ADHD

Every now and then I come across an article I wish I had written.  This one is The Business of ADHD by Child Psychiatrist Winston Chung, MD.  If I had written it, I would have titled it ADHD Greed.

Three highlights are:

    * The American Psychiatric Association is considering lowering the number of symptoms needed for an ADHD diagnosis from 6 to 4.  This is alarming because we already medicate 57% of children who don't meet the current criterion.  Lowering the number of symptoms needed will surely increase the number of children wrongfully receiving unneeded medication.  Woops, I forgot.  It's about profits.

    * Researchers promise pharmaceutical companies results that would benefit the drug company -- before they conduct the study!

    * Allen Frances, MD, Chair of the Task Force that created the current diagnostic criteria for ADHD (and other disorders) laments that his group "inadvertently contributed to three false 'epidemics' - attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many 'patients' who might have been far better off never entering the mental health system."

For years I have been critical of these three "epidemics" which I call "diagnosis du jour".

Focus for Success is individualized to meet your needs and goals. A typical program is as follows:

Individual introductory and attention screening session. Initial goals are set and your focus history is reviewed. Initial recommendations and program components are selected.

Individual computer assisted concentration sessions. There are some aspects of the program that are beneficial to all. If appropriate, we get you started with one-on-one individual education sessions using neurofeedback. This system, originally used by NASA to train astronauts and Air Force pilots, is adapted to help you increase:

  • attention stamina
  • time on task
  • working (short-term) memory sequencing
  • visual tracking
  • discriminatory processing
  • spatial memory

These skills are essential to improving concentration, academics, behavior, social interaction, and also benefit self-esteem.

Group computer assisted concentration sessions. After you've learned to focus and concentrate, we help you transfer those skills to the real world. Gradually we increase distractions and move you to a group setting so you can practice your skills in a school-like or work-like atmosphere. You'll still be working with your coach/teacher but in a group setting. Other program components added based upon your initial assessment and progress.

photo of nikOur son, Nik (the photo is a model), had been on several meds over the last two years for ADHD. As soon as he started 5th grade the school system had asked us to please get him started on something. We didn't like doing it, but we thought it was the right thing to do for him.

My husband, John, read the article in Health Watch. He talked with the parents of the young boy in the article. He was encouraged by the conversation.

We live in an instantaneous society.  Fast food, instant downloads, 24-hour shopping, overnight delivery.  We expect things now - or sooner.

Unfortunately (for our children) the brain still grows at about the same rate it has for thousands of years.  The frontal lobes are not completely developed until around age 25!  (The frontal lobes are where 'executive functioning' happens and helps us to be 'less impulsive'.)

The symptoms of ADHD are normal development for 3- to  6-year-olds.  We make a mistake by labeling kids with normal development as having ADHD (which apparently is happening as you can see in my article ADHD is overdiagnosed).

I do not agree with everything supported by CCHR, but their video below sure makes the point.



While there are many children who need help with attention difficulties -- mislabeling them as having ADHD will not help. Dr. Allen Frances was the chair of the task force that created the current DSM-IV (the manual used in US for mental health diagnosis). He states:

I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences. Our panel tried hard to be conservative and careful but inadvertently contributed to three false "epidemics" -- attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many "patients" who might have been far better off never entering the mental health system.


 

When students have difficulties in school, lack of attention is often noticed. We often assume that he/she has ADHD (Attention Deficit/Hyperactivity Disorder). But ADHD is not the only cause of attentional issues. ADHD "imitators" include the following:

    • Hearing deficit
    • Vision deficit
    • Age-appropriate over-activity
    • Coordination
    • Poor nutrition / malnutrition
    • Vitamin deficiency
    • Caffeine
    • Self-esteem problems
  • Speech and receptive language
  • Developmental language impairment ~ speech or language delays
  • Insufficient sleep (sleep disorder or environmental causes)
  • Too much stuff in the bedroom (TV, video games, cell phones, etc.)
  • Functional disorders
  • Oppositional defiant disorder
  • Conduct disorder
  • Mood disorder
  • Depression
  • Dysthymia
  • Anxiety disorder
  • Realistic fears
  • Personality disorder
  • Obsessive-compulsive disorder
  • PTSD
  • Mania or bipolar disorder
  • Adjustment disorder with disturbance of behavior
  • Situation, environmental, or family problems
  • Improper learning environment (unsafe, disruptive)
  • Inappropriate school placement (e.g. gifted child, learning disabled, developmentally delayed child in regular classroom)
  • Personality conflicts with teachers or peers
  • Family psychosocial adversity
  • Social disruption (poverty, divorce, moves, deaths, illness in family)
  • Unstable / chaotic home setting
  • Conflict
  • Adult domestic violence
  • Abuse, neglect, or both
  • Poor parenting (e.g. inappropriate, inconsistent, punitive)
  • Level of parental stress
  • Parental absence
  • Parental psychopathology
  • Fetal alcohol syndrome
    • Fragile x syndrome
    • Lead blood level
    • Thyroid deficiency
    • Phenylketonuria 
    • Petite mal epilepsy
    • Seizures
    • Sequelae of head trauma
    • Thyroid abnormality
    • Learning disability
    • Mental retardation
    • Borderline intellectual functioning
    • Frontal lobe abscess
    • Neoplasm
    • Lead toxicity
    • Medication-induced e.g. antihistamines, beta-agonists, Phenobarbital
    • Acute or chronic medical illness esp. asthma, allergic rhinitis, eczema, enuresis/encopresis 
    • Substance abuse (alcohol, OTC medication, illicit substances)

 

  • Pervasive Developmental Disorder (Autism / Asperger's)
  • Tourette's syndrome
  • Multiple tic disorder

ADHD medes make things worseIt's appalling.  Most studies for the effectiveness of ADHD medication are conducted for only 3 or 4 weeks.  But some kids take the medication for 15 years!

And the news gets even worse.

Long-term research funded by the US National Institute of Mental Health (NIMH) shows that medication for ADHD makes things worse.

Looking at 3 National Institute of Mental Health (NIMH)-funded studies:

In the 3-year follow-up they state: "participants using medication ... actually showed increased symptomatology during that interval relative to those not taking medication." From 2 to 3 years, medication made things worse.

In the 8-year follow-up, medication use was "associated with worse hyperactivity-impulsivity and ODD symptoms and CIS impairment." (CIS is a tool for rating impairment).  After 8 years, those using medication were worse.

So, medication makes things worse.  Maybe we should stop pushing it.  After all, there are many other treatments and interventions that work well.


~ Jerry Jensen, MA, LP

P.S. Click here if you want even more detail on the information mentioned above.


Whether you are in first-grade or college, all learning involves memory. Memory, in turn, requires alertness, attention to task, and rehearsal.colored pencils 190w

It's not always easy to stay on task. Our fast-paced society combined with T.V., the Internet, and other media shorten everyone's attention span. We can't expect everything to be interesting to everyone.

Often if students are impulsive or can not stay on task, it is assumed they have ADHD. Inattentive or hyperactive behavior could be a sign that a student has ADHD--or it could be related to a number of other "ADHD imitators." Gifted and talented children are often misdiagnosed as having ADHD.

That's why the first step in our Focus for Success program is to determine your goals and assess any current difficulties your student might have. We will individualize a program to improve your student's success in school including the following:

  • increase focus and concentration
  • learn to ignore distractions,
  • improve memory,
  • improve organization,
  • complete tasks on time,
  • be better at following instructions,
  • improve behavior by reducing hyperactivity and impulsiveness,
  • improve academic performance, and
  • improve relationships and social interaction.

ADHD is the most common psychiatric disorder in childhood (NIMH, 2000). Some students seem to be helped with medications used to treat ADHD. However, medications won't cure the disorder, only temporarily control the symptoms.

The National Institute of Neurological Disorders & Stroke states that "most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone."

For lasting improvement, the US National Institute of Mental Health (NIMH) suggests that medication be combined with:

  • behavioral therapy,
  • emotional counseling,
  • practical (educational) support.

The Physicians' Desk Reference (PDR), which contains prescription information from the pharmaceutical manufacturers' themselves, states that "medication for ADHD is only part of a total treatment program that includes

  • psychological,
  • educational, and
  • social measures."

To complicate the matter of treatment for ADHD is the fact that ADHD is misdiagnosed 75-80% of the time (EHSC of WA, 2004). There are over 65 “ADHD imitators” that are associated with attention difficulties. Children are more likely to be depressed, anxious, or gifted than to have ADHD.

All of this points to a great need for an accurate assessment of attention had hyperactive behaviors AND for treatment that includes education and training. That's why we developed our Focus for Success program. And that is why it has two components--a psychological component and an educational component.The psychological component or our program identifies the root causes of attention difficulties for the student. Interventions are determined accordingly.

The educational component of our program includes a system inspired by NASA technology to train astronauts to concentrate. A high-tech helmet reads brain signals for focus and concentration. These brain signals control computer games that not only teach students to improve focus, but also to ignore distractions, develop memory skills, finish tasks, and become organized.

grant scaledTo medicate or not to medicate? If I start medication when do I stop it, at the end of high school, college after I start my career? Will there be side effects? These are all of the questions we struggled with when deciding what path to take with our son. We tried meds for a very short time, but they didn’t agree with him, he couldn’t eat, would cry very easily, and he couldn’t fall asleep. We could have tried harder to find a medication that worked for our son, but then I ran into Sandy Larson and she told me that there is another answer.

ellie croppedMy husband and I came across the Focus for Success website while searching for a way to help improve our then 9-year-old daughter's attitude toward school work. Since her earliest years of school, she seemed to struggle to pay attention and stay "engaged" in her reading and homework. Her teachers had always indicated that she was "doing just fine" but as parents we felt that while she always worked hard, she wasn't getting the most out of her efforts.

 

We met with Jerry and Sandy to learn more about the program and felt its benefits seemed a natural fit for our daughter. Just a few weeks into the program, her father and I agreed that we could see improvement in her ability to stay on task when completing her homework assignments. Even in her extracurricular activities, we felt that she exhibited an expanded capacity for focus and concentration.