Is ADHD really a “disorder”?

boy in detentionMore than one in ten children are now diagnosed with ADHD at some time between the ages of 4 and 17.  Is it possible that we are diagnosing a normal variation – a condition that isn’t really a disease?

That is a possibility recently discussed by psychiatrist Richard A. Friedman on the opinion page of the New York Times (“A Natural Fix for A.D.H.D.”)  He explains that recent research shows that people with ADHD are “hard-wired for novelty-seeking.”  These individuals, he believes, may not have a disorder so much as a set of traits that don’t match well with the demands of school and work.

In people who appear to have difficulty with focus and attention, and tend to act impulsively, the problem may be not so much in their brains, but in a world that just isn’t very interesting to them.

If someone you love has ADHD, you may be aware that some activities can grab their attention and the person can focus for hours!  Even some subjects in school may be easier than others to pay attention to.  The reason is that when we feel pleasure in an activity – whether it be a video game, music, or high-risk activities like extreme sports, for example – the brain releases the chemical dopamine.  It turns out that children and adults with ADHD are actually less sensitive to dopamine (they have fewer dopamine receptors) than most people.  That  may be why so many activities, like a typical reading or math class, seem boring to them.  Apparently the stimulant drugs like Adderall and Ritalin often used to treat ADHD help by blocking the re-absorption of dopamine, and thus  increasing the levels of dopamine in the brain.

People who seem to “grow out of ” ADHD may in fact have changed their environments more than their brains.  Leaving school and finding a job that involves a lot of novelty, such as travel and meeting new people, may be the key for many people.

The author of the New York Times article thinks that ADHD has been diagnosed more frequently since young people are spending so much of their free time in the highly stimulating world of video gaming and social media.  Dr.  Charles  Gallagher, a psychologist at Psych Choices of the Delaware Valley, treats a lot of kids and adults with ADHD.  He comments that “In some ways it’s odd to say that our electronic entertainment culture is affecting our attention and concentration, when we might be just as correct to say that our attention and concentration is changing our culture, actually driving our electronic entertainment culture.”

On the other hand, Dr. Gallagher does believe that ADHD can be seen as a disorder, one which should be taken seriously.  He sees it destroying some people’s lives, people who find themselves “going off track or never getting on track in the first place.  I think the impact on relationships is often overlooked because other aspects of people’s lives are so disrupted.  Somehow the heartache of trying to live with someone with ADHD is often low on the list of clients’ priorities to address in treatment.  Untreated,  students with ADHD are often frustrated, difficult to deal with, and fail in school.”

Individual and/or family therapy can help people to manage their ADHD and improve their relationships with others.  It can be helpful, as the author of the New York Times article states, to find work or school situations that are a good fit for the curious, adventure-seeking mind.  But therapy, and often medication, can also make a big difference.

Dr. Noah Freedman, medical director of Psych Choices, explains that ADHD medications can help the person stay focused, or shift focus appropriately, and stay better organized in their lives.  Dr. Freedman explains, “Rather than working on the reward center of the brain, these medications use dopamine to suppress irrelevant stimuli, so that the organizing part of the brain can function better.”

To make an appointment with Dr. Charles Gallagher or another therapist at Psych Choices, call 610-626-8085 or use our Make An Appointment page.  After consultation with the therapist, if you decide that medication might be useful, you can make an appointment to see one of our psychiatrists.


Reaching out for help: Why it’s hard, why you should do it anyway

A middle aged smart male executive interviewingHave you been considering talking to a professional to get some help for your problems?  Perhaps you’ve tried it on your own, maybe even asked for help from a friend, but your suffering is still persistent.  If so, you are among the 40% of those affected by mental health issues who are doing the smart thing and seeking help, instead of trying to continue to manage difficulties on their own.  In other words, by asking for help, you are one of the stronger ones.

Asking for help is pretty hard.  There are many reasons why you may be hesitant to ask for help.

1. “Nobody goes through my pain.”

Well, according to the National Alliance for the Mentally Ill, one in four Americans experience mental health issues on the level of an official diagnosis in any given year (not a lifetime).  At a party with 11 friends?  At least 2 of your friends are not just having a hard time,  they are having such a hard time that it fits the criteria for a diagnosable mental illness.  One in four, at the least, then, are going through a painful time also.

2.  “Therapy can’t help anyone.  It is a waste of time.”

Every once in a blue moon I hear someone say this.  I simply acknowledge their opinion and move on ahead with helping.  Why?  Because 70-90% of people who seek mental health treatment report improvement or quality of life, according to NAMI.

3.  “Therapy costs too much.”

Yes, insurance reimbursement for therapy has reduced over the years, and copays have increased.  However, the length of therapy has decreased since its earliest days (when therapy was thought to require years and years of almost daily therapy).  For anxiety and depression issues, it is not unlikely to expect a stay in therapy on a weekly basis of about 6 months at the most.   When I am working with clients, I usually review the progress they are making before the 6 month point.  If clients need to go past 6 months, it is usually because they have seen the benefits of therapy and are working on different issues at that point.  I think I can safely say that most therapists operate that way.

In addition, frequency of sessions can be negotiated.  Due to the rise in copays, it is often that I schedule someone for every other week, although it is generally the standard that people are seen every week.  Beyond 2 weeks, too many things happen in between sessions, and it becomes difficult to sort through all of them in a 45 minute session.

However, once the “crisis management” period of counseling is done and the client is starting to stabilize, it is not unusual to move from once a week to once every other week.

After someone has been stable for a while, if they want, I do titrate them to 1x/month or longer, especially if they are on medication management at our practice, Psych Choices of the Delaware Valley.

Finally, many therapists, including myself and others at my practice, provide a sliding fee scale for those without insurance or whose co-pays are too high.

4.  “What will my family and friends think?”

Frankly, they will probably be relieved.  No doubt, dealing with mental health issues certainly doesn’t come without stigma.  However, if your family members or friends are suggesting that you see someone, respect their concern and try it out.  It may help you feel better, and help your family and friends feel better.  Additionally, if you come from one of those families where it is seen as a weakness, then you can get help dealing with family members who don’t understand.

Pain is inevitable, but suffering is optional.  Pain can be reduced or dealt with in counseling.  Try it and see.

Nate Prentice, LCSW, CAS-PC is a psychotherapist and pastoral counselor at Psych Choices of the Delaware Valley.  To make an appointment with Nate, call our Intake Line at 610-626-8085 ext. 213, or use the “Make an Appointment” page on our website:

Understanding Grief

beautiful 35 year old woman stands in front of the windowGrief, the suffering that comes with loss, is a painful reality that is a part of the human condition.  Grief will be felt by most of us more than once in a lifetime.  It can happen for many reasons, and may take many forms.  Most people experience grief with the death of a loved person, or a beloved pet.  Grief can accompany a painful breakup or divorce, or the loss of a career, or of a dream.

Sometimes the signs of grief are obvious and easy to understand.  We see the person cry, her face is sad, she talks endlessly of the one who is gone.  Other symptoms are harder to recognize and may be misinterpreted: she is irritable, flies into rages, or seems to withdraw.  After a loss, the person may appear to be easily overwhelmed, or have difficulty accomplishing anything, while others may literally withdraw into work.  Often, the person will deny having any difficulty; some people even deny that the loss has occurred.  It’s important to remember that everyone grieves differently – and may grieve differently from day to day.  There is no “right” or “wrong” way to mourn a loss.

Grief may last for a few days, for months, sometimes years.  It may lead to, or become part of, clinical depression.  About 15% of people who are grieving are still experiencing symptoms of depression a year after a loss.  If the loss is particularly traumatic – for example, a violent or unexpected death, especially death by suicide – the grief may be very complex and may interfere with the survivor’s functioning for a quite a long time.  If the mourner has underlying depression, grief is also more likely to cause worsening of symptoms.

It can be very helpful to talk to someone who understands.  A shared grief is usually easier to bear.  But sometimes, well-meaning friends or family  may say just the wrong thing. It’s often best just to sit quietly with the grieving person.  Ask “Do you want to talk about it?” and show that you can accept whatever they say or don’t say.  It’s often not very helpful to say “I know how you feel” and then talk about your own loss.  And many people won’t want to hear well-meaning reassurances like “He’s in a better place” or “God wanted another angel.”

Holidays and anniversaries are often especially difficult for people who are grieving.  At holiday gatherings, grieving families may find it useful to honor the person who has died, for example by saying a few words of remembrance, even leaving an empty chair.  This may be a good time to visit the cemetery, light a candle, or say a special prayer.

Here is a link to an excellent article which lists useful things to say, and some things it’s important NOT to say, to people who are grieving: Supporting a Grieving Person.

A helpful website and online community is Griefnet.Org.  For those who have suffered the tragic loss of a child, another website and organization to try is The Compassionate Friends.

Click here to see a companion blog inviting discussion of handling grief over the holidays.

Gratitude Can Improve Your Mood

Feeling GoodIt may sound trite, but science has shown that being grateful for what you have is one good way to increase your happiness. In one study conducted in 2003, a group of student volunteers who wrote daily about 5 things they were grateful for increased their happiness scores more than those who wrote daily about “hassles” or neutral “events.” The “gratitude” group felt better about their lives, were more optimistic, had fewer health complaints, and even exercised more than the other groups!

I have found that in keeping a “gratitude journal”, it’s most helpful to write more than a few words. Writing details tends to help you feel even better. For example, instead of writing “I am grateful for my children,” you might write “I am grateful for the way my little son looks so happy to see me when I pick him up at day care.” Instead of “I’m grateful for the good weather,” you could write “I’m grateful for the way the sun makes all the colors seem brighter today.” If it’s hard to think of things to be grateful for, remember the very small things: “I am grateful that I can breathe.” It could be otherwise…

Here are some more exercises which can help increase your gratitude – and your happiness:

Make a “gratitude visit.” Visit, write, or call someone who has helped you and express your appreciation for what they have done.  This strategy is especially helpful in strengthening your social support system, which is also a good way to prevent depression and increase happiness.

Write daily 3 good things that happened to you that day, and also write down why you think they happened. For example, “My cable was turned back on, because I was finally able to save enough money to pay the bill.”

Write about something funny that happens every day.

Write a list of kindnesses – kind things you did for someone else, or kindnesses you received from others.

If you think you have little to be grateful for, remember the small things.  For a bit of nostalgia (if you’re old enough!) and a lift in your spirits, check out this  video of Ethel Merman singing the Broadway tune, “The Sun in the Morning and the Moon at Night!”

Improving your Mood with Food

Food for thoughtAs we continue to learn more about the mind-body connection, many physicians and therapists have become aware that poor eating habits can worsen symptoms of depression and anxiety, while a more healthful diet can lift your spirits and help keep you energetic and productive all day long

Most of us have heard by now that refined carbohydrates are “bad” for us.  These foods, like white bread, pasta, cake, soda, and candy, may taste delicious and tempt us to eat more than we should.  But refined carbs causes our blood sugar to rise suddenly, and then drop.  We may enjoy the “sugar rush” for a short time but we are left feeling tired and cranky afterward.  Instead of filling up on refined carbohydrates, we may need to increase our protein intake.  We also need to keep eating healthy foods at regular intervals all day long, rather than starving all day and coming home to “pig out” at night.

When we are under chronic stress, we are more vulnerable to reactive hypoglycemia (low blood sugar), which is a result of an excessive release of insulin following a meal high in refined carbohydrates. The low blood sugar then leads to a drop in mood as well as irritability, nervousness, shakiness, and even confusion.  That’s why it’s especially important for both children and adults to start the day with a healthy, high-protein breakfast.  After “fasting” all night while we are sleep, breakfast is necessary, even if you think you don’t have the appetite for it.  Appetite rises and falls in part according to your habitual meal schedule.  If you shift your schedule, your appetite will gradually shift along with it.

Dr. Leslie Korn ( is a psychologist and nutrition expert who suggests that both adults and children can withdraw from sugar and refined carbohydrates by going on a protein-rich diet for 7 to 10 days.  People are advised to eat small amounts of protein (meat, fish, eggs, dairy, beans, or nuts) six times a day (every three to four hours) as well as one to two servings of a root vegetable, such as a sweet potato or carrots topped with butter or olive oil, along with salad or green vegetables.  She also informs her clients that artificial sweeteners such as aspartame has been found to be a possible cause of neurological, psychiatric, and behavioral disorders.  Some people also get headaches or panic attacks after consuming aspartame. Stevia, a plant native to South America and now readily available in powder or liquid form (often sold as “Truvia”), is a better sugar substitute.

To learn more about food and mood, there are a number of good books on the topic.  Try, for example, Food & Mood by Elizabeth Somer.  You may also talk with your doctor, therapist, or nurse practitioner.


Reducing criticism can help the whole family.

How to criticize without damaging your relationship

Reducing criticism can help the whole family.

Reducing criticism can help the whole family.

Couple therapist and marriage researcher John Gottman says there are 4 communication patterns that are so unhealthy for a marriage that when couples do them frequently, they often end up in divorce court.  These 4 patterns are Criticism, Contempt, Defensiveness, and Stonewalling.  Gottman calls them the “Four Horsemen of the Apocalypse.”

I’ve chosen to focus here on Criticism, not just because I’m a highly experienced Criticizer myself – and know from decades of personal experience how hard it is to change that pattern! – but also because it seems to be at the root of the other 3 patterns.  Contempt is an even more serious problem than Criticism, but you don’t usually get to the point of being contemptuous until you’ve criticized for a long time.  Defensiveness is a natural and automatic reaction to feeling attacked, which often happens when we are repeatedly criticized.  And Stonewalling, or shutting down completely, is the frustrating reaction that is very often triggered by a pattern of criticism and contempt.

So, cut down on criticizing your spouse, children, siblings, employees… and weaken the other three patterns as well, while improving the chance of having a more satisfying relationship.

Susan Page, in her wonderful book Why Talking Is Not Enough, suggests that you simply try to eliminate negative comments completely for 2 straight weeks.  It’s very hard to do! and yet if you try, I think you’ll find  your whole relationship can warm up and become more loving and satisfying for you.

Gottman has an approach to eliminating criticism which is more easily sustained than simply keeping your mouth shut.  He refers to “Complaints” as a more effective strategy than Criticism when you are frustrated with someone.  Instead of criticizing (“You are always late!  You never do your chores!” etc.), try “Complaining” in this fashion:

First, state your feeling about he problem behavior: “When you are late I start to worry about your safety, and also, dinner gets cold.”  Then, tell the person what you want: “Please leave work by 6 p.m. tonight so you can be home in time for dinner, and please call me if you are going to be more than 5 minutes late.”

That way the person is less likely to feel attacked and so gets less defensive; and, it is much more likely that you’ll end up getting what you want!  The best that can be hoped for the Criticism version (“You are always late!”) is that the other person will try to prove you wrong by being on time.  It’s an approach that sometimes works, but more often leads to defensive retorts (“I am not! You’re late more often than I am!”) and also to shutting down “Stonewalling”).  At worst, the person you love may begin to delay coming home even more.

Finally, go easy on yourself.  All of us are critical sometimes, especially when the person we care about repeatedly does something that frustrates or worries us.  You don’t have to pretend to be happy with someone when you are not, but you do have a right to express your needs.  Your partner (or child or employee) may continue to react defensively at first, especially if they have felt repeatedly attacked over a period of time.  But by turning a Criticism into a Complaint, you are on your way to having a partner (or child or employee) that doesn’t argue back or shut down – and therefore you’ll probably feel a lot happier yourself.

To read more, see books by John Gottman:

The Relationship Cure;   Seven Principles for Making Marriage Work

by Susan Page:  Why Talking Is Not Enough, How One of You Can Bring The Two of You Together

How Psychotherapy Can Help

   by Nate Prentice, MSW, LCSW, CAS-PC
Therapist and client (male)If you are reading this, it is probably because someone suggested that you may benefit from talking with someone about things which are bothering you and causing repercussions for you in your home, your work, or your relationships with other people.  It is probably not a comfortable thing to hear, but you want to feel better, so you are considering your options.  Or, perhaps you have tried other things including medication, but feel stuck and are interested in exploring other options to help you, because, after all, you want to feel better.
What are the benefits of psychotherapy vs medicine alone?   Consistently, in study after study, psychotherapy has been shown to be as effective as medication alone with many mental health issues. More importantly, many mental health issues such as anxiety and depression respond even better to a combination of psychotherapy and medication than psychotherapy or medication alone.
Why is this?  Many people do get a sense of relief from taking medication.  However, they may lack the skills to cope with life stressors, especially when nothing else in their life has changed.  So symptoms may persist.  Or, people may use ways of coping that create their own problems, such as substance abuse (self-medicating the symptoms), yelling at family members, workaholism, etc.  Psychotherapy, because it focuses on skill development and problem solving, helps with these issues.

How do you choose a psychotherapist?  There are several kinds of professionals trained to do psychotherapy.  These include psychologists, psychiatrists, clinical social workers, marriage & family therapists, and licensed professional counselors, among others.  The specific degree a person has may be less important than how experienced and skilled they are, and how comfortable you feel with them.  Some other issues to consider may be the therapist’s gender (male or female), age, or cultural background, or their therapeutic techniques and philosophy.

What is a typical psychotherapy session like?  Gone are the days of lying on the couch.  Today most therapy sessions are held face to face.  The first session is usually an evaluation, where you may be asked a number of related and unrelated questions to help the therapist discern what your issues are and what outside influences are impacting on your issues.  During or after that session, a plan for addressing these issues will be created.  Therapy sessions are usually weekly at first, and may reduce to biweekly or monthly as you begin to feel better.

Therapy sessions will then focus on how you are coping with your issues, as well as reasons why you have the issues.  When you are feeling better, and are able to get a lot of support from friends and family or other supports in the community, you and the therapist may talk about ending therapy.

What are the best things to do to prepare for psychotherapy?  First, have concrete and specific goals.  “Feeling better” as a goal is not as good as “Able to reduce crying spells to less than 3x/month”.  When you frame your goals, frame them in terms of what you want to be different in your life, not what you don’t want to experience anymore.  For example, instead of saying, “I don’t want to feel sad daily”, frame it as “I want to be able to list 3 positive things per day that make me feel good”.  The problem with framing them in terms of the absence of negative things is that it doesn’t provide a direction to move towards.  Another thing that is important is to come with an open mind, being honest with yourself and open to new ways of looking at your issues.

Finally, be aware that the therapist may not be as anxious as you are to explore why you have a problem.  When people in therapy are desperate to find the root of a problem, they often end up in “analysis paralysis” because even if they know the root of a problem, it doesn’t solve the problem in and of itself.  In order to solve a problem, one must use good coping skills to put out the fire before poking in the embers.  Cope first, find out why as you look back over your shoulder later.

It is hoped that this introduction to therapy is helpful, and that it answers any questions you may have.  Feel free to contact Psych Choices if you have any questions or concerns, or would like to make an appointment.  Our telephone number is 610-626-8085, ext. 213 for new patients; you may also email us using the contact form below, or directly to the Intake department at