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ADD / ADHD – What it is, challenges, how to overcome it.

This is a comprehensive article covering the symptoms, causes and challenges of ADHD. Most importantly, at the end of the article, we go into detail about the most effective ways to support someone with ADHD thrive in academics, and in life.

In this article we’ll cover:

Short course via Zoom: How to Understand and Support a Child with ADHD

What is ADD / ADHD?

ADD Definition

ADD (Attention Deficit Disorder) is used to refer to a specific subtype of ADHD (Attention Deficit Hyperactivity Disorder). ADD is no longer used as an official medical diagnosis, but is often used to describe people with ADHD who are inattentive (for example having trouble listening or managing time), but do not show hyperactivity or poor impulse control.

Read: Effective Support for People with ADHD

Short course via Zoom: How to Understand and Support a Child with ADHD

ADHD Definition

Attention deficit hyperactivity disorder (ADHD) is a condition that affects people’s behavior. People with ADHD can seem restless, may have trouble concentrating and may act impulsively without thinking about the consequences of their behavior.
Adapted from: [1], [2], [3]

Read: Effective Support for People with ADHD

Is ADHD a learning disability

ADHD is not considered to be a learning disability, even though it can affect learning. However, between 30% and 50% of people with ADHD also have at least one additional learning disability.

Read: Effective Support for People with ADHD

In the USA, it can be determined to be a disability under the Individuals with Disabilities Education Act (IDEA), making a student eligible to receive special education services. Individuals with ADHD can also qualify for accommodations under the ADA and Section 504, if their ADHD impacts a major life function such as learning. [4

In the United Kingdom, students with ADHD can receive specialized support from the school’s SENCO (Special Educational Needs Coordinator). [5]

Read: 

Symptoms of ADHD

People with ADHD experience an ongoing pattern of the following types of symptoms:

  • Inattention: The person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity: The person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
  • Impulsivity: The person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.
    Adapted from: [6]

Read: Effective Support for People with ADHD

People who only show inattention but not hyperactivity or impulsivity are often described as having ADD, although this term is no longer used as an official definition.

The main signs of inattentiveness are:

    • Having a short attention span and being easily distracted
    • Making careless mistakes – for example, in schoolwork
    • Appearing forgetful or losing things
    • Being unable to stick to tasks that are tedious or time-consuming
    • Appearing to be unable to listen to or carry out instructions
    • Constantly changing activity or task
    • Having difficulty organizing tasks

The main signs of hyperactivity and impulsiveness are:

    • Being unable to sit still, especially in calm or quiet surroundings
    • Constantly fidgeting
    • Being unable to concentrate on tasks
    • Excessive physical movement
    • Excessive talking
    • Being unable to wait their turn
    • Acting without thinking
    • Interrupting conversations
    • Little or no sense of danger

Quoted from: [7]

Read: Effective Support for People with ADHD

DSM-5 Diagnostic criteria for ADHD

So, what are the ‘official’ criteria for diagnosing ADHD? Here are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5) criteria for ADHD:

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

    1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
      • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
      • Often has trouble holding attention on tasks or play activities.
      • Often does not seem to listen when spoken to directly.
      • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
      • Often has trouble organizing tasks and activities.
      • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
      • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
      • Is often easily distracted
      • Is often forgetful in daily activities.
    2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
      • Often fidgets with or taps hands or feet, or squirms in their seat.
      • Often leaves their seat in situations when remaining seated is expected.
      • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
      • Often unable to play or take part in leisure activities quietly.
      • Is often “on the go” acting as if “driven by a motor”.
      • Often talks excessively.
      • Often blurts out an answer before a question has been completed.
      • Often has trouble waiting their turn.
      • Often interrupts or intrudes on others (e.g., butts into conversations or games).

In addition, the following conditions must be met:

    • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
    • Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
    • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
    • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

    • Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
    • Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
    • Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Quoted from: [8]

Read: Effective Support for People with ADHD

Is ADHD genetic

ADHD does tend to run in families. Research suggests that ADHD is caused by a combination of genetic and environmental factors. Several genes, mostly related to dopamine production, have been identified as risk factors for ADHD. Moreover, stressful life events (such as difficulties during pregnancy and birth, childhood abuse, health issues or death of a family member) can play a role in causing ADHD.
[9], [10], [11], [12]

Read: Effective Support for People with ADHD

The Superpowers of the ADHD Brain

It’s all well and good to understand the symptoms and causes of ADHD, but to truly understand what’s going on for someone with ADHD, we have to dig into how their brains function differently.

Let’s get into it…

“Attention Deficit Hyperactivity Disorder (ADHD) is a neurological disorder that affects a person’s ability to control their behavior and pay attention to tasks.

Brain images of children with ADHD may show differences compared to children without ADHD. For example, in some children with ADHD certain parts of the brain are smaller or less active than the brains of children without ADHD. These changes may be linked to specific brain chemicals that are needed for tasks such as sustaining attention and regulating activity levels.”
Quoted from: [13]
See also [14], [15]

Fundamentally, these brain differences lead to weaknesses in executive function

“What’s executive function” you ask.

Good question.

Executive function is like the maestro that conducts and orchestrates the brain. It allows people to do things like:

  • Control impulses
  • Control emotions
  • Think about the consequences of actions before acting on them
  • Initiate tasks
  • Shift focus between tasks
  • Organize things
  • Be self-aware and think about their actions and feelings

So it’s pretty obvious how weaknesses in executive function would lead to the behaviors commonly seen in people with ADHD.

Fortunately, there are effective approaches to strengthening these executive function weaknesses, both for children and adults. We’ll get into that more in: Neurodevelopmental Support for ADHD.

Through working with Oxford Specialist Tutors, I’ve learned a lot about how my ADHD – Hyperfocus brain works, and how to harness it to my best advantage.

In the mornings, I sometimes wake up in hyperfocus mode, in which case I get straight to work.

But most mornings, I wake up in full-on ADD mode. My brain is filled with a thousand thoughts and ideas, and flits from topic to topic in rapid fire. I cannot focus on one thing, but I am having useful thoughts about everything that’s on my mind. And there are a LOT of things on my mind!

When that happens, I used to try to force myself to focus, but it never worked. And I’d get really stressed in the process.

Now, instead, I let my brain flit around for as long as it needs to – while I take a walk, drink a coffee, or just gaze out of the window.

Once my brain is ready to settle, only then do I bring my focus down to just one thing.

When my brain is ready, that’s really easy to do, and I get into a hyper focused state of extreme productivity. “In the zone” as some people call it.

I’ve also learned that I need time to switch from one focus to another. If I try to switch too fast, again I get stressed out and cannot focus.

So instead, I always take a break between different topics of focus.

Overall, understanding how my brain works, and how to manage my ADD and hyperfocus has made my life a lot less stressful, and a lot more productive.

David – ADHD

The Challenges of ADHD

While it varies greatly from person-to-person, people with ADHD are much more likely than others to have other challenges in life, such as:

Some of these are likely caused by the same brain differences and executive function weaknesses that lead to ADHD. But in stark contrast others are likely the result of how hard it is for people with ADHD to meet the expectations of people who don’t understand ADHD, especially their teachers.

(Some of the information in this section is drawn from the book Outside the Box: Rethinking ADD/ADHD in Children and Adults: A Practical Guide by Thomas E. Brown. [16])

Read: Effective Support for People with ADHD

Learning Disabilities and ADHD

Studies show that people with ADHD are 5-10 times more likely to have other learning disabilities than people without ADHD.

The most common learning differences linked with ADHD are:

  • Dyslexia (trouble reading and writing) and Dysgraphia (difficulty spelling and putting thoughts on paper)
  • Dyspraxia (motor difficulties and clumsiness)
  • Dyscalculia (difficulty learning and understanding arithmetic)

Indeed, 30% to 50% of children with ADHD also have dyspraxia, and this often goes undiagnosed and untreated. [17]

As all of these learning disabilities are related to weaknesses in executive function and working memory, it’s likely that the symptoms of ADHD and their other learning difficulties are a result of the same underlying weaknesses in executive function and working memory.

Read: Effective Support for People with ADHD

Emotional Problems and ADHD

People with ADHD are more likely to have emotional problems such as poor socialization, anxiety, depression, irritability, low frustration tolerance and emotional outbursts.
[18], [19]

Some of these are most likely linked to poor executive function. They have difficulty controlling their impulses and emotions.

Others are most likely the result of just how hard it is for a person with ADHD to interact with ‘normal’ people. They’re constantly being told that they have to “just pay attention”, “stop fidgeting”, “sit down and listen”… the list goes on and on. 

But they simply cannot do these things. It’s like telling a fish to climb a tree and then yelling at it because it cannot climb.

  • Children with ADHD are up to 5 times more likely to have depression compared to kids who don’t have ADHD.
  • Children with ADHD are up to 3 times more likely to have an anxiety disorder than kids who don’t have ADHD.

It’s pretty obvious that being constantly yelled at because you cannot do things that are not in your nature can lead to frustration, anger and depression.

Fortunately these issues tend to disappear once they’ve learned how to deal with their differences. More on that in Effective Support for People with ADHD

But before we leave the topic of emotional problems and ADHD, let’s talk about the labels of RSD and ODD.

RSD (Rejection Sensitive Dysphoria) and ADHD

RSD is not a medical diagnosis, but a way of describing certain symptoms associated with ADHD. People with RSD are hypersensitive to rejection and can feel shunned and criticized even when that’s not the case. [20], [21], [22]

Some common symptoms of RSD include:

  • Be easily embarrassed
  • Get very angry or have an emotional outburst when they feel like someone has hurt or rejected them
  • Set high standards for themselves they often can’t meet
  • Have low self-esteem
  • Feel anxious, especially in social settings
  • Have problems with relationships
  • Stay away from social situations and withdraw from other people
  • Feel like a failure because they haven’t lived up to other people’s expectations
  • Sometimes think about hurting themselves
    Quoted from: [23]

Read: Effective Support for People with ADHD

ODD (Oppositional Defiant Disorder) and ADHD

Studies show that 15% to 50% percent of children with ADHD have Oppositional Defiant Disorder (ODD). In fact, the relationship between ADHD and ODD is one of the most common co-occurrences of childhood disorders.

So why is this?

Well, if you were constantly being told that you had to do things that you were just not capable of – Sit still! Shut up and listen! Just pay attention! – wouldn’t you get frustrated and a bit defiant?

Not surprisingly, one study into ADHD and ODD strongly suggested that the ODD is caused by the ADHD. [24] Our view is that this is a result of how people who don’t understand the challenges of having ADHD tend to interact with those who do have ADHD.

Read: Effective Support for People with ADHD

Can People with ADD / ADHD Truly Thrive in School and in Life?

So, we’ve gone through all the definitions and symptoms of ADHD, but what does this all mean?

Does ADHD amount to a life sentence of frustration and failure? Or are there ways to learn and grow with ADHD to live a happy and successful life?

Fortunately, the short answer is Yes! People with ADHD can be extremely happy and successful with the right support.

But before we get into how to truly thrive with ADHD, it’s worth getting into how ADHD evolved, and the unique benefits it offers.

The Hunter vs. Farmer Hypothesis

In his book, The Edison Gene, Thom Hartmann lays out compelling evidence that ADHD evolved to provide the skills necessary to be effective hunters and protectors of their tribe. [25]

People with ADHD have an extraordinary ability to hyperfocus. A necessary skill when you’re hunting down prey. If you’ve ever seen a dog or cat hunting, you’ve already seen this in action. As they get closer and closer to their prey, their focus gets more and more intense. Until in the last moments of going in for the kill, everything else disappears and their attention is entirely focused on their prey.

People with ADHD also have an extraordinary ability to get distracted by everything that’s going on around them. But how’s that an advantage?

Well, if you’re in a wild environment, and you don’t notice the tiger approaching from the distance – game over.

So the ability to be aware of everything that’s going on around you (a.k.a being distracted by everything in the environment) is a necessary survival skill.

In contrast, as humans evolved into farmers, a different set of skills were necessary. The ability to stay gently focused on repetitive activities like planting, harvesting and storing crops. And the ability to to follow the repetitive procedures necessary to perform these tasks.

All these farmer skills are great in modern-day classrooms. Farmers can maintain their focus, follow procedures, and think about their actions before acting.

So why have the hunter skills of ADHD survived in the gene pool? 

Quite simply, even in a farming community, it’s useful to still have some hunters around to get some meat and notice and protect the tribe from predators.

But how does this play out in modern society?

Well, it sure causes problems in the classroom, but it turns out that people with ADHD have many unique advantages as well.

People with ADHD are better than others at hyperfocusing on “urgent tasks”, such as last-minute projects or preparations. They are uniquely able to postpone eating, sleeping and other personal needs and stay absorbed in the “urgent task” for an extended time. They just stick with it until it is done!
[26], [27]

So if you’re hiring for a job that requires the ability to hyperfocus on critical tasks, while still being aware of environmental threats, you’ll probably do well to look for someone with ADHD. 

For example, recruiters have estimated that 30% of successful salespeople have ADHD. These are the contemporary hunter gatherers in our society.
[
28]

More generally, people with ADHD are wired to be successful as innovators, inventors, explorers, and entrepreneurs.

Let’s look at some examples…

Famous People with ADHD

    • Thomas Edison was expelled from school for behavior that today would label him as having ADHD. He was a prolific inventor in areas such as electric power generation, mass communication, sound recording, motion pictures, and the light bulb. [29]
    • Albert Einstein – Probably the most brilliant scientist of the 20th century
    • John F. Kennedy – President of the United States
    • Michel Jordan – The greatest basketball player of all time
    • Justin Timberlake – Singer, actor, producer, businessman
    • Simone Biles and Michael Phelps – Two of the most decorated Olympians of all time
    • Walt Disney – No introduction needed
    • Sir Richard Branson – Serial entrepreneur (Virgin Records, Virgin Atlantic) and adventurer
    • Ingvar KampradIkea – Founder of Ikea
    • Scott Kelly – Astronaut
    • Terry Bradshaw – Super Bowl champion and sports commentator 

So what does it take for someone with ADHD to be truly successful in school and in life?

The best way is to make sure that they get effective support…

Effective Support for people with ADHD

Here are the approaches to supporting people with ADHD thrive in academics and in life.

We’ll go into more detail on each of these below.

It’s important to note that these are not mutually exclusive options. For most people with ADHD, some combination of these approaches will produce the best results. 

So, it’s important to work with an expert who understands all the different approaches to help determine what combination of approaches is best for a given individual.

If you would like to talk with one of our experts to discuss what would be the best approach to supporting your child with ADHD, book a free consultation today.

Medication

At a very broad level, there are two types of medication for ADHD:

  • Stimulants that improve concentration, help focus attention and reduce impulsive behavior
  • Selective norepinephrine (also known as noradrenaline) reuptake inhibitors (SNRIs), which over time increase the amount of norepinephrine in the brain

These are the medicines approved for the treatment of ADHD:

  • Methylphenidate (stimulant)
  • Lisdexamfetamine (stimulant)
  • Dexamfetamine (stimulant)
  • Guanfacine (stimulant)
  • Atomoxetine (SNRI)

According to the British National Health Service, “These medicines are not a permanent cure for ADHD, but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.” [30]

There is enormous controversy about the use of medications to treat ADHD. 

According to the American Psychological association, some psychiatrists believe that professionals overdiagnose and over medicate for ADHD, while others believe that medication can provide a child with the best chance of leading a ‘normal’ life. Most psychiatrists advocate for a measured approach, combining medication with other approaches. [31]

Outside of the psychiatric profession, some ADHD specialists believe that medication is just a bandaid. It temporarily increases brain function, but does nothing to improve long-term executive function in the brain. They believe that medication should be seen only as a short-term bridge while they work on developing other things. Having said that, most do believe that it can be really useful.

Our view is that there is so much diversity in the situations and challenges of individual people that there is no blanket right answer. It really depends on the individual. Having said that, this is a decision that should be made in consultation with a licensed psychiatrist.

Nutrition

There is evidence that diet can be an important factor in ADHD. 

One study showed that children who ate an unhealthy diet (rich in processed meat, red meat, pizza, eggs, snacks, animal fat, hydrogenated fat, and salt) had higher incidence of ADHD than children who ate a healthier diet (rich in fruits, vegetables, vegetable oils, whole grains, legumes, and dairy products). [32]

Again, individuals vary greatly, so diet may be important for some people and not for others. And specific dietary changes may make a big difference for some people and not for others.

Thus we recommend a customized approach to explore and test what dietary changes may make a difference for an individual person.

Supplements

There is plenty of research that shows that various supplements can be beneficial for people with ADHD.

Here is the list of the most frequently-recommended supplements for ADHD:

    • Omega 3 fatty acids. Most neurons (nerve cells) are surrounded by myelin sheaths. These sheaths act as insulators and improve the conduction of messages along the neurons.  People with ADHD tend to have thinner myelin sheaths around their neurons. Omega 3s help to thicken those sheaths. Research has shown that Omega 3 supplementation can have beneficial effects for people with ADHD. [33], [34], [35]
    • Probiotics. There is some evidence that suggests probiotics might help with ADHD. Good sources of probiotics include fermented vegetables like sauerkraut and kimchi, fermented (plain) yogurt and multi-strain probiotic supplements. There is ongoing research in this area. [36]
    • Melatonin. When people with ADHD have trouble falling asleep, because their mind is constantly going, there is plenty of research that shows that a small dose of melatonin can help improve sleep. [37], [38], [39]
    • Allicin. Some people recommend supplementation with allicin, which is a precursor to dopamine in the brain. We are not aware of any scientific evidence that supports or refutes this option.

Mindfulness Meditation to treat ADHD

Some people recommend mindfulness meditation and other forms of meditation for people with ADHD.

There is no definitive scientific evidence that this helps, but it certainly does not hurt to try it out.
[40], [41]

Study Skills Tutoring

Children with ADHD think differently and learn differently.

This means that traditional approaches to teaching and learning often do not work for people with ADHD.

Study skills tutoring is the process of helping someone with ADHD discover how they can think and learn best.

Here are just a few examples of things that can work to help people with ADHD learn to focus and study more effectively:

  • There is plenty of evidence that shows that people with ADHD learn better when they are moving. Being forced to sit still at a desk actually makes it harder for them to learn. Also, intense physical activity can improve the cognitive performance of people with ADHD. [42], [43]
  • Even better, if teachers and lecturers can be persuaded to let them stand up and move around at the back of the class, this makes learning a whole lot easier for them.
  • They can often assimilate information better if they record their lectures and then listen to them again when they are walking. Similarly, they often do better if they listen to written course materials (using a text to voice tool) while walking, instead of sitting and reading.
  • Some people with ADHD can focus better with some distraction, like playing with a fidget toy or listening to loud music while they study. It’s counterintuitive, but it often helps.
  • If a student is able to hyperfocus on one thing, like playing a video game, while being unable to focus on other things like studying, a useful strategy can be to help them unpick what allows them to focus on the video game, so that they can apply those same strategies in their studies.

There are many different tricks and techniques that may work, but what works best varies from person to person.

So, effective study skills tutoring is a process of working with a student to help them discover what will work best for them. It involves careful detective work, with plenty of trial and error, trying out different things based on our experience of what has worked for other students with ADHD.

If you would like to talk with one of our experts to discuss what would be the best approach to supporting your child with ADHD, book a free consultation today.

Neurodevelopmental Support for ADHD

The problems that people with ADHD face are mostly the result of deficiencies in executive function in the brain and limited working memory.

This raises the question of whether those cognitive abilities can be enhanced.

Fortunately, the answer is Yes: most people with ADHD can make significant improvements in their brain function, with the right support.

This is where Neurodevelopmental Movement Programs come in.

Quite simply, a Neurodevelopmental Movement Program gives your child a way to strengthen the cognitive functions that are causing them problems.

Madeleine Portwood has written extensively about this approach in her book Developmental Dyspraxia: Identification and Intervention: A Manual for Parents and Professionals. [44]

HANDLE® providers are also trained to develop Neurodevelopmental Movement Programs for individual students. [45]

Neuroscientists at the Harborview Medical Center have shown that the HANDLE approach can be effective in addressing issues even as severe as chronic traumatic brain injury. The neurodevelopmental issues of dyslexics are generally much less severe than traumatic brain injury, and so it is reasonable to assume, easier to address. [46]

At Oxford Specialist Tutors, we use the HANDLE approach.

While it’s accepted that deficiencies in executive function lead to many of the things that people with ADHD struggle with, it’s a rather high level of brain function. It’s like the top story of a multi-story building. And before you can build the top story, you have to build a firm foundation and the stories below.

So when we work with someone with ADHD, we make sure that the foundation and stories below are in good shape before building the top story of executive function.

Here are some of the foundational things we evaluate and address to support executive function:

  • Tactility:
    Are tactile issues causing distraction? For example, do the clothes they wear irritate and distract them?
  • Vestibular system.
    Do they need to move in order to pay attention? Do they need to fidget? Do they need to move around all the time?
  • Proprioception:
    Do they have a feeling of safety within their own body? Do they focus best when they can feel their body pressing against things, for example bracing against furniture?
  • Vision:
    Are issues with eye convergence and focus getting in the way of their being able to pay attention to the task at hand or interfering with what they actually want to look at?
  • Audition:
    Do sounds startle or distract them?
  • Auditory sequencing:
    Are they able to hear and follow instructions, or is something getting in the way of that?
  • Interhemispheric integration:
    Are the two sides of the brain communicating with each other effectively?

Which all support the higher level executive functions of:

  • Impulse control:
    Do they have difficulty controlling their impulses?
  • Attention switching:
    Do they have difficulty turning their attention where they want it to go?
  • Connecting ideas:
    Can they connect ideas in their head and make relationships between them?

So the process of developing a Neurodevelopmental Movement Program starts with a thorough evaluation of what is getting in the way for the particular individual.

And then we give them movement activities that strengthen brain function in the areas that are weak. We always start from the most foundational functions and work up the stories, until we can support them in enhancing their executive function and working memory.

Read Roisin’s story of her her Neurodevelopmental Movement Program changed her life: Roisin’s Story

Get the Best Support for Your ADHD Child

If you would like to talk with one of our experts to discuss what would be the best approach to supporting your child with ADHD, book a free consultation today.

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