We are excited to talk to Dr. Heather Lewerenz, a psychiatrist who works with ADHD adults all day long.
A board-certified psychiatrist, graduate of the University of Kansas School of Medicine and the Psychiatric Residency at Beth Israel in New York, Lewerenz was on the faculty of Bellevue-NYU for seven years, where she worked in the psychiatric Emergency Department. Since 2009, Dr. Lewerenz has had a private practice in Manhattan. In 2014, she created a unique practice model, collaborating with Psychiatric Nurse Practitioners to provide high-quality, affordable psychiatric care to more New Yorkers.
You can learn more about Lewerenz by visiting psychservicesny.com or calling her office at (212)868-5550.
The Distracted Executive: You work with successful business professionals all day long. Tell my readers about their #1 challenge in getting organized and managing their workloads. What do you most often suggest in terms of solutions?
Dr. Lewerenz: The main problems I see with busy, successful professionals today is taking on too much responsibility, being too driven toward perfection, a reluctance to delegate and being unable to set limits to protect self-care and balance. We know that excessive work hours may be appropriate early in a career, but that it’s really not sustainable in the long term. Many people have been ignoring their body’s cues and their own personal health and mental health needs in the service of a career of high achievement. The over-achiever is suffering from stress and burnout, and their families and friends are also suffering from their absence or their perfectionism. I often recommend therapy and coaching.
TDE: Adults with ADHD are almost dismissed/marginalized these days – especially at work. What do you have to say about that?
HL: Unfortunately, adults with ADHD face challenges in the workplace because of ADHD, compounded by a lack of understanding. When most employers or coworkers are faced with someone with ADHD, they just see “disorganized, forgetful, distracted, restless,” without any understanding that these traits are all part of an illness, and not always within the control of the individual. Also, many workplaces have become less ADHD-friendly, with open-area seating, long days without proper breaks, 24-hour availability, and unreasonable deadlines. All of these factors can lead to very frustrating conditions for both the worker and the employer.
TDE: Give my readers one tip about what they might look for.
HL: You might suspect that you have ADHD if you feel that you struggle with any of the following: impulsiveness, difficulty concentrating or difficulty with organization. Some areas of your life that you might look at include your driving history (frequent tickets, moving violations or accidents), difficulty with some daily tasks like grocery shopping, cleaning, or paying bills, struggles with work and relationships, or a feeling that you have always had to work harder to achieve than people with commensurate intelligence and abilities. ADHD is a “diagnosis of exclusion,” which means that a psychiatrist, neurologist, or therapist would have to be sure that you are not suffering from Depression, Anxiety, Bipolar Disorder, or another mental illness to be able to diagnose you with ADHD. However, the gold standard for the diagnosis is still the clinician examination, so for most people extensive (and expensive) neuropsychological testing is not required.
TDE: In your adult patients with ADHD, what is the #1 presenting challenge/struggle?
HL:In my experience, the main struggle for patients with ADHD is the struggle itself and how it affects a person’s self-esteem. Many people with ADHD have been told their whole lives that they are “lazy,” or “not applying themselves.” Impulsiveness, disorganization, trouble with task completion, and distractibility can create very real social and occupational struggles.
TDE: Diagnostically speaking, how do you know if a patient actually has ADHD or not? Doesn’t “everyone” really have a little bit these days?
HL: The first thing a clinician must look for is another explanation for the symptoms such as Depression, Anxiety, Bipolar Disorder, etc. One question for the clinician is, are these symptoms longstanding, or are they episodic? Many other illnesses might cause symptoms that look like ADHD but are recent in onset. ADHD is a lifelong illness that has its origins in childhood, so getting a good history is critical. Also, we are looking for symptoms in three domains, which are impulsiveness/hyperactivity, distractibility/trouble concentrating, and organizational problems (what we call “executive function”). And no, not everyone today has ADHD. Unfortunately, many situations today (excessive demands of work and school, other stresses and pressures of modern living) create stress, distraction, and extreme demands, but an astute clinician should be able to differentiate an underlying ADHD from a stressful and distracting environment.
TDE: Have you seen more people presenting with ADHD symptoms today versus five years ago? If so, what do you attribute that to?
HL:No, I have not seen an increase in actual ADHD. We know that the rate of ADHD in the population is pretty stable over time. I have seen an increase in stressful and demanding workplace situations, which are even more difficult for people who really have ADHD, but which should be unacceptable for any of us. I believe we are all entitled to work-life balance and to the basics of self-care. Too often, especially for highly-educated, professional people – what we now call the “knowledge economy” – the demands of work have increased dramatically over the past decades. I often find myself advising a patient in an extremely stressful, demanding work situation that “I don’t have a pill for that.”