ADHD Newsletter November 1997

Dr. Dave's Advice
Vitamin Therapy
Dietary Interventions
Herbal Remedies
BioFeedback
SENSORY INTEGRATIVE THERAPY
INDIVIDUAL THERAPY
Rick Pierce, The HyperActive Teacher** **Dear Mr. Pierce**
ADD/ADHD and the Military*

Wow!! Here it is the middle of November already! Can you say 29 Shopping days left until Christmas??? Ack!!

My apologies for being a day late on the Newsletter. After my son was mistreated, (again) by the school district, I have been drowning in their sea of red tape known as their complaint system. This has been a new experience for me as I have never taken a complaint up the chain of command before and believe me, it's not a pretty site. So far, my situation has been trivialized by the Super-intendant and I was "strongly encouraged" not to proceed with a complaint but rather let the pricipal handle it at their level. ( in school-ease, that means let the principal sweep it under the rug at the school level). Magically, my super-intendant manage to take a 5 page type written complaint and resolve it with a 2 paragraph report ( I don't think so!) so now I have taken the compalint to 3 new levels, 1. referred it to the State under the special education code that protects the safety and welfare of a child. 2. Filed a Uniform Complaint and 3. I have requested and will be able to address the board of supervisors on Tuesday the 18th. I just want to enourage you as parents to advocate for your children. Play the games, jump through the hoops and learn the rules and familarize yourself with the system. My mother told me that the school wouldn't waste a moment holding my son accountable for his actions and it's time we held the school resposible for theirs. Follow your heart and listen to your instincts. You are the only advocate your child has and if you do not stand up for your child, no one will. Don't let the process intimidate you nor those in charge.

I've been receiving several questions each week about a variety of different treatments for ADHD. Without meaning to step on any toes, I thought it would be a good idea to briefly review some of these alternative approaches and what is known about them. Let me say at the outset that if you have found something that works for your child that is FANTASTIC, and it is not my intention to "put down" any of the treatments described below. Instead, my purpose is to simply review the evidence that exists to support different treatments. If anyone is aware of supporting research that I have missed, I would very much appreciate hearing about it.

Treating ADHD with very high ("mega") doses of vitamins is based on the premise that children with ADHD lack specific vitamins and minerals which are normally present in the body. Because vitamins are associated with good health, this has an intuitive appeal, and the fact that they are "natural substances" makes this approach seem safe.

Unfortunately, there is no scientific evidence which supports mega-vitamin therapy as an effective treatment for ADHD. At least 3 well controlled studies have failed to find any benefits for this treatment. When taken in extreme doses, several studies have also shown the possibility of toxic effects.

The belief that ADHD was caused by various food additives was popularized by Dr. Ben Feingold, originator of the Feingold diet. Dr. Feingold claimed that when children with ADHD were placed on his diet, about half showed dramatic improvement.

As far back as 1982, the National Institute of Health reviewed evidence for the relationship between an additive free diet and ADHD. Their conclusion, which still holds today, is that for the VAST MAJORITY of children with ADHD, food additives play no role and dietary changes will not effect their symptoms. A small percentage of ADHD children, however, may derive significant benefits from dietary changes.

Sugar free diets have also been proposed as a viable treatment for children with ADHD. Careful studies have found no convincing evidence, however, that sugar has a significant adverse effect on the behavior of school age children. When effects have been found, they are quite small and apply to only a small percentage of children.

Please don't misread the above to suggest that good nutrition is not important. Clearly, all children would benefit in important ways from a healthy and well balanced diet. For some children with ADHD, dietary changes may even have a large positive impact. Making sure your child follows a healthy diet can thus certainly be helpful, but is unlikely to adequately address the difficulties of the vast majority of children with ADHD.

A variety of herbal remedies and other natural alternatives have also been touted as effective treatments for ADHD. In theory, this would seem to be plausible. After all, some of our most powerful and effective medicines are derived from natural substances and ingesting certain substances can certainly alter brain chemistry. Unfortunately, according to the American Academy of Child and Adolescent Psychiatry there is absolutely no empirical evidence from well conducted studies that any such remedies are effective.

Biofeedback is a technique in which a person is taught to gain voluntary control over normally involuntary body functions such as heart rate or blood pressure. When used to treat children with ADHD, children are trained to increase brain waves that are presumed to be associated with focused attention and to decrease brain waves presumed to be associated with daydreaming.

Impressive results have been reported for this treatment. Proponents have claimed that after training over 60% of children with ADHD no longer required medication. Large increases in IQ scores have also been reported. Most impressive of all, the results obtained with biofeedback have been claimed to be PERMANENT, which is in sharp contrast to all other treatments for ADHD.

Biofeedback treatment for ADHD is expensive - ranging from $3000 to $6000 for an entire course of treatment. Given this expense, parents should approach this option cautiously: to date the evidence supporting these claims is not very substantial. Studies that document its effectiveness using appropriate control groups are NONEXISTENT. Although this approach may have promise, most mental health professionals believe that it is a very much unproven treatment at this point.

This therapy is based on the assumption that hyperactivity in children is caused by "poor sensory integration" - i.e. children's brains don't effectively combine information from different senses which makes them confused and out of control. The treatment consists of exercises that stimulate various sensory systems to give the child practice with integrating different sensory information. The treatment is fairly long and involves multiple training sessions. Several well controlled studies of the effectiveness of this approach have not found that it produces any improvement in children's attention.

There is also no evidence that traditional therapy produces any improvement in ADHD symptoms. It can be very useful to deal with the secondary emotional problems that often develop in children with ADHD, but is unlikely to be helpful for reducing the core ADHD symptoms of inattention, hyperactivity, and impulsivity.

More recently, cognitive therapy approaches have been formulated specifically to treat ADHD symptoms. In cognitive therapy for ADHD, the child is taught specific techniques that are intended to make him or her less impulsive and more reflective. For example, the child would be taught how to use "self talk" to approach problems more methodically.

In contrast to the other treatments described above, cognitive therapy approaches were developed by academic psychologists and have been carefully studied. Initial results appeared promising, and this approach is based on accepted theories of behavior in general, and ADHD in particular. Unfortunately, cognitive therapy has not lived up to its early promise. Results with children with ADHD have been QUITE modest, and efforts to teach children self-control strategies have clearly not been as effective as stimulant medication or traditional behavior therapy.

The above review addresses only a portion of the alternative treatments for ADHD which have been proposed. For an extensive discussion of this topic, I would strongly recommend the book Attention Deficit Disorder and Learning Disabilities: Realities, Myths, Controversial Treatments by Drs. Barbara Ingersoll and Sam Goldstein. I think you will find it to be excellent.

Once again, it has not been my attention to criticize approaches that some of you may have found to be helpful. It is important to approach "new" treatment approaches cautiously, however, particularly those which make impressive sounding claims which are based on little more than anecdotal evidence and individual testimonials.

There is NO KNOWN cure for ADHD, and researchers are involved in trying to develop what will be effective long term treatments. To date, the only documented effective treatments are medication and behavior therapy. Even here, however, it is short term effectiveness that has been documented. What treatment, or as is more likely, combination of treatments will help children with ADHD maximize their potential over the course of their development is a critically important question that has yet to be fully answered.

NOTE: Dr. Dave's AddVice is written by David Rabiner, a clinical child psychologist who specializes in the evaluation and treatment of ADHD. Dr. Rabiner also publishes a newsletter called ADHD RESEARCH UPDATE that keeps parents informed about new research on ADHD and how new findings can be applied to help their child. To receive a sample copy of this newsletter e-mail your request to addhelp@mindspring.com or visit www.svr.com/addhelp.

Over the past few months, I have been receiving a variety of questions from concerned parents. Although I can not print them all, I thought that other parents might have similar concerns. Soon I will include these and others on my website.

Dear Mr. Pierce ,

I'm a mother of 2 boys that have ADHD. My oldest child is 12 and he is having a very hard time with reading. If something is read to him he is at his grade level but if he has to read it himself he drops down to a 4th grade level. What can I do to help him in his reading.

Thanks, Concerned,

Dear Concerned,

I have dyslexia, as well as having ADD. I have the same issues as your son. I listen to books on tape for my reading pleasure. I also read aloud to myself. This helps me a lot. You may want to suggest to the teacher allowing him to take tests or do reading in a separate place or afterschool, so he can read to himself without being considered odd by the other children. Another approach to try which may seem strange, but it works for many, is to get a clear yellow plastic sheet (like an overhead transperancy) and have him put it over the book. For some reason the text settles down and is more easily read. Try it. You may want to try to teach him to use a highlighter when reading to highlight important ideas. This will help with loss of information while struggling with the words.

I hope this help. Rick Pierce

Dear Mr. Pierce,

I have a quick question. My son is in 6th grade and seems to be doing better with school this year, although he still hates it. He took a math test. The teacher asked the students to show their work on 6 - 8 problems on the test because they had been learning the "4 steps" to problem solving. My son didn't show his work on all the problems that the teacher asked for, although he got the estimation problems correct he did not recieve full credit/only half credit because he didn't show his work. That made a difference between an A and B-for a grade. All questions were answered correctly on the test but one. I tried to explain to the teacher how people with ADD aren't going to remember to show their work for a few problems on a test and that perhaps next time she should remind him or have him circle the problems/highlite them or something. I also think that if he got these math problems right he should have gotten credit. Her response was: Well I gave the instructions but, he can take the test over for a better grade if he wants too. I let all my students who get less that 80% do that. The second test grade counts. Needless to say my son wasn't interested 1. He didn't want to chance a lower grade, 2. He knows that he knows the material - even if he doesn't get full credit, 3. and he feels he did ok on the test. My concern is grades do help to get people into college. Am I asking too much from this teacher? He does attend a private school. Conferences are coming up and I really dread hearing about his terrible penmenship and drawing on worksheets. Any ideas?

Sincerly, Caring Mom

Dear Caring Mom,

It sounds like you made great suggestions to the teacher. Unfortunately, this will not be the last time your son will be marked down for his ADD. On one hand, your son is right, he did ok, he did his best and this one grade may not affect his overall grade. On the otherhand, settling for ok all the time may not be in his best interest. As for college, yes colleges look for grades, but they also look heavily on entrance tests like SAT's. That is what happen to me. Eventhough I had a poor GPA in school, my high achievement tests made me eligible for almost any school in the country. Nowadays, colleges are savy to ADD and have programs to admit and help them. I bring this up because there is a good chance that some failure is in your son's future, but this should not stop you or him from reaching for the dream. As for showing the work, I have taught and many bright students will avoid showing the steps if not made to. They reason they can do the work in their head: however, easy examples are used at first for teaching. These same students begin to have real problems when problems become more difficult. By not practicing the steps now, it may bring frustration later. However, the suggestions you made are reasonable accomodations. Also, if your son demonstrated he can follow the steps on a few of the problems this should show the teacher he is capable of doing the work. Teachers feel a need to be fair with all students, have a standard for all students, these rules are effective for the "normal" student. If the teacher bends for one they feel like they should bend for all. However, fair is not always best. This is why I have focused on training educators and parents on ADD. This teacher needs some information and training. It sounds like the teacher is trying to do what she feels is right. Hang in there. I hope this helps.

Rick Pierce The Hyperactive Teacher

Dear Mr. Pierce,

I was wondering if you could help me. I am looking for an answer to my question. Here goes: Do persons with ADD want to rush through their work? Then when the work is rushed through it becomes short and messy. I have a child that rushes through his writting assignments. I am told that when he slows down he can write neatly. I also know that he rushes through all his work and he does not care if there are mistakes or if he does not know the information. I do not know if he has ADD. He has reading and writing problems. Do you have any specific information on ADD symptoms? Is rushing through your work, a symptom? I know that CHADD has a list but I would like something that has alittle more information. ( details) Thank you for your help!

Curious

Hi Curious,

Many teachers and parent of bright ADD children notice this problem. When I did my work at school, this was my approach. Just get it done. ADD children take this approach for a few reasons. First, the immediate rewards are given for completion not accuracy. These rewards include being able to do something else of their choice when finished and a sense of completion and even superiority over others. I suggest you and his teacher immediately check all work for correctness at the time it is being handed in. By switching the immediate reward to correctness rather than completeness, he may be more careful eventually. Remember it may take a while to break old habit. Also, concentration is difficult if they do not get the thought down quickly they can lose the thought and then become frustrated trying to remember the thought..Brainstorming or orally reviewing the work can help get the thoughts down or organized before needing to do the work neatly. I have dyslexia, and many ADD children do as well, writing properly has always been very difficult. I thank God for computers, they have opened up the world of writing to me. Your son may rush through not worrying about mistakes because writing correctly is nearly impossible and may mean that homework would take forever. Then he couldn't do the things he enjoys.. I also suggest that neatness and even minor mistakes are less important objectives than correctness and completeness. If neatness is important then he should write the first draft for developing the thoughts and then copy the draft for neatness allowing him to focus on one objective at a time.

In writing assignment, one way to avoid short, rushed writing is to require specific information and not accept the work without the required information. However, short writing is not always bad. I have had students who avoided writing a lot by being succinct and concise. These students will become better writers because of this ability.

I hope this answers your question.
Rick Pierce
The Hyperactive Teacher
www.hyperactiveteacher.com

Author of "How to Help an ADD Child Succeed in Life" For a copy send $15 + $2 P&H check or money order to: 7907 River Otter Way, Elk Grove, CA 95758

I had some responses to ADD and the Military and wanted to share them with you so here goes:

Also a comment on ADHD and the military. Let me preface this: this concerning applying to the the Naval Academy. Concerning the comment about the local Air Force recruiter and the ADHD medicine issue. Things may be different when talking abou straight enlistment versus the academies. It states in the handbook from the Naval Academy that ADHD is an automatic medical disqualification for an appointment to the Naval Academy. It does not state any mention of drug free for one year. Good thing we didn't read the handbook very carefully, because my son applied to the Naval Academy. The questions on the Medical form ask for comments concerning ADHD, learning disabilities, etc. We clearly marked that he was off medicine for 4YEARS !!, and they automatically disqualified him for this reason "ADHD requiring Ritalin", an admissions officer at the academy stated this is an automatic kickout from the computer and we needed to apply for a waiver. Even after all the test, the Naval Academy finally waived it, but the Air Force Academy did not.(Believe me, the medical wanted board not only wanted a psychologist evaluation but a psychiatric evaluation and educational testing (WISC-Adult, etc.) It was like being reevaluated. Our psychologist was great.) They wanted to see him perform at the college level off of medication and with academic success and reapply next year. He got admitted to the Naval Academy and that is where he is now. I would be happy to correspond with anyone about what we went through.

Gerry ballpart@cdmnet.com
Brandi,

I just wanted to give you a quick update. First of all thank you for posting my request. In 48 hour I was flooded with letters, each story was diffrent, each story was heartbreaking. It is amazing how many people have been affected by the militaries discrimination againt ADD and ritalin. It seems that the discrimination goes beyond medication. There were a few young men who were denied because of their ADD/ADHD diagnosis.

I copied all of these letters and sent them to 4 media personalities. 3 from ABC and 1 from MSNBC, I have already heard positive feed back from both networks, and the information has been passed on to a reporter. She has told me that no one at ABC was aware that this situation even existed. ABC has already checked the info. out with their medical resources and now they are in pursuit of investigating the issue with the military. I have been assured that this will make the news, if not on Nightline than on another ABC news show.

A correspondent from MSNBC has also contacted me, she works with a discrimination group who would like to see this brought to the senate floor. They also have this situation under investigation.

I am sure this will all take some time, but I am very hopeful. I heard another story yesterday from a Social Worker here in Northern Virginia. She had been working with a young man with ADD, he went through college and just completed law school. When he went to take the BAR Exam he was informed that he could not be licensed to practice law because he had been taking ritalin. They considered ritalin a mind altering narcarcotic.

It seems to me that the discrimination that we are now hearing about is just the tip of the iceberg. Once again, thank you for your help.

Kerry has promised to keep me up to date on this issue and I will pass along any information when I get it!!

I'm running our of space for this issue of Added Attractions! Two quick things I want to mention are:

1. Special Education Rights and Responsibilities Manual! My BIBLE!! Very informative and now online!! I have used this manual successfully for the last 4 years and wouldn't be caught dead without it. You will find it linked to the main page of my website at http://adhdnews.com/index.html If you have problems viewing the manual, I have made a zip file of all 13 chapters, 306 pages and will be glad to send it to anyone requesting it. Write me at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a> for more info.

2. I am now supporting Bob Seay of the mining co in his efforsts to begin an online support community through chat. here are the times and days of his hosted discussion.
SUNDAY EVENINGS: 9 PM - General Chat about ADD - your host, Bob Seay"We will cover a variety of ADD related topics, issues and just kill some time together."
MONDAY EVENINGS: 8 PM - Parents of Kids with ADD- your host, Char "Parents supporting one another."
TUESDAY EVENINGS: 9 PM - Newly Diagnosed Adults - your host, Jake "A chat directed to those who have just found they have ADD." Jake would also welcome any ADDers diagnosed long ago who wish to contribute to this discussion.
WEDNESDAY EVENINGS: 9 PM - Adult Students with ADD- your host, Tawny "I am aiming mostly at college, and graduate school students, and untraditional students ie. married with children while in school "older students" etc."
THURSDAY EVENINGS: 11PM - Late Night With Bob your host, Bob Seay "anything that has to do with ADD, and the occasional special guest."
SATURDAY MORNINGS: 9AM - Women With ADD your host, Judy "Addressing the special issues of women."
You can join chat from Bobs site at add.miningco.com.

You can help thousands of Kids and Parents everywhere.

Be a story teller. Tell us your stories of success so they can be shared with others in a HOPE newsletter called " i did it! " We want stories from both kids and parents Any success story is great, no matter how short or long on any topic. When a parent reads of successes in areas they are having difficulty with at home or school concerning their child or teacher, it gives them hope. When a kid reads about successes that other kids have had, in areas they are struggling with, told in kids language ( by kids for kids ) , it gives them a feeling " if that kid can do it, maybe I can too." WE BELIEVE THAT WHERE THERE'S HOPE,THEIR IS POSITIVE CHANGE AND RESULTS.

As parents of two boys: a 15 year-old with A.D.H.D. and 3 other disorders; and a 12 year-old who is in full-blown puberty, we've been there. And not only that, we're still there, everyday. And believe it or not, we just celebrated our 18- year wedding anniversary. And we are still growing together.