpleasant situation go away. But it can
give you the power to cope in a healthy way and to feel better about yourself and your life.
Getting the most out of psychotherapy
Take steps to get the most out of your therapy and help make it a success.
 Make sure you feel comfortable with your therapist. If you don't, look for another therapist with
whom you feel more at ease.
 Approach therapy as a partnership. Therapy is most effective when you're an active participant
and share in decision-making. Make sure you and your therapist agree about the major issues and
how to tackle them. Together, you can set goals and measure progress over time.
 Be open and honest. Success depends on willingness to share your thoughts, feelings and
experiences, and to consider new insights, ideas and ways of doing things. If you're reluctant to talk
about certain issues because of painful emotions, embarrassment or fears about your therapist's
reaction, let your therapist know.
 Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip
psychotherapy sessions. Doing so can disrupt your progress. Try to attend all sessions and to give
some thought to what you want to discuss.
 Don't expect instant results. Working on emotional issues can be painful and may require hard
work. You may need several sessions before you begin to see improvement.
 Do your homework between sessions. If your therapist asks you to document your thoughts in a
journal or do other activities outside of your therapy sessions, follow through. These homework
assignments can help you apply what you've learned in the therapy sessions to your life.
 If psychotherapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from
therapy after several sessions, talk to your therapist about it. You and your therapist may decide to
make some changes or try a different approach that may be more effective.

Borderline Personality Disorder

 Overview

 Treatment
 Support
 Discuss
Borderline Personality Disorder (BPD) is a condition characterized by difficulties regulating
emotion. This means that people who experience BPD feel emotions intensely and for extended
periods of time, and it is harder for them to return to a stable baseline after an emotionally
triggering event.

This difficulty can lead to impulsivity, poor self-image, stormy relationships and intense
emotional responses to stressors. Struggling with self-regulation can also result in dangerous
behaviors such as self-harm (e.g. cutting).

It’s estimated that 1.4% of the adult U.S. population experiences BPD. Nearly 75% of people
diagnosed with BPD are women. Recent research suggests that men may be equally affected
by BPD, but are commonly misdiagnosed with PTSD or depression.
Symptoms
People with BPD experience wide mood swings and can feel a great sense of instability and
insecurity. According to the Diagnostic and Statistical Manual diagnostic framework, some key
signs and symptoms may include:

 Frantic efforts to avoid real or imagined abandonment by friends and family.

 Unstable personal relationships that alternate between idealization (“I’m so in love!”) and
devaluation (“I hate her”). This is also sometimes known as "splitting."
 Distorted and unstable self-image, which affects moods, values, opinions, goals and
relationships.
 Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe
sex, reckless driving, or misuse or overuse of substances.
 Self-harming behavior including suicidal threats or attempts.
 Periods of intense depressed mood, irritability or anxiety lasting a few hours to a few days.
 Chronic feelings of boredom or emptiness.
 Inappropriate, intense or uncontrollable anger—often followed by shame and guilt.
 Dissociative feelings—disconnecting from your thoughts or sense of identity or “out of body” type
of feelings—and stress-related paranoid thoughts. Severe cases of stress can also lead to brief
psychotic episodes.

Causes
The causes of BPD are not fully understood, but scientists agree that it is the result of a
combination of factors, including:

 Genetics. While no specific gene or gene profile has been shown to directly cause BPD,
research suggests that people who have a close family member with BPD may be at a higher risk
of developing the disorder.
 Environmental factors. People who experience traumatic life events—such as physical or
sexual abuse during childhood or neglect and separation from parents—are at increased risk of
developing BPD.
 Brain function. The emotional regulation system may be different in people with BPD,
suggesting that there is a neurological basis for some of the symptoms. Specifically, the portions
of the brain that control emotions and decision-making/judgment may not communicate optimally
with one another.

Diagnosis
There is no definitive medical test to diagnose BPD, and a diagnosis is not based on one
specific sign or symptom. BPD is best diagnosed by a mental health professional following a
comprehensive clinical interview that may include talking with previous clinicians, reviewing
previous medical evaluations and, when appropriate, interviews with friends and family.

Treatment
An effective treatment plan should include your preferences while also addressing any other co-
existing conditions you may have. Examples of treatment options include psychotherapy;
medications; and group, peer and family support. The overarching goal of treatment is for a
person with BPD to increasingly self-direct their own treatment plan as they learn what works
and what doesn’t.

 Psychotherapy—such as dialectical behavioral therapy (DBT), cognitive behavioral therapy

(CBT) and psychodynamic psychotherapy—is the first line of choice for BPD. Learning ways to
cope with emotional dysregulation in a therapeutic setting is often the key to long-term
improvement for those experiencing BPD.
 Medications may be instrumental to a treatment plan, but there is no one medication specifically
made to treat the core symptoms of BPD. Rather, several medications can be used off-label to
treat various symptoms. For example, mood stabilizers and antidepressants help with mood
swings and dysphoria. And for some, low-dose antipsychotic medication may help control
symptoms such as disorganized thinking.
  Short-term hospitalization may be necessary during times of extreme stress, and/or impulsive
or suicidal behavior to ensure safety.

Related Conditions
BPD can be difficult to diagnose and treat, and successful treatment includes addressing any
other conditions a person might have. Many with BPD also experience additional conditions like:

 Anxiety Disorders
 Posttraumatic Stress Disorder
 Bipolar Disorder
 Depression
 Eating Disorders (notably bulimia nervosa)
 Substance Use Disorders / Dual Diagnosis

There are good long-term outcomes for people experiencing BPD who engage in a
comprehensive treatment plan. Most experience the best results using a combination of
psychotherapy, peer and family support and medications (when indicated) to address their
symptoms. People with BPD often have other co-occurring conditions and their treatment plan
should address these as well.

Work with your treatment team to understand the risks and benefits of each of these individual
courses of action as well as how they work with each other.

Psychotherapy
Psychotherapy is considered the cornerstone for treating BPD because it aims to address the
emotional dysregulation associated with the condition. A hallmark of effective treatment is
learning to master dysregulation with coping skills, insight and acceptance. There are several
types of psychotherapy that have shown to be effective in doing this:
 Dialectical behavioral therapy (DBT) focuses on teaching coping skills to combat
counterproductive urges, regulate emotions and improve relationships. Involving individual and
group work, DBT encourages practicing mindfulness techniques such as meditation, regulated
breathing and self-soothing. DBT has been shown to be effective in reducing suicidal behavior,
psychiatric hospitalization, treatment dropout, substance use, anger and interpersonal
difficulties. Learn more about DBT.
 Cognitive behavioral therapy (CBT) helps address the negative thinking and behaviors
associated with BPD. The goal of this therapy is to recognize negative thoughts and learn
effective coping strategies.
 Mentalization-based therapy (MBT) teaches people how to become conscious of their internal
states and how to develop empathy for other people’s experiences. This treatment is also used to
explore emotions and develop alternative explanations for negative interactions with others.

Medications
There is no singular medication designed to specifically treat the core symptoms of BPD.
Medications can be useful in treating certain symptoms associated with BPD, such as
depression and anxiety. They can also be used to help increase a person’s ability to engage in
psychotherapy.
Level Of Care
While most people can live in the community during their treatment (outpatient), higher levels of
care may be useful at moments when more intensive clinical support is needed. For example, a
hospital inpatient unit can provide a safe environment for a person with BPD who is actively
suicidal.

In the DBT framework, the goal is usually to learn coping skills while in the community; it is not
organized around inpatient care. Though, there are some facilities that have a DBT track in
inpatient-partial hospital program, which is a model where you sleep at home and attend during
the day. It’s important to determine the level of care you or your loved one might require before
engaging in (and throughout the duration of) treatment.

Coping with BPD can be very challenging. But if you, a family member or friend is struggling,
there is help. NAMI is here to provide you with support and information about community
resources for you and your family.

Contact the NAMI HelpLine at 800-950-NAMI (6264) or info@[Link] with any questions you
may have about BPD.
Helping Yourself
Although you may recognize that your behaviors are destructive, it may still be difficult to control
them. Effective treatment can help you. Here are some other ways to help manage your
condition:
 Connect with others. Find emotional support from others experiencing BPD. It’s helpful to share
your thoughts, fears and questions with others who have the same condition. Use online
message boards or groups found through social sites like [Link] or Facebook. We also like
the peer-hosted chat room at Healing From BPD.
 Take care of your body. Eat well and exercise. To relieve stress, try activities like meditation,
yoga or Tai Chi.
 Avoid drugs and alcohol. These substances can disturb emotional balance and interact with
medications.
Learn more about managing your mental health and finding support while living with mental
illness.
Helping A Family Member Or Friend
The support of family and friends is critical in the treatment of BPD, as many people with this
condition may isolate themselves from relationships—even when they need them most.

 Look for warning signs. BPD often presents in erratic behavior, like shopping sprees, sexual or
substance binges and fighting/arguing. If your loved one is open to it, discuss their behaviors with
them, so they can recognize the signs early.
 Encourage treatment. Family and friends can be helpful in encouraging someone to begin and
engage in proper treatment for this complicated and frustrating illness.
 Understand treatment. If your loved one is in a skills-based approach like DBT, learn the
language of this treatment and use it to help provide support.
 Speak honestly and kindly. Don’t ridicule your friend of family member for failing to be in control
or making bad choices. Instead, make specific offers of help and follow through. Tell the person
you care about him/her. Ask how they’re feeling.
 React calmly. Even if your family member or friend is in crisis, it’s important to remain calm.
Listen and make them feel understood, then take the next step toward getting help.
Find out more about taking care of your family member or friend (without forgetting about
yourself!).

Attention Deficit Hyperactivity Disorder

(ADHD)
  Overview

 Treatment
 Support
 Discuss
Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by
inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people.
An estimated 8.8% of children aged 4-17 have ADHD. While ADHD is usually diagnosed in
childhood, it does not only affect children. An estimated 4.4% of adults aged 18-44 have ADHD.
With treatment, people with ADHD can be successful in school, work and lead productive lives.
Researchers are using new tools such as brain imaging to better understand the condition and
to find more effective ways to treat and prevent ADHD.

Symptoms
While some behaviors associated with ADHD are "normal" and not a cause for concern to most
people, someone with ADHD will have trouble controlling these behaviors and will show them
much more frequently and for longer than 6 months.

Signs of inattention include:

 Becoming easily distracted, and jumping from activity to activity.

 Becoming bored with a task quickly.
 Difficulty focusing attention or completing a single task or activity.
 Trouble completing or turning in homework assignments.
 Losing things such as school supplies or toys.
 Not listening or paying attention when spoken to.
 Daydreaming or wandering with lack of motivation.
 Difficulty processing information quickly.
 Struggling to follow directions.
Signs of hyperactivity include:

 Fidgeting and squirming, having trouble sitting still.

 Non-stop talking.
 Touching or playing with everything.
 Difficulty doing quiet tasks or activities.
Signs of impulsivity include:

 Impatience.
 Acting without regard for consequences, blurting things out.
 Difficulty taking turns, waiting or sharing.
 Interrupting others.

Causes
There are several factors believed to contribute to ADHD:

 Genetics. Research shows that genes may be a large contributor to ADHD. ADHD often runs in
families and some trends in specific brain areas that contribute to attention.
 Environmental factors. Studies show a link between cigarette smoking and alcohol use during
pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to
increase the likelihood of ADHD in children.

Diagnosis
ADHD occurs in both children and adults, but is most often and diagnosed in childhood. Getting
a diagnosis for ADHD can sometimes be difficult because the symptoms of ADHD are similar to
typical behavior in most young children. Teachers are often the first to notice ADHD symptoms
because they see children in a learning environment with peers every day.

There is no one single test that can diagnose a child with ADHD, so meet with a doctor or
mental health professional to gather all the necessary information to make a diagnosis. The
goal is to rule out any outside causes for symptoms, such as environmental changes, difficulty
in school, medical problems and ensure that a child is otherwise healthy.

Treatment
ADHD is managed and treated in several ways:
 Medications, including stimulants, nonstimulants and antidepressants
 Behavioral therapy
 Self-management, education programs and assistance through schools or work or alternative
treatment approaches

Related Conditions
Around two-thirds of children with ADHD also have another condition. Many adults are also
impacted by the symptoms of another condition. Common conditions associated with ADHD
include the following.
 Learning disabilities
 Oppositional defiant disorder: refusal to accept directions or authority from adults or others
 Conduct disorder, persistent destructive or violent behaviors
 Anxiety and depression
 Obsessive-compulsive disorder
 Bipolar disorder
 Tourette's syndrome
 Sleep disorders
 Bed-wetting
 Substance use disorders/ Dual Diagnosis
Symptoms from other conditions make treating ADHD more difficult. Talking to a skilled
professional to help establish an accurate diagnosis can help increase the effectiveness of
treatment.

Treatment
A treatment plan is most effective when tailored to an individual's needs, and implemented early
on. ADHD treatment plans should consider learning style and include medication prescribed by
a professional. A doctor or mental health professional may also include behavioral therapy into
treatment.

Medication
Medication improves the symptoms of ADHD so that people can focus more on the things they
enjoy and improve quality of life. Finding the right medication is a process and not every
medication will work for everyone.
Effective medications can improve attention span, your ability to deal with frustration. and lead
to better relationships.

Stimulants
The most prescribed medications for ADHD are stimulants. These medications work by making
it easier for nerve receptors in the brain to communicate with each other. The impact of
stimulants can often noticed quickly, but they may reduce appetite and impact sleep. They can
also shorten a growing child’s height a small amount if taken for many years, so be sure to track
growth over time.
Stimulants affect how the brain controls impulses and help to regulate behavior and attention.
They are usually the first choice of medication to use for the management of ADHD.

 Methylphenidate (Methylin, Ritalin, Concerta)

 Methylphenidate SR (Ritalin SR)
 Transdermal (Daytrana)
 Dexmethylphenidate (Focalin XR, SR Focalin)
 Dextroamphetamine (Dexedrine, Dextrostat, Spansule)
 Amphetamine (Adderall, Adderall XR)
 Lisdexamfetemine or Dimesylate (Vyvanse)
Medication Misuse
Because of the fast-acting nature and effects, stimulants have the potential for misuse. People
have used these medications to improve academic or athletic performance or for the physical
reaction. Possession of these medications without a prescription is illegal.

Nonstimulants
Non-stimulant medications are also commonly prescribed. It may take some time for
these medications to become effective. Nonstimulants affect the nerve receptors more indirectly
than stimulants. It is necessary to keep track of treatment results over time.

Nonstimulant drugs are used to increase and adjust the levels of neurotransmitters in the brain.
This helps with concentration by increasing attention span and reducing impulsivity.

 Atomoxetine (Strattera)
 Guanfacine (Intuniv)
 Clonidine Hydrochloride (Kapvay)
Antidepressants
Antidepressants may also be something a doctor suggests. This is especially true if someone is
living with ADHD and depression. For medications that are not first- or second-line treatments
for ADHD, ask your doctor why they recommend this treatment. You should also ask about their
knowledge and experience with treating ADHD with these kinds of medications. Always be sure
to check the FDA approval status of any medicine.

 Nortriptyline (Pamelor, Aventyl)

 Desipramine (Norpramin)
 Imipramine (Tofranil)
 Bupropion (Wellbutrin, Wellbutrin XL, Welbutrin SR)
 Venlafazine (Effexor, Effexor XR)
Remember that dosage and scheduling of medication will impact treatment outcomes. Young
children need to be monitored to ensure they are taking the correct dosage of the medication.
Dosage may change as they get older. Some parents choose to only give their children
medication when they are in school.

Note that any medication may cause side effects. Common side effects of ADHD medications
include appetite, sleep problems, anxiety and irritability. You can manage side effects with a
change in dosage and often lessen and even disappear over time.

Behavioral Treatment
A mental health professional can help a person come up with ways to improve behavior. For
example, a doctor may provide guidance on how to organize and complete homework
assignments. Mental health professionals may also help you learn how to work through
frustrating events. Providing feedback as well as support is key in improving behavior. Having
structure, routine and clear expectations of what is allowed and not allowed can help a child
learn and feel more in control of their own life. Talk about what behavior and outbursts are
acceptable.

Behavior therapy can also help improve social skills, such as sharing and interacting with peers.
Learning appropriate responses to everyday situations can help your child have healthier
relationships. Better relationships with teachers, friends and family can improve the quality of
life for your child.

Complementary Health Approaches

Outside of therapy and medications, there are many approaches to managing ADHD. These
alternative methods, called complementary and alternative medicine (CAM), can supplement a
treatment plan and support day-to-day health.

 Elimination diets are based on the theory that people are sensitive to sugar and artificially added
colors, flavors and preservatives. Eliminating these substances from the diet could improve
learning and behavioral problems.
 Nutritional supplements, such as omega-3s, may help the deficiency of fatty acids that are
sometimes associated with ADHD.
 Interactive metronome training consists of a computerized metronome making a rhythmic beat
that individuals try to match by tapping a hand or foot. It is suggested that improvement in
matching the beat reflects gains in motor planning and timing skills.
 Chiropractic medicine addresses muscle tone imbalance that can affect imbalances in brain
activity.
 Neurofeedback (EEG biofeedback) teaches individuals how to increase activity in the frontal
areas of the brain. This is because people living with ADHD show low levels of arousal in these
areas, which results in an impaired ability to focus. Through training, people can learn how to
increase arousal on their own.

SUPPORT
ADHD is one of the conditions most strongly linked to genetics. People with ADHD do not lack
intelligence or discipline. They are just challenged at focusing to complete tasks. Contact the
NAMI HelpLine at 1-800-950-NAMI (6264) or info@[Link] if you have any questions about
anxiety disorders or need to find support and resources.
Helping Yourself
Many of the strategies that help youth with ADHD, including structure, organizational tips and
coaching as well as medication can be helpful for adults living with ADHD as well. An
individualized approach to treatment that focuses on strengths and circumstances is critical for
adult and children.

One of the major areas of focus for adults living with ADHD is learning to manage the disorder
in the workplace. Symptoms can cause difficulties in some or all the following areas:

 Organizing paperwork, prioritizing tasks and estimating the amount of time it takes to get started
on and complete projects on time
 Focusing, sustaining and shifting attention from one project to another
 Staying alert, sustaining effort and processing information in a reasonable amount of time
 Remembering facts while actively processing other information
 Regulating impulsivity and picking up on the nonverbal cues from others
There are a lot of things you can do to keep yourself organized and work with a low level of
stress. Know your rights and work with your employer to make your environment suitable for
your needs. Some common accommodations include:

 Scheduling regular meetings with supervisor to prioritize tasks

 Developing a checklist of assignments, and a workflow chart that provides an idea of time
required for each project
  Using an electronic filing system
 Extending deadlines on projects and tasks
 Providing a distraction-free workspace
 Breaking up big assignments into smaller tasks
 Providing structured breaks
 Integrating interesting projects with more mundane tasks
 Allowing the employee to audio record instructions and meetings, and/or providing written
instructions on projects and training
 Allowing the employee to work from home
 Engaging the help of a job coach
 Allowing the employee to skip social events
 Assigning a mentor to assist the employee
You will want to talk with your supervisor and ensure that these accommodations will not cause
an burden on your place of employment. You can find more information about accommodations
by visiting the Job Accommodation Network website.
ADHD Coaching
Coaching has emerged as a new industry over the last half century to enhance the personal
and professional development. ADHD Coaching has developed over the last few decades as a
component to the treatment of ADHD. It is a support that is well-suited to the needs of people
living with ADHD, including adults and youth. In general, ADHD coaching:

 Enhances understanding of ADHD’s impacts on a client’s life

 Provides a framework that includes self-acceptance
 Provides a laboratory for effective, experiential learning
 Works with a client to identify areas of strength
 Identifies avenues for managing challenge areas
 Develops personalized strategies for success
ADHD coaches often work with you on scheduling, goal setting, confidence building, organizing,
focusing, prioritizing and persisting at tasks. ADHD coaching is an effective way to create
lasting change. A coaching relationship provides the structure to focus on what’s important, find
the clarity peopel need to make decisions, determine the actions they want to take—and then
hold them accountable.

Coaches can also help parents of children living with ADHD. For parents, coaching offers a way
to:

 Help kids determine their strengths and motivations

 Expose kids to the benefits of celebrating successes
 Teach kids to shift perspectives and get “unstuck”
 Pass on life lessons, both positive and negative
 Support kids in figuring out what they want in their lives
 Provide constructive feedback and accountability
 Share their values, beliefs and perspectives
To learn more and find ADHD coaches, visit the EdgeFoundation (for ADHD students), Impact
ADHD (for parents), the Institute for the Advancement of ADHD Coaching (IAAC) and
the International Coach Federation.
If you live with a mental health condition, learn more about managing your mental health and
finding the support you need.
Helping A Family Member Or Friend
ADHD is one of the most common conditions in children, so first you should know that you and
your child are not alone.

ADHD is not a byproduct of parenting style. Also, children living with ADHD do not lack
intelligence or discipline—they are just challenged by sustaining the focus needed to complete
tasks appropriate for their age.
To provide support for your child at home there are many things you can do:

Maintain a positive attitude. Focus on successes and victories and less on the challenges or
obstacles of the condition. Always have his strengths, goals and interests help drive the
services and supports he receives to manage the symptoms of ADHD. For example, if your
child is always moving, consider engaging him in physical activities like yoga, dance class,
running, martial arts or similar activities in which the symptoms of ADHD may actually help him
excel. It is helpful to create experiences that build on strengths and bolster self-esteem. Your
positive attitude is the best tool in helping your child overcome the challenges of ADHD.

Create and maintain structure. Children living with ADHD are more likely to succeed when they
have a regular schedule of tasks each day. They can experience serious problems if their daily
structure changes, or they are forced to make a big change. Create and sustain a supportive
structure so that your child knows what to expect every day.

Communicate rules and expectations. Children living with ADHD do well with clear and simple
rules and expectations that they can easily understand and follow. Write down any rules and
expectations and post them in a place where your child can easily read them. You may also
want to create a chores chart for her to look at every day. She may also respond well to an
organized system of rewards and consequences—consistency is key. Explain the
consequences when rules are broken and to praise her when they are obeyed. Rewards should
be immediate experiences and activities with a parent to encourage bonding and connection
rather than tangible rewards or treats. Consequences should not punish the child but the
behavior (e.g., time out from any reinforcing activities).

Encourage movement and sleep. Children who live with ADHD have energy to burn. Organized
sports and other physical activities can help them increase their self-esteem and unleash their
energy in healthy and productive ways with other children in their age group. Children living with
ADHD who exercise often tend to sleep better, which can greatly reduce ADHD symptoms.
Have a nighttime routine that encourages a healthy sleep cycle—this may include reading,
avoiding electronics and encouraging self-soothing activities before bed. Martial arts can be a
helpful strategy as they emphasize self-control and increase confidence.

Focus on social skills. Children living with ADHD often have difficulty with peer relationships and
making friends. They may have trouble with reading social cues, talking too much, interrupting
frequently or coming off as inappropriately aggressive. Their emotional immaturity may cause
them to stand out among other kids in their age group, contributing to low self-esteem. Model
social skills, hire a life coach or work with your child’s therapist to address this issue. Being
connected to family and friends is an important part of living well with ADHD.

Students living with ADHD may experience unique challenges in the classroom. The common
symptoms of ADHD—inattention, hyperactivity and impulsivity—can cause disruptions to a
child’s learning, peer relationships, functional performance and behavior within the school
setting. ADHD may manifest itself differently in the classroom than what you see at home. Girls
living with ADHD are at times overlooked as their presentation often involves less behavioral
disruption than boys.

Your child’s school will likely offer programs and special educational services if you feel that he
may need them. The school can conduct an evaluation to see if he qualifies. You should speak
with your child’s teacher and other counselors about these opportunities.

The following is a list of typical accommodations that a student living with ADHD may receive
from their school:

 Modified homework assignments, testing and deadlines

 Use of helpful tools (calculator, tape recorder, computer and electric spell-checker)
  A behavioral plan or social skills training
 Continual progress reports assessing behavior and assignments
 Peer, volunteer tutors or working one-on-one with the teacher
 Sitting the student near the teacher and away from doors and windows
 Increased parent and teacher collaboration
 Providing the student with a note-taking partner
 Letting the student run occasional errands for the teacher to burn off some energy
The following is a list of more intensive services and supports that may be provided for students
living with ADHD:

 Supplementary aids and services

 School-based counseling
 Family counseling and training
 Resource room services (small group work)
 Test modifications, such as small group testing in a separate location
 One-on-one service providers, such as crisis management services, transportation services and
more
 Collaborative team teaching