ADHD Information Resources

Greetings!! With all the rain and snow across the country I hope this Newsletter finds everyone safe and well. We've Been experiencing a lot of rain here in California and many Folks are facing some serious challenges with flooding And mud slides but so far, outside of a little too much Rain, and some trees down, we've been able to get By with little trouble.

I am still experiencing some troubles with my system. My computer has been going up and down like a YO-YO. Needless to say, this has caused some corruption to a couple Of my programs and the loss of some files, mostly email. I Make it a point to respond to all email so if you've written me And I haven't replied, please write again.

Dr. Dave's AddVice

For my column this month I'd like to share with you an article from the recent edition of ADHD RESEARCH UPDATE, an electronic newsletter I publish to keep parents informed about the latest research on ADHD and how new findings can be applied to help their child. The article I've chosen reviews a recent study from the Journal of the American Academy of Child and Adolescent Psychiatry about the age of onset of ADHD symptoms.

If you haven't already received a sample of this newsletter, please let me know - I'd be delighted to send you some sample issues to review. Just send me an e-mail addhelp@mindspring.com and put "Sample issues" in the subject line.

Is it still ADHD when symptoms emerge after age 7?

One of the current diagnostic criteria for ADHD is that impairment from symptoms must be evident prior to age 7. This means children whose symptoms emerge at a later age can not be diagnosed with ADHD, and it is assumed that their symptoms are reflective of some other condition or are secondary to school failure. (For a complete discussion of diagnostic criteria go to www.svr.com/addhelp/criteria.htm. This age of onset criteria was included in DSM-IV because ADHD has always been considered a disorder that arose during early childhood. When symptoms emerged beyond the early childhood years, it was believed that this could not be ADHD, but instead reflected behavior arising in response to failure at school and/or the development of another psychiatric condition (e.g. depression). A study recently appearing in the Journal of the American Academy of Child and Adolescent Psychiatry casts doubt on the validity of this belief. In this study, 380 children between the ages of 4 and 17 who met symptomatic criteria for ADHD were compared according to whether the initial impairment from their ADHD symptoms was evident prior to age 7.

Results indicate that the validity of the age of onset criteria depends on what type of ADHD the child was diagnosed with. Recall that the core symptoms groups for ADHD are problems with attention and problems with hyperactivity/impulsivity. According to current diagnostic guidelines, children who show attention problems but not hyperactive/impulsive problems are diagnosed with ADHD, Predominantly Inattentive Type. (This is what used to be called ADD, a term which is no longer technically correct). Children with hyperactive/impulsive symptoms but not attention symptoms are diagnosed ADHD, Predominantly Hyperactive/Impulsive Type. Children who display symptoms of each type are diagnosed with ADHD, Combined Type.

Results indicated that nearly all subjects diagnosed with the hyperactive/impulsive subtype of ADHD first showed impairment from their symptoms prior to age 7. Nearly 20% of the combined group and 43% of the inattentive group, however, did not show impairment by this age. These were all children that trained clinicians agreed had "true" cases of ADHD, and imposing the age of onset criteria would thus have reduced the accurate identification of these cases. These results question the usefulness of requiring an early age of onset for diagnosing ADHD, especially for the combined and predominantly inattentive subtype. My own experience is that for children who display only the attention problems, difficulties often do not emerge until late elementary school or even middle school. This is probably because children with attention symptoms only are generally not behavior problems, and are often able to get by in the early grades when the academic demands are not that great. This is especially true for a child who is above average inability because they can often do okay in their school work even if they have trouble attending. As children move in to the later grades, however, academic demands and the need to sustain attention increase considerably. Children also begin to get more homework. At some point, it doesn't matter how smart you are - you simply need to be able to sustain attention and concentration in order to do well academically.

In middle school, children also change from having a single teacher to having multiple teachers. When this occurs, it becomes increasingly difficult to stay organized and keep track of assignments from multiple classes. As a result, a child who did okay in prior grades can suddenly start to struggle in a major way. Many times, because a child has done well in earlier grades, the assumption is made that he or she must now be unmotivated or lazy. As a child starts to struggle and do poorly, they often can lose their motivation as a result. Parents and children can start butting heads and get locked into an escalating power struggle and conflict as a result.

It is important for parents to be aware that ADHD symptoms, and the difficulty these symptoms cause, will vary tremendously depending on the context. In some situations, a child with ADHD will appear indistinguishable from his or her peers. In other situations, the symptoms will be quite apparent and create significant difficulties. Unfortunately, the classroom environment is often one of these latter situations, and this is especially true of how most middle schools are structured. Trying to alter these environments in ways that make it more likely for a child with ADHD to be successful can thus become a critically important aspect of a child's treatment.

It should also be stressed that although requiring a strict cut off like age 7 apparently reduces diagnostic accuracy, it is important to be very careful when diagnosing ADHD in a child whose symptoms do not create significant impairment until a later age. When this occurs, it is usually the case that there would have been some indication of symptoms at an earlier age, even if the difficulties they created were not especially severe. Thus, teachers may have noted that the child had trouble completing assignments, or seemed to daydream and be off task more than peers.

When ADHD symptoms first emerge in an older child without their being ANY prior evidence that they were present, however, it is likely that they reflect a problems other than ADHD. For example, a 12 year old who had NEVER displayed any prior attention problems is suddenly observed to have significant problems with sustained attention, to be frequently daydreaming, and stops completing assigned work. This situation would be more likely to reflect some type of emotional disorder (e.g. depression) or perhaps a reaction to a traumatic event, rather than ADHD. A careful evaluation in which these and other alternative possibilities were carefully considered would definitely be warranted.

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That's all for this month. I'm delighted that many of you have already sent in for the monitoring system I've developed to help parents keep careful track on how their child is doing at school. In my experience, this is really critically important for parents to do. If you'd like to receive this simple but effective system to use, send $5.00 and a self address stamped long envelope to me at ADHD Assessment Services 4711 Hope Valley Rd. - Suite 207 Durham, NC 27707-5651.

I look forward to visiting with you again next month.

David Rabiner, PhD
Licensed Psychologist

P.S. I hope I'll hear from you about requesting samples of ADHD RESEARCH UPDATE. To receive them addhelp@mindspring.com and type "free samples" in the subject line.

Special Request

This parent is in need of any information you might have. Please Read their story and reply to Ghostprincess@worldnet.att.net if You can help.

Help!

I have a son who has been diag. ADHD/ODD and we can't seem to get anyone to understand what this really is. The Alabama Dept. of Human Resources has taken him from us, alledging, we are not fit as parents, and are now investigating us as to whether or not we should be "allowed" to keep the other kids. What can we do to bring pressure on these people to do what is right? We have a court-appointed atty. that doesn't seem to give a damn, and the Guardian adLitem that was appointed for the child has no idea what ADHD/ODD is. I have tried to educate all parties concerned, and no one is willing to take the time. It's too easy to put the blame on us as parents rather than get the help he needs. We have agencies willing to help out, but DHR won't co-operate and send the required forms. Any help would be appreciated. Thanks Ghostprincess@worldnet.att.net

I ran across this site called the Crime Times and found some very Interesting articles concerning adhd, fetal alcohol syndrome, hyper- Activity, impulsivity as well as new research being done in the Areas of diet and nutrition as they pertain to behavior. Check them out At www.crime-times.org

"Crime Times provides current information on research about the link between aberrant behavior and neurochemical imbalances, physical injury, drugs, toxic environment, diet, food and chemical sensitivities, birth trauma, and genetic vulnerabilities to such factors."

Here is their Statement:
WHY CRIME TIMES?

More than twenty years ago Congress set up the Law Enforcement Assistance Administration within the Department of Justice, in an all-out effort to reduce crime and violence. Funding was provided to build more jails, to obtain more police and police cars, to increase street lighting, to help the disadvantaged, etc. After a few years and hundreds of millions of dollars, funding was stopped; the effort was a failure, and crime and violence continued to escalate.

Today Congress is set to do the same thing again, except this time funding is tens of billions of dollars.

It has been established that four to six percent of boys of a given age will commit over half of all the serious crime produced by all boys of that age. That four to six percent is not going to be helped by counseling, better education, or tougher laws. To assume so overlooks the fact that most of these individuals lack the innate ability to benefit because of their dyslogic, lack of insight, lack of fear, impulsivity, and inability to realize the consequences of their actions or learn from experience.

Their basic problem is not TV violence, poor parenting, poor teaching,broken homes, or poverty. There are too many good, law-abiding citizens who have grown up under these same circumstances. Such problems most certainly can contribute to crime and violence, but the basic problem in the hard-core offender is more likely to be a malfunctioning brain.

Some people fear that biological causes must be treated with radical medical interventions such as heavy psychopharmacological agents or even psycho-surgery. But research shows that measures as simple as better prenatal care, better nutrition, reduced exposure to environmental toxins, or remediation of neurochemical imbalances can be highly effective in correcting problems in behavior.

Unless the physiological functioning of the brain is included in the quest to alleviate crime and violence, we suggest that any effort will be a failure.

Be sure to check out their articles!

HUMOR

This popped up on one of the message boards and caught Myself chuckling at more than just a couple so thought I'd Share it with everyone.

HEART OF THE WEB: Is a collection of outstanding websites By people who've been where we are and want to share What they've learned with others so that they might learn from Them.

ADDiaries: I wanted to start a collection of stories/thoughts that Others could read and perhaps relate to and learn from. If you have Something you'd like to share with others, please send it to me and Let me know if you would like your email address included so that Readers can correspond with you.

BRAG BOARD: My attempt to help us focus on the positive Steps, no matter how big, nor how small, rather than the Negatives. These children are truly a challenge to parent And often their days as well as our own are filled too many Negative interactions. All posts are welcome, anything From a good day at school to getting the homework done Or finding a way to successfully deal with a particular behavior.

Please remember that this Newsletter is open to contributions From readers. If you have anything you'd like to submit and/or Contribute, please do. Stories, ideas, poetry etc. Please Send it to Contact Us

As always, I want to thank my sponsors who help make this All possible:

DR. DAVE RABINER
RICK PIERCE, THE HYPERACTIVE TEACHER

If you would like information on how to advertise On my site please email me at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a>

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