KS Services Now Offering ADHD Consultations

KS Services is now offering ADHD Consultation services held by an ADHD Clinical Services Provider.

Image courtesy of Highland Springs Clinic

An ADHD consultation is an opportunity to explore a recent or suspected ADHD diagnostic impression in your family. The goal of these consultations is not to diagnose an individual but to provide a safe space for an individual or family system to process what an ADHD diagnosis can mean. Consultations are helpful if a person has already received a formal diagnosis or does not need a formal diagnosis to access support at work or school. Consultations are helpful if a person or family is seeking increased self-awareness, understanding, or resources.

A consultation session is client-led; the clinician will ask reflective questions that provide insight into where support may be needed for the individual or family. Often, consultations are an opportunity to reframe life experiences through the lens of ADHD - helping clients process past experiences with increased self-understanding and compassion. ADHD consultations specifically focus on increasing understanding about ADHD and its impact on a client’s daily routine outside of just “attention deficits.” Often clients leave feeling validated and working to externalize difficulties that have been previously framed as character flaws. Consultations also provide opportunities to explore local resources and identify area supports. Based on client feedback, the clinician will seek to offer practical easily-applicable strategies aligned with the client’s current needs.

Consultations are available as single and up to three sessions depending on client and family needs. Clinical recommendations will be made regarding how many consultations will be helpful based on the goals presented. Each consultation is $100 and can be done via phone, virtual meeting, or in person. Please note that the consultations are not able to be submitted for reimbursement to your insurance company as they are not direct clinical counseling support. Consultations can be with an individual, parents, or a family unit.

If you are interested in learning more about ADHD consultations, please feel free to reach out to counseling@keystoneservices.biz for a free 15-minute discussion about whether this would be the right fit for your child or family.

Making the Case for a Deep Breath

Trying your best to be a calm parent to a toddler or a teenager in tantrum mode?

Making an important phone call and your heart is pounding?

Reading through an assignment for school or insurance enrollment paperwork and you instantly feel overwhelmed?

Talking about something heavy and feeling all the feelings so much so that you can’t even think anymore?

Feeling stressed, tense, under pressure?

If you’ve ever found yourself in one of these situations or a thousand more, and you are looking for something TO DO to make it a little better I would like to make the case for taking a deep breath.

Really. I mean it.

I realize that this is not new information, and you have probably heard the suggestion tens of times already. I also know that knowing and doing are two different things. I’ve “known” about the value of focusing on your breath forever, but it is only in the last few years that it has become a personal go-to tool. Two things made the difference - science and necessity. First, I did some reading about how slowing your breath is the most impactful way to calm down your body. It slows down your heart rate and tells your nervous system to stand down; this is not a fight or flight situation. Anxiety and anger go down (shoulders peel away from your ears), and the thinking part of your brain is able to take the wheel. Hallelujah that was what I wanted! The second thing that made the difference and led to deep breathing becoming a part of my life was…..necessity. I was feeling significant distress and needed some additional tools. This led to a willingness to try something new and the energy to stick with it. And it worked. It didn’t cost any money, could be done anywhere without anyone knowing, and took only a few minutes to make an impact.

There are numerous deep breathing cues out there to guide you, but the two I return to over and over is 1. Square breathing and 2. 4/8 breathing

Square Breathing

Start by drawing the shape of a square on your leg. On the first line of the square breathe in through your nose and then pause at the corner. On the second line of the square, breathe out slowly through your mouth and pause at the corner. On the third line breath in and pause at the corner, and the fourth line breathe out through your mouth and pause at the corner. Draw the square again, counting to 4 in your head as you trace each line.

Image via cherylschirillo.com

Complete 4 rounds of square breathing, and check in to see if your body and brain feel a little calmer.

4/7/8 Breathing

Start by breathing in for the count of four, pause for a count of 7, and then out for the count of 8. Repeat three more times. Return to normal breathing for a minute and then repeat the cycle. The numbers aren’t a magic formula and can be adjusted to what is comfortable for you, but the key is to breathe out for twice as long as you breathe in.

Practice both of these now when things are calm and easy. Then, when you find yourself in distress and looking for something that will help, draw a square on your leg or focus on counting while you breathe. Deep breathing has the potential to make a real difference for you the way it has for me and for many others.

Please share in the comments other breathing cues that work for you or stories of when deep breathing has helped.

Kathryn Marcantel, MS

Licensed Resident in Counseling

ADHD - Not an Excuse but an Explanation

As previously outlined in the first post in our ADHD series, ADHD is not a disorder of attention but a disorder of regulation; a skill that stems from executive functioning. When considering ADHD, it is important to consider how often throughout the day children and teens are asked to internally regulate. Here are just a few examples:

1. The alarm goes off; it is a cold winter morning, and the teen has to get up knowing they have a full day of tests, sports practice, and homework. The teen feels a sense of dread and wants to stay home and relax. Regulation is needed to control the feeling of frustration and initiate the task of getting up and doing all the things. What might it look like if the teen has a regulation deficit? The teen may have difficulty initiating the task of getting out of bed and starting the process. The teen may have difficulty controlling the frustration and appear extremely irritable and hostile.

2. The child sits in school and is asked to sit on the floor with peers for a morning meeting. The child is asked to regulate attention on the teacher despite consistent wiggling and movement around them from their classmates. The child is asked to regulate their motor movements and implement self-control to stay in an acceptable seated position. This might look like the child having difficulty waiting her turn and interrupting, losing important instruction given by the teacher or lots of fidgeting.

3. The teen is home from a long day of school and is asked to regulate motivation and initiate tasks that need completion including after school chores and homework. Trouble with this might look like a teen on the couch who has not started their tasks after multiple reminders and prompts.

4. The teen is given a multistep semester long project and is asked to regulate their ability to see time. The teen is asked to organize the project in order to plan ahead, seeing into the future, and working towards a larger goal. The teen is asked to identify how long each task in the project will take in order to plan out a timeline for completion. Having difficulty with regulating time, a deficit may look like a teen who is scrambling at the last minute with late nights to complete the assignment.

5. The child is asked to regulate their emotion and display flexibility when expecting an afterschool activity to be their only commitment and is then asked to run multiple errands before going home. Having difficulty regulating may look like a child in tears or being angry. It may even look like a child who refuses to get out of the car or stomps around while running the errand.

6. The teen is asked to regulate their emotions when noticing on social media that their friends attended an event without them. The teen is asked to use self-regulation skills to control emotions that feel overwhelming and big - emotions that impact their self-esteem and confidence at school and around their peers. Difficulty regulating may look like increased isolation, hostile words towards parents, impulsive action taken towards friends (think posting angry posts on Instagram), or lots of crying and distorted thoughts (I am always alone; no one likes me, etc).

All of these examples are situations children and teens face on a daily basis whether they have ADHD or not. The difference is that when a child or teen is diagnosed with ADHD, these moments of needed regulation will present with increased difficulty. These examples could go on for multiple blog posts because the ability to regulate is critical to success socially and academically.

To truly understand ADHD and its impact on our kids, it is necessary to identify how many times throughout the day they are asked to regulate - attention, emotions, time, thoughts, and motivation. Imagine experiencing a sense of frustration and failure when regulation is difficult throughout the day - multiple times a day. To help our students maintain a sense of self-worth and to increase our compassion and understanding as we parent and teach them, it is vital to externalize the ADHD and separate it from our children and our teen’s identity.

How do we do that? We begin to recognize that these moments throughout the day are difficult and we begin to verbalize why. It may sound like this:

He is having trouble initiating this task - it is difficult to pivot from this activity to homework. I am asking him to engage in an act of self-regulation.

She is having difficulty regulating her attention on what I am saying right now. I am asking her to engage in an act of self-regulation.

First we begin to identify and understand how ADHD impacts the overall ability to regulate. As we increase our understanding, we begin to recognize that ADHD is not an excuse, but it IS an explanation. And once we understand that, we are able to provide helpful strategies for self-regulation with compassion and empathy. However, these strategies will always be secondary to an increased understanding of ADHD and its impact on our kids.

Laura Waller, MS, LPC, NCC, ADHD-CCSP

Licensed Profesional Counselor