My son is now in second grade and I have now met many, many people whose children have been diagnosed with ADD.
Here is what I've learned about ADD: First off, some children's brains just mature later than others. That link is to a NPR article about a scientific study showing that some kids mature later, so it's not just my opinion. Here's another article showing that the brighter the kid the longer the cerebral cortex takes to mature. Again, doesn't apply to all, but these observations often don't even make it onto the table.
Before we start, I want to put more on the table. This is my opinion about ADHD: Data is showing us that more and more of the autistic children are affected by sensitivities to their environment. Real data. Why should ADHD kids be any different? Before medicating my child, I would
- Rule out sensory issues, such as hearing, vision, speaking, balance, and so forth, and ALSO
All of these things, I would do before starting him on any drugs. Now doesn't that sound reasonable to you?
What Causes ADHD?
For example: Let's say that your son or daughter is diagnosed as ADD. What causes ADD? It's really *not* a smiting blow from the heavens, you know. It's a condition, and one that's caused by something. Here's a very nice overview to the possible causes of ADD from the nice people at Developmental Delay Resources.
According to the DDR link, some of the causes of ADD might be:
- General sensory (e.g. immature sensory system)
What are the Treatments for ADHD?
Let's say that your child is diagnosed as having ADD. What are the treatments? Drugs, yes. Although please note that drugs should always be combined with a behavioral treatment plan, otherwise you're just medicating the symptom (during the day), not helping the child to grow. But what are the other treatments? And can you help your child grow out of it? Does a creative segment of our society all of a sudden need to be drugged for life? Really?
Things to Consider with ADD
ADD drugs are pimped, big-time, by big pharmaceutical companies, and these companies, seriously, are Not Your Friends. Regardless of whether the little pill helps your child to focus, calms them, makes them happier, I urge you to start at the beginning. Look at the building blocks first. I know of one little boy who is the size of a six year old - but he's eleven. He's been on ADD drugs for years and years. Sometimes your child will end up needing medication, but in the wide world of medicine you just cannot rely on a fatherlike doctor figure any more. You must do your own homework.
It's hard to do your own homework on the ADD issue, though, because when you first look at the issue, all roads seem to lead to medication.
- The organization CHADD was partially funded by Novartis, as mentioned in this PBS special report.
- That glossy magazine called Attention that you see in your doctor's office is also funded by drug companies - and it only has one, 1/4-inch ad for a therapy that is not drug-based in the entire magazine.
- It takes time and effort to look the allergy, sensory, and movement issues for a kid. Oftentimes parents and doctors who do so are deemed "out there" by more standard doctors.
- It's expensive to try alternative therapies, and the insurance companies will fight you and try not to pay. A pill, after all, is easier.
Here's an excellent Time Magazine article from 2001, talking about the explosion of Ritalin use. One of the things that the article mentions is that in 2001 the percentage of children with an ADHD diagnosis walking out of a doctor's office with a prescription jumped from 55% in 1989 to 75% in 1989. At the same time, the number receiving psychotherapy (the other half of the drug treatment equation) fell from 40% in 1989 to 25% in 1996.
[from this point on, this page is totally out of date. The links might be interesting, but it must be rewritten.]
It's amazing how intense the "medicate/don't medicate" debate is, and it's only as intense as a group of guilt-wracked parents can be. Sure. Some kids need medication. But have you checked out the other stuff also?
Here is a seemingly valid site that talks about many of the nutritive therapies that are currently being tried for ADHD. The Massachussetts General Hospital has a website called Braintalk Communities: Online Patient Support Groups for Neurology. They are very helpful. Here's a list of the Braintalk Communities. And don't forget the value of an educational therapist - one who can help your child to profile what they're good at and what they have problems with -- and work to get better.
Neurology and Learning Blogs
Dr. Richard Dowell Jr. PhD is a neuropsychologist who evaluates more than 400 children and adolescents a year. Here is his description of the "state of the nation" as it pertains to ADHD. Part 1, and Part 2. His blog, Inside Neuropsychology, is fascinating and shows wonderful levels of both knowledge and pragmatism. I love his perspective on how quick everyone is to push meds on ADHD-ostensible kids, for example.
ADD and ADHD - overview
So many kids are being diagnosed with this that there's a significant backlash. Why are so many kids being medicated? For many children, it's unnecessary. For many other children, it means the difference between a really scary kid situation and happiness -- in short, it's needed.
In my humble opinion, the "ADHD is lie, Ritalin is the Devil" people are ... well, I think that they are vaguely related to the "I will never vaccinate my children" people, who are in turn perhaps located sooomewhere in the family tree of the proverbial "rabid amateur." Some of the stuff is ... well, it reminds me vaguely of aliens, let's just leave it there.
I'm not going to list too many of the really "frothing at the mouth" "it's all a plot" ADHD people, but you might want to check out ADHDFraud.com, the website of Dr. Fred Baughman, Jr (pediatric neurology).
Notes on diagnosis
I recently spoke with a friend whose son was finally successfully diagnosed as having ADHD after several harrowing years. She told me that they got a 25-page diagnosis from the specialist whom they waited about 9 months to see (so if you have any doubts at all, get on a waiting list. Don't wait to "actualize" and don't worry about being "fair" to your child. Just get on the list -- and cancel it if you don't need it! -- that's my humble opinion. Again and again, I hear from parents just how long it takes to get into the system.)
At any rate, these are some of the tests that they administered:
Weschler Preschool And Primary Scale of Intelligence-III
Developmental teest of Visual-Motor intergration
Tests of Apraxia
Right-Left Discrimintion Test
Auditory Discrimination Test
Motor-Free Visual Perception Test-III
Ishihara's Test for Colour Blindeness
Sentence Memory Test
Knox's Cube Test
Cancellation of Rapidly Recurring Targets Figures test
Burks' Behaviour Rating Scale
conners' behavioral Rating Scale
Mental Status Examination
More notes on diagnosis
hey check this out! It's a place called "Integrative Psychiatry" (what a great name, hmmn?) that lets you send away for a whole battery of tests to determine what's wrong with you. A hypochondriac's DREAM!! Bypass those pesky doctors and redecorate your medicine cabinet! Ahem. OK, that said, this place looks pretty impressive. The thing that pertains to THIS topic is the Attention ADHD neurotransmitter test. I really have no idea why you would need this test or what you would use it for. Perhaps it's because it's so hard to separate out the ADHD children simply by using behavior? The mind boggles...
Notes on Treatment: Professionals
In the San Francisco Bay Area, there are many professionals who are suggested for treatment. Here are a few:
Here's a link to something called "One ADD Place," which bills itself as "The Source for aDD and ADHD Information."
People in the bay area who work with ADHD etc.
Dr. Susan Johnson comes highly recommended. Here is her bio. She is a behavioral and developmental pediatrician in Colfax, CA, whose background is varied and impressive.
We took our child to Susan Johnson and were very impressed. She doesn't throw movement issues over the fence to some unnamed technician. She is probably the only doctor I know who does a full evaulation of your child, and if she finds something like proprioception, tells you where it is in the brain, how it is responsible for behavior that you see in school and every day, and what to do about it.
Seriously, this drives me crazy. Do you know how few doctors straddle the chasm between brain testing (e.g. sort these blocks in the right color) and physical testing? (e.g. skip and let me see if your bilateral coordination is developed.) Very Few. For some absolutely ridiculous reason (probably having to do with strange doctor caste systems), neurologists don't test kids physically. Instead, they hand you over to an occupational therapist (if you're lucky.) Well, nobody sent us to an OT. We went ourselves. She found about 16 things wrong, but had "no idea" of what caused the problem. The conversation was amazing.
"What causes this?"
"I don't know?"
"Who can we ask about this stuff?"
"I don't know."
Seriously. No ownership. It wasn't the OT's fault. I put this right at the feet of the doctors who check young children with attention, focus, handwriting, and reading problems. For each of these things, you must look at the physical components, because young children don't all develop at the same speed, and sometimes if they miss a building block, it has a big affect on larger issues. (For example, a kid with proprioceptive problems cannot sit still. Cannot. Sound familiar? And it's not all that hard to fix! See the OT page.)
Dr. Johnson did things during the test like tell us that a child who has balance issues (like our child) will often have problems listening if their brain thinks that it is going to fall over. (Our child had no balance while standing still. He couldn't stand on one foot.) So we worked on it, and he listens much better.
She brings an entirely new level of pragmatism and competence to the table. No, it's not ridiculous to take a look at some of the alternative therapies and suggest that parents use them. Why do so many doctors have trouble with this?
She tests your child and if she sees anything, she tells you right then what it means. She's smart, she's well-read and well-studied. She has a can-do, out-of-the-box attitude and is the best doctor that we've seen in eight years.
Movement Therapies that help the Brain
Brain Gym is a learning readiness program. Belgau Learning Breakthrough Program and Bal-A-Vis-X (herein called Bags and Balls) are strongly rooted in rhythm, require full body coordination, improve brain organization and processing for higher levels of functioning and cognitive ability, and enhance vestibular, tactile, kinesthetic, visual and auditory skills.
Handwriting Therapy to help the Brain
Jeanette Farmer is a very interesting woman. From her Retrain the Brain website: "With 30 years experience in handwriting analysis, Jeanette Farmer is one of only a few handwriting remediation specialists in this country. Her rarefied expertise in viewing handwriting from a brain dominance perspective is grounded in 30 years of research of the late German neurologist/ graphologist, Dr. Rudolph Pophal. In studying how the brain's various motor centers impact the movement style, he identified which brain areas had the greatest impact on the movement style." Jeanette's research is pretty fascinating. If you need to do handwriting work with your child - or if your child has attention issues or a plethora of other issues, do read her background page.
Jeanette has been recommended by very solid ADHD sites and for handwriting.
Here's a software program called Play Attention ostensibly based upon NASA research that is apparently a modified neurofeedback system of some sort. Their website is very nice looking, although I remember reading an article saying that the level of neurofeedback machine that you deal with at a neurofeedback's office (and I would presume definitely with something that is low-cost enough to use at home) is not strong enough to measure the brain waves that you would need to measure in order to be functional in the way that neurofeedback claims. Whew! That was a handful. At any rate, I don't know much about this, but here it is.
Here's something called Cebrate Calm. I just saw it recommended for children who have outbursts.
Drug and Nutrition Treatments
When my son was younger, I sneered at the entire ADHD situation. But I have now seen children who 'have to" take their drugs in order to exist in the world and it's made me realize that you cannot always choose an idealistic, bucolic solution to ADD (e.g. moving to Ireland, buying a farm and making your child run around on on it, and homeschooling.) For one thing, children really want a community, and often the ADHD problem makes it very difficult for kids and all of the dimensions to their lives. Social, family, school, academic, sports... It gets complicated. Drugging them makes things easier.
For another thing, I hear that some children will space out between looking at the board and writing things on a desk, for example. So ADHD isn't just a case of "Billy acts like he's on a sugar high."
Some of my friends give their kids ADHD meds and it seems to help them a lot. That said, this section talks a lot about alternatives to drugging your kid.
About drug treatments
I don't know much about this, but this Schwab learning document seems like it's a nice overview to ADHD drugs. I would strongly suggest running drug suggestions through the internet (e.g. to see if suicide is a side effect).
Alternative treatments to Ritalin: nutrient therapy
"I have seen great results in treating issues like these (bipolar
disorder, ADHD, ADD, etc.) with nutrient therapy. See
the midwest, does outreach clinics around the country and will be
in the Bay Area soon."
Dr. Powell, above, mentions the 4-A healing program as a possible thing that parents who don't want to medicate might want to try. As he puts it, there are no studies showing that it's effective, but it's just about diet, supplementation, and removing toxins, so it won't do any harm (that was a loose summary; not a quote.) Here's the 4-A healing program, and here's how they suggest you "start" it. Some ADHD symptoms can be brought on by food allergies. The Gluten File website has articles about ADHD symptoms and food sensitivities and allergies. Many Americans, especially, apparently have an undiagnosed sensitivity to wheat. This paper references that celiac spru afflicts close to 1% of the general population, making it the most common lifelong ailment among humans. Also in this paper: reports that show that 66-70% of children with celiac disease have ADHD symptoms. Here's a study that shows improvement in ADHD children supplemented with magnesium-vitamin B6.
Here's a testimonial I pulled from a discussion group: "There is a great organization called Feingold that every parent should know about. My son was displaying behaviour problems often associated with ADD. He also had problems concentrating and sitting still at school. On the other hand, he was able to sit
still for a very long time at certain times. The Feingold organization has done ''numerous studies that show that certain
synthetic food additives can have serious learning, behavior,
and/or health effects for sensitive people.'' My son has become a
different person with the help of this organization. It is well
worth the effort."
There is a man named Allan Darman on the internet who talks about how he put together nutritional supplements to heal his son's ADHD and bipolar. There are references to Mr. Darman's approach, but it's an interesting story.
ADHD and Social Skills
ADHD children are known for often having social skills problems. Some experts postulate that it goes with the package, while others postulate that underlying sensory problems got in the way of ADHD children learning how to socialize properly. But either way, the ADHD child often has troubles.
Michelle Garcia Winner
One of the most effective and most respected approaches is from Michelle Garcia Winner, who is located in Campbell, California.
Some other silicon valley professionals offer programs based upon Winner's theories and teachings, for example, Social Strides in Redwood City.
How does your Engine Run?
Another approach is the How does Your Engine Run? approach which is warm, whimsical, makes total sense (does your engine run fast? slow? See? You get it!), and comes with a CD. I've scanned this book and I like it a lot.
Notes on ADHD and the School System
This is really not a comprehensive page, but it does contain a few links on dealing with the school system. Here you go:
School system notes
If your child has been diagnosed by a medical doctor with ADD or ADHD then you can request testing through the public school to see if he/she qualifies for special education (most likely resource time). If there is not a significant discrepancy in her cognitive ability and her cognitive functioning she would not qualify as learning disabled, but if she is having significant problems in the
classroom she can be qualified as Other Health Impaired because
of the ADD. Also, if she is not significantly low and you do not
want her tested or in special ed, she should be able to qualify
for a 504 plan which entitles her to modifications made in the
classroom. This is not a special ed function, it is part of
the American Disabilities Act.
You might want to get the book ''The Complete IEP Guide: How to Advocate for Your Special Ed Child'' by Lawrence M. Siegel. I know it's available at Amazon and possibly @ nolo press. It is extremely informative and helpful. Special Ed departments are overwhelmed and underfunded, be polite, but learn your rights (the book will help), make it clear to the district that you know your rights, and be a squeaky wheel. You will have to push to get services, but it can be done. There is also an organization called
CASE,Community Alliance for Special Education, that will advise
you on a sliding scale basis and has an excellent publication (I
think for free) called Special Education Rights and
Responsibilites. Their # is (415)928-CASE.
ADHD Support Organizations
There is an organization called CHADD, which is Children and Adults with Attention Deficit/Hyperactivity Disorder. It is said to have cutting edge research on this issue.
ADHD Links and Information
Here is the ADHD page from Hoagies' Gifted Education Page
Tools for getting along better
Here's a lovely essay by a sixth grader who is both gifted and has ADHD, talking about her life and challenges. I really enjoyed it. She mentions that she went to a special education school that taught her the Slingerland method for reading, special ways of learning to spell, and new ways of studying for a test.
Here is a comment from the internet which caught my eye:
"I was diagnosed with adult ADHD and began taking Straterra about 8 months ago...it has been an incredible help to me. The
advantage over Ritalin is that it is not a stimulant, and
therefore not a controlled substance. The disadvantage is that
it is patent-protected and therefore much more expensive. For
me! the cost is very worth it. A holistic approach would include
therapy but I don't have the time or patience. :-)"
ADD-Related: Executive Functioning Problems
In Schoolbehavior.com, Leslie Packer, PhD, writes "Executive Dysfunction is an often-overlooked source of the difficulties children have initiating, completing, and turning in tehir homework and classword... The foundations for learning are attention, memory, and executive function."
"central processes that are most intimately involved in giving organization and order to our actions and behavior. They have been compared to the "maestro" who conducts the orchestra. But what are these processes? The whole topic is very controversial, but there seems to be a consensus that executive functions involve (at the very least):
- Planning for the future and strategic thinking
- The ability to inhibit or delay responding
- Initiating behavior, and shifting between activities flexibly
Kristin Kight has a very interesting website and consulting service where she helps smart people who are coping with executive dysfunction and nonverbal learning disorders. Krsitin says that "the executive functions that pertain most closely to academic performance include:
Executive functions most directly related to academic performance include:
- Setting a goal, (understanding what the assignment or question is asking one to achieve)
- Planning a course to achieve it, (remembering the procedure appropriate to the task)
- Holding the plan in working memory while executing it,
- sequencing the steps in the plan,
- Initiating taking those steps and shifting between them,
- Monitoring progress for both pace and quality,
- Regulating attention and emotional responses to challenges that arise,
- Making flexible changes in the plan as needed, and
- Evaluating the outcome for use of the plan in a subsequent similar activity.
Harcourt Assessment has a powerpoint slide about reading problems. On page 25 of this slide is a very interesting list of problems associated with executive functioning. Article in USA today about a study saying that physical exercise helps with executive functioning.
ADD-Related: Dyslexia and Language-Related Skills
Nonverbal Learning Disorder
This is the NLDline site, which tells you a lot about NLD. Here's the NLD page from Hoagie's Gifted Page
I am way out of my league here. Not sure if Parkinson's is even a neurological disorder! I mean, yes, of course, it is, but not sure if that's the main classification. At any rate, here's a nice page of links regarding Parkinsons, called GrassrootsConnection. Do check out the links listed, including Clognition. For an excellent overview, I'd suggest the site named James.
Spinal Bifida and Hydrocephalus
Organizations and links