Brought to you by Anne J. Ford, MSW, LICSW

ADHD affects peer relations, social judgment and behavior choices.  ADHD is the most commonly diagnosed mental health disorder in children today.  5% to 8% of children will be diagnosed with ADHD.  That is 2 children out of every classroom.  It is manifested in impaired development and adaptation, with school adjustment problems and learning difficulties.  There is an increased risk for accidental injury, substance abuse, and driving accidents.
ADHD is diagnosed when parents and caregivers describe symptoms such as difficulties with distraction, sustaining attention, disorganization, easily distracted, forgetful, doesn’t seem to listen, inattention and/or activity symptoms such as fidgets, squirms, difficulty playing quietly, seems driven by a motor, talks excessively, runs about, blurts out answers, difficulty waiting for a turn, impulsive, acts before thinking through, interrupts, and socially intrusive.  The most common intervention for this diagnosis is medication and behavior management training.  These often work to manage the behavior problems of ADHD.  Unfortunately the interpersonal and learning problems are rarely remediated.  This is due to the inability to create monitor emotion, social cues, processing language and responding.

Much like our muscles, nerves and joints need to move together, our brain has separate functions that need to work together in order to function, organize, and learn.  Our brain needs to integrate to work in a balanced and coordinated way.  Our brains are made up of the left side that helps us to think logically and organize our thoughts and the right side that allows us to experience emotions and the ability to read non-verbal cues, the reptile brain which allows us to act instinctually for survival skills and in making split second decisions.  The mammal brain allows us to connect and relate to others.  This integration of the areas of the brain allows us to survive and thrive.  When our brains are not integrated well enough, common functioning challenges seem chaotic and confusing with tantrums, meltdowns and aggression.

New technology has confirmed that our developing brain has plasticity and is moldable, that it can change through our lifespan, not just in childhood.  New experiences, learning and therapy can actually change the structure of the brain.  Therapeutic intervention may prevent or reduce symptoms, severity and impairment of ADHD by changing the neuronal architecture of the brain.  According to Karen Bierman at Penn State University, with the help of therapy there has been a positive response for remediating interpersonal difficulties, improve behavior management, and learning difficulties.

Instead of supporting the handicap through environmental interventions, therapy actually addresses brain development differently so separate parts of the brain become better connected and work together.  This is done through a multi-modal approach of redefining how language is used to help the child think through the process of the promotion of executive skill functioning through therapy, practicing pacing skills to thwart impulsivity and increase social judgment, empathy skills.

Brought to you by Anne J. Ford, MSW, LICSW

This article comes from Ned Hallowell, an entrepreneur with ADHD himself, embracing his ADHD and sharing his creativity.  He has written 19 books, given numerous lectures on ADHD, and is the founder of the Hallowell Center for Cognitive and Emotional Health.  Help for functioning with ADHD in the adult world is here!  Have questions?  Come see me at 763-546-5797.  Best, Anne

The complete game plan for excelling at work: career advice for adult ADHD

by Edward Hallowell, M.D.

Adults with attention deficit hyperactivity disorder (ADHD/ADD) are all looking for career advice to help us excel at the workplace. Yet managing rigorous deadlines, demanding bosses, and constant distractions — perennials of the office — are the bane of ADHD adults. Here are valuable tips to help us meet the challenges and rise above them.

Find the right boss.
As Freud said, if you can find happiness in love and work, you will be a happy person. Yet many adults with ADHD mistakenly believe they need to be scolded or reprimanded because they have been scolded their entire lives, and wind up working for controlling people who fail to recognize their talents and strengths. Is this you? If so, reassess. You need to work with, and for, people who find and support the best in you.

Before accepting a job offer, check out the boss. Ask former and current employees whether she has a solid record of promoting people. Is she supportive? Do people respect her? How did she get to where she is? Trust your intuition. An associate of mine turned down an exciting job offer when her prospective boss said, “Of course, you’ll have to learn steno with the other girls!” Neither the steno nor “with the other girls” sat well with her.

If you work for someone who demeans you and your performance, and you can’t find a way to resolve it, try to move to another department within the company—or to another company.

Do what you’re good at.
You probably spent your childhood trying to get better at what you were bad at. The time for that is over! I you can’t assess your strengths, talk with close friends or a career coach to help you list them. A supportive boss can help you with this; ask whether part of your periodic review can be spent discussing your strengths.

Get well-enough organized.
By “well-enough,” I mean organized to the point that disorganization doesn’t impact your work. The devil is indeed in the details. Details may be boring, but you can find ways to manage them. (See “Everything in Its Place,” left.)

Take care of your brain..
Your brain is your biggest asset at the workplace. First, you need to feed it right. A diet that maintains steady insulin levels—plenty of protein and fiber—will help you avoid periods of low mental performance. I model my meals on the Zone diet, but there are other programs that work just as well. Taking omega-3 fatty acids may also improve focus.

Regular aerobic exercise elevates levels of our favorite brain chemicals—dopamine, norepinephrine, and serotonin. Engaging in physical activity is like taking a little Prozac and Ritalin. And make sleep a priority, rethinking your morning and evening routines, if necessary.

Find a “closer.”
Just as baseball teams have a closer—a pitcher who’s brought in to win the game in the eighth or ninth inning—so should you. How many projects are lying idle on your desk? If you can’t count them all, ask your boss if you can enlist a coworker with closing skills to help out. Think of this strategy as a way to help both your job performance and your job satisfaction.

Last but not least, have a full evaluation of your ADHD. Treating the condition appropriately can lead to improved self-confidence and a better understanding of your strengths. Also, look into career counseling. Some medical centers offer programs designed for those with learning disabilities or ADHD. Take advantage of the advice—and start climbing the ladder at work.

The complete game plan for excelling at work: career advice for adult ADHD.
by Edward Hallowell, M.D.

Brought to you by Anne J. Ford, MSW, LICSW

If you’re a mom with ADHD who is struggling to raise a child, or    children, with ADHD, it’s time to take heart. Here are ways to ease the journey of parents who share a diagnosis with their kids.  Several authorities share similar advice:

• Keep your cool when clueless people tell you to “just stay calm. This is an extremely challenging task and mom needs to find some stress reducing ways such as yoga, walking, friend’s time consistently.
• Monitor yourself and self correct when needed. Sleep, exercise and eating habits can help or put you into the “upset zone.”
• Medication is not magic. Meds most likely will not solve all of your problems, they may reduce hyperactivity and inattention, they do little to lessen parenting difficulties. Behavioral therapy among others is needed to improve social interaction including family relationships.
• Hold “fire drills’ with your kids. Handle conflict at a no conflict time. Talk about what you all can do next time you aren’t calm. Then act it out, go to time out, use problem solving strategies.
• Avoid finger pointing. Don’t blame everything that goes wrong on one family member. Family members influence each other, it’s best to acknowledge the ways which everyone contributes to a conflict, everyone learns.
• When you find you’re in a power struggle, back out. No more destructive battles, find a way to discuss the limit setting at a calmer time.
• Don’t sweat the small stuff. Parents consider which power struggles should be pursued, as matters of safety and which should be let go for the sake of the family’s sanity.
• Manage bad behavior. Sometimes a parent who shares a diagnosis will identify so closely with a child that she or he will fail to set appropriate limits. There’s a fine line between explanation and excuse, be specific.
• Outsource what ever you can. Find out if your school offers help with homework or if your child has accommodations, request a lighter homework load. If you can afford it, hire a tutor.
• Maintain your SENSE OF HUMOR.

ADHD never goes away, but you can make improvements by managing
symptoms and learning new therapies that can increase skills for
processing, pacing and improve self control.

Adapted from Kathleen Nadeau Ph.D and Andrea Chronis-Tuscano Ph.D
article, "The Double Whammy Game Plan."

NDNR Naturopathic Doctor News & Review

Categorized | Autoimmune/Allergy Medicine
Article found online at: http://ndnr.com/web-articles/autoimmuneallergy-medicine/gluten-sensitivity-vs-celiac-disease/

Gluten Sensitivity vs Celiac Disease
Posted on 19 April 2012.

Two Distinct Clinical Entities
Nate Champion, ND

It seems as if more and more individuals are being seen with clinical symptoms associated with adverse reactions to gluten, the structural protein component of wheat, barley, and rye. Often, these patients have already been to see a gastroenterologist, and many have had serologic testing performed for celiac disease (CD), wheat allergy, or both. When the results of their blood work come back negative for antibodies to gluten, these patients are often told that wheat or gluten is not a problem and are offered little other advice. These patients are many times left confused, discouraged, and frustrated without any answers and wonder where to go from here. As NDs, we have known for years that individuals can have problems arising from gluten without having true CD. More recently, our understanding and knowledge of gluten sensitivity (GS) has grown, and research has begun to reveal evidence that GS is a separate clinical entity from CD.1

Wheat Allergy and CD

The 2 best-known illnesses related to gluten exposure are wheat allergy and CD, both of which are mediated by the adaptive immune system, with the reaction to gluten being mediated by T-cell activation in the mucosa of the gastrointestinal tract. However, in wheat allergy the release of chemical mediators (histamine) from mast cells and basophils is triggered by the cross-linking of IgE.2 In contrast, CD is an autoimmune disorder indicated by specific serologic markers, most notably serum tissue transglutaminase autoantibodies. Besides CD and wheat allergy, there are many individuals who experience gluten reactions in which neither autoimmune nor allergic mechanisms are involved, generally defined as GS.3

GS vs CD

Gluten sensitivity affects approximately 10% of the general population and is considered a diagnosis of exclusion in which patients are considered to be “gluten sensitive” after CD, wheat allergy, and other clinically overlapping diseases (inflammatory bowel disease, type 1 diabetes mellitus, and Helicobacter pylori infection) have been ruled out. In addition, symptoms are triggered by gluten exposure and are alleviated by gluten avoidance. In contrast to CD, which affects approximately 1% of the general population, these adverse symptoms that occur while eating gluten are not followed by the appearance of autoantibodies in the blood or by persistent damage to the small intestine. Table 1 lists characteristics of GS vs CD. A 2011 landmark study3 reported for the first time evidence of different responses in the intestinal mucosa to gluten in GS vs CD. This study showed significantly reduced small intestinal permeability in patients having GS compared with those having CD when tested with a lactulose and mannitol double-sugar probe.
Patients with GS do not seem to present with significant autoimmune or allergic comorbidities, and their serologic test results are negative for common autoantibodies, including transglutaminase IgA. In CD, there is a strong genetic association with the class II major histocompatibility complex proteins. About 95% of patients with CD carry the HLA-DQ2 gene, and the remaining 5% carry the HLA-DQ8 gene. Only about 50% of patients with GS carry either HLA-DQ2 or HLA-DQ8 (a percentage only slightly higher than that in the general population). This suggests that the adaptive immune system has a much more limited involvement in patients with GS and may explain why this condition is not accompanied by significant autoimmune phenomena, as in CD.3 This adaptive immune response in CD has been shown to be triggered by tissue transglutaminase deaminated gluten peptides bound to DQ2 or DQ8. This mucosal recruitment and activation of the helper T cell, subtype 1 (TH1) and TH17 clones and their associated cytokines (interferon γ and interleukin [IL] 17A) contribute to the initiation of tissue damage and disruption of barrier function. In addition to IL-17A, IL-6 and IL-21 (both of which promote differentiation of TH17 cells) are expressed at significantly increased levels in the mucosa of patients with CD but not in those with GS.4 Furthermore, other investigations have demonstrated that IL-17A cytokines are expressed at significantly higher levels in the small intestinal mucosa of patients with CD but not in those with GS. The authors of one study state: “We conclude that GS, albeit gluten-induced, is different from CD not only with respect to the genetic makeup and clinical and functional parameters, but also with respect to the nature of the immune response.”5(p75)

Toll-like receptors (TLRs) have a crucial role in the initiation or maintenance of various immune responses in the innate immune system. One study3 compared the expression of various TLRs using fresh intestinal biopsy specimens from patients with GS or CD. Small intestine expression of TLR2 was significantly increased in patients with GS. TLR1 and TLR4 were generally higher, without reaching clinical significance. Results of this study suggest that the innate immune system has a prevalent role in the pathogenesis of GS, whereas in CD it is the adaptive immune system that has the primary role. More studies are needed to confirm these results, but this finding may help explain the clinical and serologic differences in GS vs CD.

Clinical Implications

So what is the clinical relevance of identifying patients with GS vs those with CD? Is it possible that changes in the innate immune system may precede or accompany the progression of CD and other autoimmune conditions? Based on the current research, it may be too soon to tell. However, investigations have demonstrated that the expression of various TLRs is increased in the small intestinal mucosa of patients with CD, which may lend support to this idea.6 The typical lesions found in the intestines of patients with CD are thought to be mediated by both innate and adaptive immune pathways. Based on the landmark study3 already cited, it seems that GS is associated with prevalent activation of an innate immune response.

When possible, I believe that it is essential to differentiate between GS and CD (tolle causam). It is important for many obvious reasons to understand if you are working with an autoimmune disorder like CD because it can lead to other secondary disorders (thyroid disorders, infertility, etc), not to mention the importance from a genetic and family history standpoint. More and more research has been demonstrating the adverse effects that gluten can have on an increasing percentage of the population. These often include your typical gastrointestinal symptoms, such as gas, bloating, abdominal pain, diarrhea, and constipation. However, many other extraintestinal symptoms involving psychiatric and neurologic manifestations can often present as well. Neurologic manifestations of GS with or without enteropathy are also common. These clinical manifestations can vary, but the most common syndromes involve peripheral neuropathy and cerebellar ataxia. Earlier detection of GS could provide remarkable benefits to patients with neurologic manifestations.7 Finally, Table 2 gives an immunologic overview of the innate immune system vs the adaptive immune system.8

Summary New research has enhanced our understanding of GS and CD and has shown them to be 2 distinct entities. More double-blind placebo-controlled studies are necessary to further our understanding of GS and to search for specific biomarkers for a proper diagnosis because there is still much we do not know in this regard. The objectives of this article were to inform the clinician about this new research, to further our understanding of these conditions, and to better equip us in the care of our patients. I believe that this information is valuable to our patients as well because it gives credence to what they often experience but rarely have acknowledged by other medical professionals, especially those in allopathic medicine. As NDs, we already have diagnostic tools and specialized testing that we use to detect gluten sensitivities and are in an excellent position to help this growing population of individuals.

Table 1. Characteristics of Gluten Sensitivity vs Celiac Disease

Abbreviation: IL, interleukin.

Table 2. Immunologic Overview of the Innate Immune System vs the Adaptive Immune Systema

aFrom Mayer G. Immunology Textbook. 7th ed. http://pathmicro.med.sc.edu/ghaffar/innate.htm.8
Nate Champion, ND is a graduate of Southwest College of Naturopathic Medicine & Health Sciences, Tempe, Arizona. He is founder and co-owner of Champion Naturopathic Health, LLC, Minnetonka, Minnesota. Dr Champion has a private practice in Minneapolis, Minnesota, with a special focus in digestive disorders, particularly inflammatory bowel disease. In addition to his practice, he regularly reviews research and writes reports on natural medicine for a private health advisory company. 

For more information, please visit www.championnh.com and www.pih-mpls.com.
 References
1. Jackson JR, Eaton WW, Cascella NG, Fansano A, Kelly DL. Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity [published online ahead of print August 30, 2011]. Psychiatr Q. doi:10.1007/s11126-011-9186-y. Medline:21877216
2. Tanabe S. Analysis of food allergen structures and development of foods for allergic patients. Biosci Biotechnol Biochem. 2008;72:649-659.
3. Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011;9:e23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065425/?tool=pubmed. Accessed November 17, 2011.
4. Castellanos-Rubio A, Santin I, Irastorza I, et al. TH17 (and TH1) signatures of intestinal biopsies of CD patients in response to gliadin. Autoimmunity. 2009;42:69-73.
5. Sapone A, Lammers KM, Mazzarella G, et al. Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. Int Arch Allergy Immunol. 2009;152:75-80.
6. Szebeni B, Veres G, Dezsofi A, et al. Increased mucosal expression of Toll-like receptor (TLR)2 and TLR4 in coeliac disease. J Pediatr Gastroenterol Nutr. 2007;45(2):187-193.
7. Hernandez-Lahoz C, Mauri-Capdevila G, Vega-Villar J, Rodrigo L. Neurological disorders associated with gluten sensitivity. Rev Neurol. 2011;53(5):287-300.
8. Mayer G. Immunology Textbook. 7th ed. http://pathmicro.med.sc.edu/ghaffar/innate.htm. Accessed November 16, 2011.

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It's Infertility Awareness Week from April 22-28. So many people are struggling with infertility.  LISTEN.  ASK.  HELP. 

Partners in Healing of Minneapolis was well represented at Resolve's Annual Family Building Conference in Minneapolis over the weekend.  Dr. Deborah Simmons, Dr. Nita Champion, and Diane Tanning, L.Ac. presented information on how to approach a new infertility diagnosis, depression and anxiety related to fertility challenges, gestational surrogacy, when to let go of biological dreams, naturopathic medicine to treat infertility, and Chinese medicine for infertility.  Don't Ignore Infertility.

At Partners in Healing (PIH), we approach reproductive loss and bereavement comprehensively.  Reproductive loss includes a number of difficult experiences, including infertility, miscarriage, stillbirth, premature delivery, and unexpected fetal anomaly, among others.  

Some losses result in death.  Other losses feel like a death.  Some losses are symbolic.  For example, when a woman is told that she will need infertility treatment, or that her baby has an anomaly, she is experiencing profound loss.   Often people experience more than one type of loss in their reproductive lives.  This can also include complications in pregnancy or trauma during labor and delivery. 

People do not “get over” a reproductive loss, but they can integrate the experience into what is hopefully and long and happy life.  Telling the reproductive story is a must for healing.  Too often people are afraid to tell their story for fear of burdening others or because others minimize or deny the physical and emotional pain caused by reproductive losses.  This can lead to isolation, resentment, and depression.  At PIH, we actively elicit the story and provide hope for healing and transformation.  

It is insufficient to say that loss is difficult, as each person and each couple experiences loss differently.  

We explore:

• Gender issues
• Psychological make-up
• Childhood trauma
• Medical trauma history
• Family history and dynamics
• Belief systems
• Social environment
• Spiritual beliefs
• Resilience factors 

Our PIH team, including Dr. Deborah Simmons, PhD, LMFT, Dr. Nate and Dr. Nita Champion, ND, and Diane Tanning, RN, MS, L.Ac. provide clinical hypnosis, EMDR (Eye Movement Desensitization and Reprocessing), acupuncture, individual and couples therapy, and naturopathic medicine to those who have experienced reproductive loss.  We listen to our patients’ unique situations and partner with them in developing the most appropriate treatment plan.  Many of our patients have found healing and new purpose. 

We collaborate actively with physicians, nurses, acupuncturists, naturopathic doctors, and other health care professionals across the Twin Cities to ensure that healing is complete and that hope can spring anew for family building in the future.  Dr. Simmons is available for professional consultation, as well.  Compassion and clinical know-how ensure good outcomes at PIH.  To schedule, call us at 763-546-5797.

Have you ever wanted to do a detox or cleanse but weren’t sure which one you should do? Consider our science-based, physician-supervised detox program: DETOX WITH YOUR DOCTOR, a comprehensive detoxification system that addresses both phase I and phase II detoxification.  Dr. Nate Champion, ND and Dr. Nita Champion, ND are offering this group detox event in order to provide patients with additional support, including daily encouragement emails, and a kick-off presentation on April 16th, 6:30pm-7:30pm.  Space is limited.  Sign up soon to reserve your spot!  Please click on the picture below for more details!

Clinical Neuropsychology is the field that studies the relationship between brain functioning and behavior.  It uses standardized testing protocols developed in psychology to explore changes to one's thinking that can result from various neurological conditions or from other circumstances (i.e. the influence of medications used to treat other conditions, use of mood altering chemicals, or psychiatric conditions).

At the Institute for Brain-Behavior Integration (IBBI) at Partners in Healing, neuropsychology can be applied in a wide range of situations, including:

•    Attention-deficit/hyperactivity disorder
•    Disorders related to aging (e.g. Alzheimer's disease)
•    Brain injuries
•    Developmental conditions (e.g. learning disabilities, Autistic Spectrum Disorders)
•    Neurodegenerative disorders (e.g. Parkinson's disease and Multiple Sclerosis
•    Strokes
•    AIDS Dementia Complex
•    Thyroid Disorders
•    Renal Disease
•    SAT/ACT/GRE accommodations

The decision to seek a Neuropsychological Evaluation can be a sensitive issue.  Sometimes, the patient is the one to raise a concern about mental functioning, while at other times it is family members, health professionals, or teachers who raise the initial concern.  The results of a Neuropsychological Evaluation often are necessary to provide solid evidence of what has changed, identify the reason the change has occurred, describe what can be done to potentially reverse or minimize the change, and begin to guide people in their decision-making efforts to better manage their future.

Call Dr. David Alter and Dr. Nancy Foster at the Institute for Brain-Behavior Integration at 763-546-5797 to schedule a Neuropsychological Evaluation.

Dr. Deborah Simmons will be speaking at the annual conference of Resolve, the National Infertility Association on April 21st at Calvary Lutheran Church in Golden Valley, MN.  She will be speaking on gestational surrogacy, depression and infertility, and decision-making about ending treatment.  Join with the Resolve community for information on Western and holistic fertility treatment and adoption.  For more information, go to Exploring Paths of Hope: 28th Annual Infertility and Adoption Family Building Conference

Based on the whole person, integrated therapy addresses the needs of individuals with Asperger’s and high functioning autism.  At Partners in Healing, Anne Ford, MSW, LICSW provides a treatment approach compatible with each individual’s ability, interests and goals.  She provides empathetic, upbeat therapeutic approaches and research-driven explanations of the inner world of individuals on the spectrum.  Anne Ford works to create new concepts and workable strategies for the individual to function and find sources of satisfaction in his or her life.

Individual, Couple, and Family Therapy
Individual, couple, and family therapy involve insights and new behaviors that empower individuals to explore their role in their relationships whether it is in their family, work setting, school setting or community. Anne and her clients identify strengths and build new skills to utilize effective strategies for responding to individuals needs. Parents, spouses, and family members may play a role in the treatment process to improve family relationships, support new learning, and create new templates for behavior.

Integrated Training and Consultation
Anne Ford also provides training and consultation for health care providers, parents, employers, teachers, professionals, and spouses who are involved with individuals on the autism spectrum.  This includes information on causes, symptoms, co-morbidity, and treatments for a whole range of often co-existing neuro-behavioral disorders in individuals.  Anne and her colleagues at Partners in Healing provide autism spectrum services throughout the life span:    

•    Neuropsychological evaluations for child, teens, and adults
•    Parent support for families with someone on the spectrum
•    Marital therapy when a spouse has Asperger’s/high functioning autism
•    Psychoeducation and support for siblings of a family member on the spectrum
•    Classroom skills necessary to navigate the school and social world
•    Workforce skills necessary to navigate the work and social world, to apply knowledge to real life situations, and aid in the development of a strong work ethic.
•    Naturopathic medicine and nutritional counseling for individuals on the spectrum

Treating Co-existing Conditions
Co-morbidity often accompanies Asperger’s/high functioning autism.  Anne Ford also treats a range of concerns with cognitive-behavior therapy and EMDR:

•    Mood Disorder, Depression and Bipolar Disorder
•    Anxiety Disorders, OCD, Panic Disorder and Social Anxiety
•    Adoption and Attachment Issues
•    Trauma/PTSD
•    Strained relationships with parents and authority figures
•    Decline in academic performance
•    ADD/ADHD issues
•    Anger Management
•    Thought Disorders
•    Personality Disorders
•    Negative peers
•    Somatoform Disorders
•    Eating disorders