ADHD Article Article November 1998

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For my column this month I'd like to share with you an article that I recently reviewed in ADHD RESEARCH UPDATE, the newsletter I publish to keep parents informed about new research on ADD/ADHD. This article summarizes an important paper that was published in the Journal of Clinical Child Psychology (Volume 27, 190-205)in which the efficacy of non-medical treatments for ADHD was discussed. I will try to highlight major conclusions that are reached by the authors, including the cautions they discuss about stimulant medication treatment (e.g. Ritalin).

In regards to medication treatment, the authors emphasize that numerous studies have clearly documented the efficacy of pharmacological treatments for ADHD. Stimulant medications have been shown to have large, beneficial, effects on multiple domains of functioning in children with ADHD. In fact, the efficacy of stimulant medication treatment is so well-established, that it is the benchmark against which alternative treatments must be compared. Having made this general conclusion, however, the authors raise several caveats about medication treatment that are very important to be aware of.

First, it is important to note that despite the positive effect of medication on children's daily classroom performance, evidence that stimulant medication results in long term positive changes in children's academic achievement does not yet exist. Similarly, although stimulant medication has been shown to reduce disruptive behavior and negative peers interactions in children with ADHD, there is also no evidence that medication yields long term gains in children's social relationships.

The authors also emphasize that although between 70 and 80% of children with ADHD respond positively stimulant medication, for most children this does not result in their behavior being "normalized". In other words, even though medication often results in dramatic improvements, many children with ADHD will continue to exhibit important difficulties. It is for this reason, that medication alone is an insufficient treatment for many children with ADHD.

As is evident from the above discussion, the major limitation of medication therapy is that studies that have followed children treated with medication for periods up to five years have failed to demonstrate that the drugs improve children's long term prognosis. Thus, although dramatic short term improvements in children's academic, social, and behavioral functioning are frequently evident, this has not yet been shown to result in long term improvements in the same areas.

I would like to emphasize, as do the authors of this excellent paper, that an important reason for this may be the way that medication treatment is often conducted. For example, systematic efforts to evaluate the effectiveness of different doses and/or different medications in individual children are rarely done. As a result, many children who are taking medication do not receive either the dose or type of medication that would optimize benefits for them. This is a real shame, because several studies have shown that when careful efforts are made to identify the optimum dose and medication, the benefits received by children with ADHD are much greater.

In addition to this limitation in how medication is typically prescribed, an even more important problem may be the duration that children often receive it. For example, a survey of all prescriptions written in one NY county over a one-year period revealed that the vast majority of children for whom physicians prescribe stimulants received only one or two months worth of medication. This implies that many parents failed to have their child's prescription refilled, and that physicians may often fail to monitor this. If this is the case, as it unfortunately appears to be, it is little wonder that long term positive effects of medication treatment have yet to be conclusively demonstrated. Whether the more careful and appropriate use of medication will result in long-term gains for children with ADHD is currently under investigation in several well designed studies.

For those of you children are being treated with stimulant medication please do not conclude from the above discussion that medication is not helpful for children with ADHD. Although the authors of this paper do an excellent job of pointing out the problems with how such treatment is often conducted, they also note that stimulant medication remains the most effective form of treatment for ADHD that has yet been investigated. Making sure that your child is receiving the optimum type and dose of medication for him or her, and then carefully monitoring the ongoing effectiveness of the medication, will significantly enhance the value of this form of treatment for your child.

Empirical Support for Psychosocial Treatments

What we know about how effective psychosocial treatments are for children with ADHD? Based on their extensive review of the research literature, the authors conclude that two types of nonmedical interventions have been demonstrated to be effective for children with ADHD. These two interventions are behavioral parent training and contingency management interventions in the classroom. Empirical support for other types of treatments has not yet been clearly established.

Behavioral Parent Training

Behavioral parent training typically involves teaching parents how to implement a consistent system of rewards and negative consequences to their child to encourage good behavior and to discourage inappropriate behavior. In typical behavioral treatment programs, parents are educated about ADHD and about effective behavioral management strategies. Parents are taught how to appropriately encourage and reward positive behavior and how to ignore and or punish inappropriate behavior. In addition therapists in such programs often work with the child's teacher develop classroom management strategies for the teacher to use, as well as daily report cards that provide feedback to parents on children's school performance. This daily feedback from the teacher provides a basis for either rewarding the child or for removing certain privileges. A more extensive discussion of behavioral treatment can be found at www.helpforadd.com/behtreat.htm

The general approach to treatment outlined above has been shown in several studies to produce clinically important improvement in children with ADHD in both home and school settings. Although this is encouraging, the authors make a point stress that the improvements obtained with clinical behavioral interventions are typically not as large as those obtained with medication.

Contingency Management Interventions

In contrast to the type of behavioral treatment described above, contingency management approaches are characterized by more intensive interventions. Although contingency management approaches also rely on the use of positive and negative consequences as described above, they are implemented directly in the setting of interest by a highly trained and experienced individual.

For example, a child with ADHD might have an aide with him or her throughout the school day who would carefully monitor the child's performance, and give the child frequent feedback about how they were doing. The day might be divided into distinct 15 minute intervals with specific behavioral goals for each interval. At the end of each 15 minute segment the child will either gain or lose points depending on how well they did in meeting those goals. Depending on the number of points accumulated during the day, the child would be able to earn different rewards. Obviously this is a very intensive form of treatment, and is not something that can typically be done by the regular classroom teacher.

The positive effects of this type of intensive treatment are larger than for the approach to behavioral treatment previously described. As with more standard behavioral treatments, however, the effects of contingency management interventions are typically not as large as the effects of medication. The long term gains that are produced by such interventions, as opposed to more easily demonstrated initial improvements in children's behavior, also remain to be clearly documented. In addition, just like stopping a child's medication will eliminate the positive effects and lead to a return of the child's symptoms, the same holds true for contingency management interventions - once the program is stopped, it is very likely that the child's behavior will soon return to how it was before the program was implemented. In other words, this is not a "permanent" cure.

Summary and Conclusions

There is a lot of extremely important information in this paper and I would like close the discussion of it by trying to highlight the major conclusions reached by the authors.

So far, no form of treatment for children with ADHD has been shown to be more effective, or even as effective, as stimulant medication.

Not all children benefit from medication, however, and some cannot tolerate the side effects. In addition, in many cases, medication is not administered in the careful manner that is necessary to optimize the benefits that the child can receive from it.

The authors suggest that for many children, combining a low dose of stimulant medication with behavioral treatments may be the most effective and cost-effective treatment for ADHD.

Apart from stimulant medications, behavioral parent training and contingency management interventions in the classroom are the only forms of treatment for which clearly documented empirical support has been obtained.

Obviously, there have been many other way for helping children with ADHD that have been proposed, and numerous other treatment approaches have been touted as being effective. There is an important difference, however, between anecdotal reports that a treatment approach has been helpful, and well controlled studies that provide data to support such claims. At this point, such data has only been provided for the treatments reviewed in this article.

I want to emphasize, however, that just because other types of treatments have not been demonstrated to be effective yet, does not necessarily mean that they may not be helpful for some children. Different children may be helped by different treatments, and evidence for the effectiveness of other treatment approaches may emerge down the road. At this point, however, empirical support for treatments other than medication, behavioral parent training, and contingency management interventions has not been clearly provided.

So far, no form of treatment has been clearly shown to produce long term gains in the adjustment of children with ADHD.

Even for the empirically supported treatments reviewed in this article, it is important to emphasize that it is only short-term improvements that have been documented. In part, this may be because the well designed studies required to demonstrate long term gains have not yet really been done. Such studies are currently underway.

What this means, is that parents must be carefully monitoring how their child is doing over extended periods of time. One can not assume that just because a child has shown a good initial response to a treatment such as stimulant medication that everything will go well from there. Treatment needs to be ongoing and it's effectiveness needs to be continually monitored.

I hope that you will not read this and be discouraged. My own belief, based on experience in working with children and parents over a number of years, is that parents can make a tremendous difference in helping to promote their child's long-term success. By being aware and educated about how the best help children with ADHD, by carefully monitoring how their child is doing, and by making adjustments and modifications in their child's treatment when this appears necessary, parents can exert an important positive impact on their child long term development. It can help tremendously, of course, to find an experienced professional to assist you in this task.

David Rabiner, PhD
Licensed Psychologist

Note: If you would like to receive a Free Trial subscription to ADHD RESEARCH UPDATE, just click on this link: addhelp@mindspring.com, type "Free Trial" in the subject line of the message window that pops up, and hit send. I'll send you 3 sample issues to review that I believe you will find to be interesting and informative.

** An Invitation From Dr. Dave **

Just a reminder that the next on-line discussion is scheduled for this Wednesday, November 18 at 9:00 PM EST. The general topic of the discussion will be behavioral treatments for ADHD, but I will be happy to try and respond to whatever questions/issues you would like to discuss.

Instructions for being able to participate in the discussion are listed below. I hope you can make it.

Sincerely,
David Rabiner, PhD

After a brief absence from the internet, Rick Pierce is back with a new column and a new website. Get a practical, first-hand look at Attention Deficit with insightful perspectives on the disorder and simple, but effective approach to training the ADD child from the Hyperactive Teacher. Rick Pierce has posted his entire book on his site and is dedicated to making http://www.hyperactiveteacher.com The primary source for ADD information and training, a place you can refer others, like your child's teacher. Free articles, Free Newsletter, Free access to his book and more.

Does ADD Really Exist?
by Rick Pierce, The Hyperactive Teacher
www.hyperactiveteacher.com

I was not diagnosed with Attention Deficit (ADD) until I was an Adult. Once I started telling my friends and colleagues about my diagnosis, they began accusing me of making excuses for my shortcomings.

I believe this attitude abounds among my fellow educators. Many teachers feel that they have seen enough bad parenting, and poor situations, to dismiss Attention Deficit as just behavior caused from environmental issues such as chaotic households, divorce, abuse, neglect, nonattentive parents, etc. They feel that ADD has become the "disease du jour," and that certainly not all these kids can have Attention Deficit. The parents of these children think that those teachers are totally out of line when they do not believe that a child has ADD. However, there are kids who have ADD-like symptoms, but yet, are treatable. However, true ADD has a biological, not environmental, cause and can not be cured just treated.

On the other hand, parents - when they hear that their kid might have Attention Deficit Disorder - also jump to the defense of, "No, it can't be. My kid is a good kid. It must be something else, it must be the teacher's fault!" The assumption is that ADD children are somehow "bad" children or somehow not good enough. People hear the word "disorder" and refuse to believe that there is something wrong with their bright, energetic, and creative child. "If only the teacher would challenge the student more. He acts up because he is bored."

Either way, what we end up with is parent versus teacher. This conflict is not good for the student. The two most important groups of people in children's lives are their parents and their teachers - especially in the elementary age. This acrimony, or distrust between parents and teachers, is not a good thing.

This confusion exists because sometimes bad parenting or poor situations can create inattentive and/or inappropriate behaviors. Sometimes bored, unchallenged, bright students will fail. Many reasons exist for ADD-like behavior. We'll call this phenomenon, Psuedo-ADD. But let's be sure not to throw the baby out with the bathwater and blame all inattentive, hyperactive actions on other people. At least 3% to 5% (approx 2 in every classroom) have ADD.

I offer the following comparison between ADD and Psuedo-ADD to provide clarity and encourage proper diagnosis.

ADD is a chemical imbalance. There aren't enough neurotransmitters in the brain to get thought messages efficiently from memory storage to the decision-making part of the brain called the executive function. Without these neurotransmitters, the executive function within the brain can not make proper decisions; therefore, these people tend to be inattentive, impulsive, and hyperactive, due to this chemical imbalance. We discuss this process in more detail in Chapter 3, How ADD Works. (You will find my entire book posted on the web at www.hyperactiveteacher.com )

Pseudo ADD appears the same, but it's because of a reaction to an environmental stress or other disabilities. For example, if a child has a hearing problem or a problem deciphering words, it may appear that they are not paying attention. It may appear that they're not interested in what's going on, but possibly, that is just because they are not hearing or understanding. The behavior my look like ADD, but I don't care how much Ritalin you give the child, he will not hear any better.

Just imagine if your family is going through a divorce, or there is a death in your family, or there's incredible stress, or your parents aren't paying attention to you. What kind of behavior is going to happen? Would you care about school? Would you complete your homework? No, of course not! Would you appear to be disorganized or disinterested? Well, absolutely!

These behaviors can look like Attention Deficit Disorder. Teachers and parents - quick to try to solve a problem - might try to get a student on medication or try to get him or her diagnosed when, in actuality, other issues are involved. However, we cannot dismiss all behavior to Pseudo ADD because there truly is a chemical inherited behavior called Attention Deficit Disorder.

ADD is inherited, which means it's passed from parent or grandparent on to the children. In fact, many people say, "Well, you can tell that this kid has problems because just look at his parents." Well, if it's inherited, where did the kid get the ADD? From his parents.

Pseudo ADD is not inherited; it's just inappropriate coping. Pseudo ADD behavior is a mechanism that helps this person's mind to cope with things it doesn't want to deal with. So the child may just tune out, or act out.

ADD is lifelong and is observable before the age of seven.

In contrast, pseudo ADD is situation-driven. If after awhile the situation gets better, or the problem with the learning disability is dealt with, then the ADD-like behavior will begin to disappear, and you can have a child who will then be very successful in a normal way.

Another difference between ADD and pseudo ADD is that ADD is incurable. ADD will disappear for thirty percent of the people after adolescence, but, for most ADD people, it just goes underground a little bit. I like to say "You don't grow out of ADD, you grow into it." Because of maturity, some of the acting out is pushed underneath, but the issue still hasn't been resolved; the inattentiveness is still there. Often, we'll call the behavior "attitude" when it tends to show up in a teenager. And also, teenagers tend to be just somewhat ADDish just in that stage, so it's sometimes hard to pick out. However, ADD has no cure, just treatment.

On the other hand, pseudo ADD is curable. Find what the issue is - the stress, the trauma, the difficulty - and deal with it if it can be dealt with. Work with it. Teach the coping skills, and these people can get through it without having a residual throughout their life.

The percentages of people who truly have ADD depend upon the research. Most research presents a figure of three to five percent of people who have ADD. Some conclude that five to ten percent of people have ADD. So, I've picked a number between three and eight percent of the children in your classroom, or of people in general, who have ADD. However, there is probably a much larger number of people who have pseudo ADD, and it's becoming greater as time goes on.

As our society changes, as divorce increases, or single parenting increases, or stress in a child's life increases, or things get faster, or television becomes more and more hyperactive itself, we are creating a pseudo-hyperactive world. The numbers are somewhere between twelve and seventeen percent. We're looking at about twenty percent of our classrooms exhibiting ADD-like behavior.

These similar appearances are why it's extremely important to get a proper diagnosis and to know what it is that is causing the behavior of this child. Whether it's ADD or something else, it needs to be discovered, so it can be appropriately dealt with.

With an ADD person, there are two ways of dealing with treatment. There is stimulation, (See Chapter 4, Balancing the Brain) which includes, but is not limited to, medication, and there are coping skills, the types of skills that these children need, or these adults need, to be successful.

For people with pseudo ADD, treatment involves situation management, which is figuring out what is creating the behavior and then dealing with it, as well as training coping skills. Now I want you to notice something - the one treatment that both of these have in common is coping skills. The same skills that need to be taught and trained with Attention Deficit Disorder are equally as effective for persons with pseudo ADD. These skills are where I'm going to spend quite a bit of time in my book. Because whether you have pseudo ADD or ADD on your hands - whether you're a teacher or a parent or you have it yourself - these skills will be success strategies for anyone.

I discovered this piece of humor being passed around and thought it seemed appropriate. Imagine wanting more information regarding ADD and calling the Psychiatric Hotline.

Welcome to the Psychiatric Hotline

If you are Obsessive-Compulsive please press 1, repeatedly.

If you are Co-Dependent please ask someone to press #2.

If you have Multiple personalities please press #s 3,4,5 and 6.

If you are Paranoid Delusional We know who you are and what you need. Just push any button and stay put. The homing device implanted in your body will lead us to you.

If you are Schizophrenic Listen carefully, a little voice will tell you which number to press.

If your are Manic-Depressive It doesn't matter which number you press. No one will hear you.

And if you have Attention Deficit Disorder You probably can't hear this message because you are unwinding the receiver cord to see how fast it spins.

Source unknown, (ADD line is mine)

This article is an edited excerpt from "How to Help an ADD Child Succeed in Life." I have decided to post my entire book on my website. If you are interested, please visit my website at www.hyperactiveteacher.com

** Reader Requests **

I'm looking to start a Boy Scout Troop for Special Needs Boys. This troop would be for boys with special needs like ADD/ADHD, Tourette syndrome, MS, and other needs. I have a 19yr old son who has ADHD and is on Ritalin which is helping him tremendously he has been on it since he was 10 yrs old. My youngest son is in scouting currently and we are looking to start this troop. It was kind of a family agreement to do this because of the problems my oldest son had in scouting because the adults didn't understand his problems. I would appreciate any ideas or suggestions any of you may have.

Please email me at rsjs@execpc.com
Thank you, Rick Schmid

A lot of the response that I have been getting is where do I get information, tell me more about your book, and how do I get started on a natural program?

Along with this is usually a description of age, symptoms, and medications that are presently being used.

When I started pursuing natural alternatives on a full time basis for my son it was due to my son being 50 pounds and certain individuals wanted to place my son on 70 mg plus being on clonidine. What I learned is that my son's behavior was getting even worse since being on prescription drugs. I didn't understand why at first, but my son was continually being increased in his dosages and intermingling drugs was being introduced.

I began to research the background of the prescription drugs and their side affects. Appetite loss was a major factor with my son and I later realized that this was leading to even more deficiencies.

Researching natural alternatives led me to see that there was a lot of common elements in the various selections of options at the health stores and with independent distributors. I bought and tried them with my son.

I was introduced to a woman who was a distributor of E'ola for herbal drops. These worked with the nervous and circulatory system and similar to prescription drugs they got into the blood stream within a thirty or so minute period. I could see and monitor the effects as I had with the prescription drugs but without the worry about further deficiencies. My son's behavior was his own and not altered only the positives seemed to be emphasized in behavior, but this was only a part of the solution.

Through reading the common components on the various cure alls it was the addition of various vitamins/minerals that made the difference. By themselves they had little to no effect. It seemed that for them to work I had to continue to increase the amounts given to achieve improved behavior. By looking up what the various vitamins, minerals, and herbs id I then researched on what amounts to give of each.

Deficiency was not something new in respects to family history, but understanding the reasons behind the deficiencies was.

I believe that my own family history of drugs, alcohol, and poor nutrition have led to the severity of symptoms displayed in behavioral and learning disorders.

With my son's behavioral disorders I needed to implement into our natural program some antispasmodic herbs to help control outbursts of aggression, verbal abuse, and compulsive behaviors.

What worked best for us was the addition of Valerian root and Kava Kava. Valerian root has been used in other countries for centuries and well known St. John's Wort is.

Behavioral and learning disorders are categorized from mild to extreme. For those whose disorder(s) are milder and are comfortable with the prescription drug that they are on(or their children) then I just ask you to consider implementing into your program some vitamins and minerals. The body can heal itself over time and my son is living evidence of this fact and also that it has helped me to help my own body when symptoms of my own arose.

I am happy to tell you all that my son no longer exhibits compulsive behavior and within a two year period has dropped the hyperactivity. The only time that there are signs of more activity is when he eats or drinks things that are not appropriate. As for that, maybe we can say that goes for me, too! :)

My son is not in any special programs and I live in the light instead of the darkness now. I now deal with regular little boy problems.

My book is a reference for the whole family for options, strategies, and more.

Please list behaviors, medications, and family history (if comfortable) when asking for help and information.

I am now able to reduce the price to %19.95, 7.5% tax, and $3.00 s&h through the company that I have my book printed through and cover printing costs. It is more important to get the information out there to you the reader than anything else.

To order send check to Michelle Davis, P.O. Box 10757, Prescott, AZ 86304. Email: brundage@primenet.com

If you have a fax include this in your response.

I hope that this brief family background of my own has been of help. Recently, a child of 4 yrs. of age has been taken off a prescription drug and is now on natural alternatives. (Better behavior, more attention, and is sleeping through the night. Quality of life is much improved for the child and all those around.)

Please consult with a doctor or natural alternatives physician when starting any program.
Follow through, consistency, and faith are the keys to success.
God bless you all,
Michelle Davis

Every year Barb and I have the same conversation: "Money is kind of tight. Let's not buy any Christmas presents for each other, and just get gifts for the kids."

And, every year, we end up buying something for each other. Last year, she gave me a Joe Sakic jersey (for you non-Hockey fans, Sakic plays for the Colorado Avalanche). Total cost - about $100. I bought a "surprise gift" for her too - a macaw. Total cost - $1200. Cage and accessories not included. We should have the bird paid off just in time for Christmas this year.

Barb always like parakeets, so I figured she would love a macaw.

Ok, it seemed like a good idea at the time. Besides, Sapphire (that was what Barb eventually named the bird) was just a baby, and he had been placed on this perch with an older African Grey Parrot. The Grey had attacked him, and had torn away most of his wings and tail feathers. I entered the pet store just after this assault had occurred. Here was this blue and gold bird, with no tail feathers and totally destroyed wings.

The pet store owner was scolding the rogue Grey as I entered the store. The yet-to-be-named Macaw was screaming - a sound not unlike that of a pterodactyl. There was general pandemonium through out the bird kingdom.

My heart went out to this once beautiful, now butt-ugly, creature. In typical ADD fashion, I saw not what was there, but what could be. "How much for the Macaw?"

The look from the store owner should have been a good clue. However, he quickly regained his composure, stopped convulsing with laughter, and spoke to me. We haggled over the price - from $1800 to a mere $1200 - and 30 minutes later I, er, I mean Barb, was the proud owner of the biggest bird I had ever held on my arm.

Barb went into shock. "You paid HOW MUCH for a bird with no feathers?"
"You bought me a blue and yellow chicken for Christmas?"

She eventually recovered - around July. She was noticeably apprehensive as her birthday approached in September. Today, she made me swear that I would not buy her anything for Christmas this year.

So I won't... not until at least December 23. And only if I can get a good deal.. like $600 off.

This was not my first offense. I have a problem with Impulse Shopping. For one thing, money is a totally abstract concept to me. I pay for almost everything by check, so I never actually see the cash. Or, as with the bird, I use the credit card - even worse for a person with ADD. The ADD concept of money is a lot like the ADD concept of time. ADDers have basically two perceptions of time - NOW and NOT NOW. Likewise, with money, its either HAVE MONEY or DON'T HAVE MONEY. One dollar is the same as one thousand dollars - the point is we have money so we can afford this purchase, even if it means having to charge the balance.

According to the Washington Post, the American Bankers Association says that 45 percent of the consumers surveyed think they can pay off their holiday charges in two months or less; 23 percent said it would take three months; however, in reality, the typical pay-off time for holiday debt is six months.

Another problem is that I like to give gifts. It goes back to that "Hunter/Farmer" thing. I am Primitive Man, searching the wild to provide for those whom I love.

Since last year, I have tried to think of ways to deal with this problem of impulse gift giving. Here are a few:

1. Establish how much I will spend before I leave the house. Be realistic - don't shoot the moon, but don't put the limit so low that I will probably exceed it either.

2. Take cash only. No cards, no checks. I want tangible, folding, money, even if the new 20's 50's and 100's do look kind of stupid.

3. Buy for those I am buying for and not for myself. Good: Barb would like a Yanni cd. (gag!)

Not good: Did Barb ever mention that she wanted a Harley? No, but that doesn't mean that she might not like one. Who knows - it might spark some kind of new interest or something. Besides, I think women who ride Harleys are kind of attractive. I think Barb might actually like a Harley. Now, what size of a leather vest should I get her to go with it?.....

4. Remember that things don't have to cost a lot in order to mean a lot.

5. To satisfy that "Hunter Thing", go shopping in off beat places and stay away from the mall. Antique stores, little Ma and Pa places, places in small towns, stuff like that.

Yes, I promised to not buy anything for Barb this year. Just as I have made that same promise for 10 years before.

Hopefully this year, I will find a great gift to not give to Barb without having to pay for it all year long.

Bob
add.miningco.com

You've been doing it since you were born. As a child you had lots of help with it. Since you're getting older, you're finding that you're having to do it more on your own. Hopefully, you've listened and learned from your parents, experiences, and other influential people (like teachers) as to HOW to best do it. Unfortunately, however, many kids haven't. Therefore, many kids end up with messes in their lives. What's this "thing" you've been doing since birth? Well, you're doing it right now. YOU'RE MAKING A DECISION….AND HOPEFULLY, YOU'LL DECIDE TO CONTINUE READING THIS ARTICLE!

Decisions come in all sizes and kinds. You make choices about your life each and every day. During the course of a day, you'll make hundreds of decisions. Some will seem easy, like what you're going to wear to school, whether to order sprinkles, M & M's or both on your yogurt, or which movie to choose at the Cinema 10! Others will be more difficult, for instance, whether to study for the physics test or go out with your friends. Then some decisions you will make can be potentially life-threatening: whether to exceed the speed limit while driving, whether to drink and drive, or whether to "just try" (only once) drugs.

Decisions allow you to make choices. The POWER to make the RIGHT choices will separate you from the deadbeats and those who move ahead in their lives. You have the power to decide what you will do, how you will think, and where you want to be. That's what separates human beings from other mammals. Along with this POWER comes heavy responsibility as well as immeasurable freedoms, IF you make the right decisions.

All choices come with consequences and outcomes. These consequences and outcomes are intended to be "life's teachers." Some of your choices and decisions will be wrong. Now, that's not really bad if you take it a step further and LEARN from your mistakes. This is what people refer to as the "school of hard knocks"; for those who don't learn from their mistakes, life continues to be a series of ups and downs, hardships and frustrations. These people continue beyond the "school of hard knocks" to the "university of adversity." If you want to make sound decisions, then there are some things you need to know about yourself and there are some skills you need to acquire.

Knowing who you are, what makes you tick, and why you do the things you do are important in making decisions. Step back from yourself and try to evaluate YOU. Ask yoursefl these questions:
1. Am I easily influenced?
2. Is it important for me to be accepted (at almost any cost) by my peers?
3. Do I find myself compromising what I feel is RIGHT/WRONG in order to fit in?
4. Am I gullible and naïve?
5. Do I think I know A LOT about life and living?
6. Do I have certain boundaries in my life that are cast in concrete? (i.e. No drugs, No alcohol, No sex, etc.)
7. Do I have well established GOALS and ASPIRATIONS for myself?

If you answered "yes" to more than one of the questions 1-5 and/or "no" to either question 6 or 7, then you very likely are prone to making some poor choices and decisions. Something that will help is a systematic way to make better decisions, even if you are a pretty good decision maker now!

If you follow these six steps in decision making, then you'll certainly find yourself making more solid, mature decisions. Let's walk through a practice dilemma as the steps are discussed. Here's the dilemma: You are at the mall with your friends. Everyone is waiting to go to a movie which doesn't start for another 45 minutes. Several girls and guys in the group pull out cigarettes and light up. You've never tried smoking before. You're encouraged to "try." There's no chance of anyone catching you: you're assured of that. (If cigarettes don't seem important, then substitute marijuana.)

STEP 1: Establish the "goal" of your decision. Ask yourself "what is the purpose?"

Dilemma: Is your purpose to be accepted by the group? Are you afraid if you don't engage, you'll be rejected by the group or labeled "goody two-shoes?" Do you want to "look" grown up? Is it something you believe you have to try "just once" and then you can say you've done it?

STEP 2: What are your choices? Do you think with your "head" or with your "heart" or, worse yet, impulsive emotions?
Dilemma: Your choices are clear with this situation. You either partake of the situation or reject the "opportunity."
STEP 3: Analyze the pros/cons of the choices.

Dilemma: What "costs" are involved? If you choose not to take part, then do you risk being ostracized by your peers? Will you be hassled to take part (and after a while you cave in because of all the pressures)? Could you possibly get caught? (Even though you've been assured that "that" cannot happen!) If you were cuaght red-handed, what would your parents do/think? What is the potential legal ramification of your choice? (If drugs or alcohol are being considered, then you'll certainly have a "visit" to the police station and maybe juvenile court.)

STEP 4: Prioritize mentally the choices.

Dilemma: which runs the most risks and/or restrictions? In the long run, what is more important to you, your good name and reputation or risking embarrassment, anguish, and pain for you and your family. Remember, YOUR CHOICES do not just affect you. There is a domino effect. Whether you like it or not, like throwing a rock into a pond, there are ripples that touch other people!

STEP 5: Now is the time to make that choice.

Dilemma: Sometimes you just have a few seconds to mentally process steps 1-4 (that's why you need to prethink situations that you will face, especially the uncomfortable ones, and be prepared!) Here's where you have ALL THE POWER-it's your choice. Like the old saying goes, if you make your bed, you'll have to lie in it!

STEP 6: Evaluate your decision based upon the outcome.

Like the theme song from the old movie, "The Poseidon Adventure," there's always a morning after. The last step in decision making is EVALUATION. It's called learning from life's lessons.

Dilemma: What did I do right/wrong? What could I have done differently? How will I take this experience and apply it to other aspects of my life?

There are some other pointers also to be remembered and practiced in making smart decisions.

1. Don't let your heart overrule your logical thinking. Act rationally, not emotionally.

2. Don't make decisions with "anger"; this often spells Danger.

3. Seek the advice and counsel of wiser, older people when making BIG decisions. Don't forget they've probably walked the path before! Mark Twain once commented that when he was a teen if was amazing how little his father knew, but when he reached 21, it was incredible how much smarter than his father had become! (Yes, it's only a matter of an open mind and listening!)

There's a quote that says, "It does not take much strength to do things, but it requires GREAT strength to decide on WHAT to do." Add to that the footnote that it takes IMMENSE strength to do what's RIGHT. Doing what's right and making the best decision may not be poplar and cool ( it rarely is), may not win you friends (in fact, your may lose so-called friends), and will not be easy. But, doing what's right WILL NEVER be WRONG!!

Visit Dr. Alice's website and learn the key to success! www.powerorganizer.com

Classroom Coaching: Developing Constructive Internal Language

School is one of the most potent influences upon the social and emotional development of our children. Peer pressures, teacher evaluations, academic challenges, and a host of other forces await our kids everyday. These forces shape children's evolving repertoire of life skills in a variety of ways. Sometimes the impact is favorable; for example, warm and healthy friendships can spur the continued growth of empathy, perspective-taking, and mutuality. On the other hand, the potential negative impact of teacher criticism or peer rejection can threaten academic motivation and self-acceptance. While it is reasonable for parents to try to shield youngsters from the negative influences of school, teachers and guidance counselors are in the best position to do so.

In my role as child psychologist I am often in contact with the teachers and school counselors of those children I treat. I try to share my understanding of my patients so as to "lengthen the shelf life" of therapeutic intervention. Often there are certain school requirements and triggers that children do not possess adequate skills to manage, i.e., sharing attention, complying with rules, containing energy, accepting critical feedback, being the object of teasing, etc. Teachers and counselors are eager to help and receptive to my suggestions for school-based intervention. When I explain my coaching model and Parent Coaching Cards, they invariably ask how such coaching might be implemented in the school. This article will discuss one of the major points that I have offered in response to this question.

The overriding goal of my work with all children, and AD/HD kids in particular, is to teach them emotional and social skills for successful coping. My coaching model leans heavily upon empowering one's "thinking side" and strengthening one's watch over the "reacting side. One critical way this is accomplished is through the development of constructive internal language. Internal language is what we silently think to ourselves. It takes on a constructive quality when it is used in the service of coping with life demands. Unfortunately, many children are more accustomed to using internal language as a release valve when faced with challenge, rather than as a pathway to effectively contend with challenge. For example, when various school pressures build up, students are more likely to think or say to themselves, "this is awful...I can't do this...I'll never make a friend, etc." These internal statements may temporarily relieve pressure by projecting responsibility and forfeiting participation. But, in the long run, they just perpetuate problems by drawing a child away from the construction of solutions.

Children can be coached in how to use their internal language in all phase of emotional and social skill building. The school is the ideal place to conduct such coaching due to the presence of demands and the support of teachers and counselors. One of the first steps is to help children identify their constructive internal language. It may be referred to as their "helpful thinking voice" to distinguish it from some of the self-defeating thinking that goes on in children's minds. Teachers or counselors might explain that the "thinking voice" helps to solve problems and make good decisions while the "unhelpful voice" can actually make problems worse or lead to bad decisions. An example can make this clear:

Suppose a boy sat down to do his worksheet of ten problems and realized that he could not do three problems on the page. Two thoughts come to mind:

A. "This is impossible, I'll never get a good mark on this. Why even bother trying?"
B. "Well, just because I can't do these three doesn't mean I shouldn't try my best."

"A" can be characterized as the "unhelpful voice" and "B" as the "helpful thinking voice." Next, children might be presented with the following dichotomy to reinforce their understanding:

Helpful Thinking Voice

In Response to Academic Challenge "This looks hard and probably even too hard for me to do... but I'll never know unless I try. I'm going to take it step by step and just forget about how hard it is so I can keep myself trying."

Unhelpful Voice

"This looks hard and probably even too hard for me to do ...I'm definitely not going to be able to do it. I hate this kind of stuff and can't see why we have to learn it.

In Response to Social Challenge:
Helpful Voice

"They don't like me and I don't like the way they are treating me. Maybe I'm different from them and they can't deal with that. Or, maybe they just don't really know me yet, and they'll change their minds when they get to know me better."

Unhelpful Voice

" They don't like me and I don't like the way they are threating me. They're idiots and I feel like smashing them. If they say one more thing to me, I'm definitely going to make them pay for what they're doing to me."

In Response to Emotional Challenge
Helpful Voice

"Things didn't work out...again. This is frustrating. It's hard to un- derstand why it's happened to me this time. Maybe somebody else can help me figure it out. Who should I ask?"

Unhelpful Voice

"Things didn't work out ....again. Why does this always happen? This is so unfair. I can't believe it. I don't deserve it. Why me?"

Most children will recognize how in each example, the initial thoughts are identical, but the resulting internal dialogue is completely contrary. Discussion then focuses on the imaginary scenarios that might lead to each one of these examples, and the specific phrases that each voice utilizes. In the case of the helpful thinking voice, words and phrases such as "step by step," " maybe" and "hard to understand" are offered to stress the importance of plotting a strategy to cope, making the option of change seem viable, and expressing the quest to make sense out of circumstances. In contrast, words and phrases such as "definitely," "hate," idiots," "feel like smashing them," "always," and "unfair" reveal the emotionally charged and absolute thinking of the unhelpful voice.

The helpful thinking voice examples also demonstrate the attempt to construct solutions to the problems faced by the child in question. In the academic challenge, the child adopts a strategy of minimizing awareness of difficulty. In the social challenge, the child adopts the perception of things changing for the better in the future. In the emotional challenge, the child decides to pursue helpful consultation.

Once children grasp the importance of constructive internal language they will be better able to benefit from the school-based coaching of social and emotional skills. Future articles will address the next steps in that progression.

Dr. Steven Richfield
Parenting Pointers
November, 1998
Be sure to check out Dr. Steve's website at www.parentcoachcards.com
Again, my thanks and deepest gratitude to all of those who help make my site and this newsletter possible.
LIVING WITH AN ADHD CHILD: www.adhdbook.com
NATURAL AND ALTERNATIVE THERAPIES FOR ADHD: www.naturaladd.com
GRANDMA'S PET WILDEBEAST ATE MY HOMEWORK: A practical guide for teaching and parenting adhd kids: www.adhdcounselorguy.com
FOCUS: www.cdipage.com/focus.htm
THE PHONICS GAME: www.cdipage.com/phonicsg.htm
LIVING WITH AN ADHD CHILD: www.adhdbook.com
ADDwarehouse: www.addwarehouse.com/indexbv.htm
DR. DAVE RABINER: Home of ADHD Research Update
BOB SEAY: add.miningco.com
DR. STEVEN RICHFIELD: www.parentcoachcards.com
MICHELLE DAVIS: www.freeyellow.com/members4/michelledavis/index.html
POWER ORGANIZER SUCCESS SYSTEM: www.powerorganize.com/Copyright 1998 Brandi Valentine. All rights reserved. This Newsletter is copyrighted by the authors and/or publisher. ADDed Attractions may be used for non-commercial purposes only and may not be redistributed for commercial purposes without the express written consent of Brandi Valentine.

Appropriate credit should be given to this resource and it's authors if It is reproduced in any form. Brandi Valentine