ADHD Part 2

Hmmm… I said I would get back to you (my own ADD / ADHD is currently under control and I actually recalled that I would finish my discussion on ADD / ADHD interventions)… so here it is…

…while not a “magical” treatment or even a “new” healing program (this will not make Oprah or the Early Morning Shows), research also clearly indicates hat behavioral interventions are of significant benefit among children with features of disinhibiiton including ADD / ADHD symptoms. In addition to the previously identified environmental and parental interventions, research suggests that introduction of cognitvive behavior therapy (CBT) interventions have promise particularly among children over the age of about ten years. Great thing about CBT … you don’t need to drop $120,000 on an education to learn or use it!

CBT is a step-wise intervention strategy that includes:

(a) increasing self-observer functions by labeling emotions (ie., “it looks like you are feeling…”) (to assist in articulation of negative emotions)

(b) providing cues/assistance in identification of antecedents or triggers for negative emotions (ie., “when did you begin to feel that way? where were you?, etc.) (to assist in identification of trigger zones or antecedents)

(c) learning to identify that behaviors are choices (ie., “what did you choose to do with those negative emotions?”) (to enhance higher level executive contributions to behavior)

(d) assistance in identification of outcomes (ie., “how did that work out for you?”) (to facilitate self-observation and utilization of feedback)

(e) assistance in recognition of the extent to which outcomes influenced triggers (“did those outcomes change the triggers?”) (to avoid vicious cycles in which behaviors have no impact on the triggers).

Existing research indicates that cognitive-behavioral therapy (CBT) – type interventions are among “what works” among high risk children and adolescents involved in juvenile probation. Parental instruction in the use of these techniques is critical to success because the therapists are the parents. So, finally, you get to do something! In addition to formal programming or therapeutic strategies, avoidance of emotional trigger words including “should”, “why”, “have to” and “try” often proves beneficial. These four words (or phrases) are often viewed as parental words that tend to elicit child responses including oppositionality, aggression, withdrawal, etc. See the old stand-by book I’m OK, You’re OK (Thomas Harris) for an explanation (read chapters 1-7). In lieu of these four curse words, insert choices (ie., what might you choose to do?) and questions (ie., what happened? when did it happen? what could you do?, etc.).

So… tired of waiting for the doctors to make things better? Want to get some control over your life and participate in the development and maturation of your child? Please do not “try” these interventions… but you could choose to implement them.

_______________________________________________________________

Dr. Richard Dowell is a Neuropsychologist located in Pennsylvania. Dr. Dowell evaluates upwards of 400 children and adolescents each year. In addition, Dr. Dowell is recognized as one of the top Forensic Neuropsychological witnesses in the North East.

Dr. Dowell can be contacted at DrDowell@NeuropsychologicalServices.net

For more information on Neuropsychology visit NeuropsychologicalServices.net

ADHD Part 1

“My four-year old son was just diagnosed with ADHD. My husband says it’s a lot of “hooey” (which I assume is Pennsylvania Dutch for BS) and that the physician is a drug pusher. His mother (good old mother-in-law) thinks all the drug companies are a bunch of crooks, no better than an organized form of crime. My best friend says it's an epidemic, no one ever heard of ADHD when we were kids. And me? I think… well… I don’t know what to think. What’s the truth?”

The statistics for ADD / ADHD are staggering; 3-10% of all children have symptoms consistent with a diagnosis of ADD / ADHD; 3.5 million children take daily ADHD medications; $3.1 billion was spent on ADHD medications in 2005, an amount that reportedly is four times the number in 2000. So, is it an epidemic? The statistics would say “yes” if an epidemic is defined in terms of a disease or disorder “that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is expected, based on recent experience (the number of new cases in the population during a specified period of time is called the "incidence rate").” (taken from Wikipedia). However, is the epidemic real or related to other factors?

Research appears to indicate that improvements in our diagnostic tools (and accuracy), introduction of higher demands within the educational system (“No child left behind”) along with “punishments” for schools that “leave a child behind” and the advent of medications that are both safe and effective (ie., why diagnose a disorder if you cannot treat it) contribute to the dramatic increase in diagnoses of ADD / ADHD.

But beyond that, there is some equally compelling evidence that the actual incidence of children with ADD / ADHD is on the increase much like the diagnosis of childhood autism, cancers, etc. And the cause? Hmmm. round up the usual suspects, toxic chemical factors, stress associated with our high speed technology lives, poisoning (heavy metals, mercury, lead, etc.) and nutritional deficits. Add in two parents working full-time with children being rushed from home to day-care to stores to … (you get the point), over-stressed families who have moved away from grandparents and extended family support… 133 television stations, video games…

Since we are not in a position to treat our modern lives nor control our children’s exposure to atmospheric toxic substances or heavy metal poisoning beyond normal precautions, parents often feel both helpless and powerless. However, recent work has suggested that a combination of interventions that ARE under your control may just have an impact upon a subset of children presenting with symptoms of ADD / ADHD.

Biological interventions: One such “biologcial” program under the control of parents (I’m excluding medications at this time since parents do not control medications) is the 4-A Healing Program of Dr. Kenneth Bock. The 4-A (which stands for ADD / ADHD, Autism, Allergies and Asthma) Healing Program components include: (a) Nutritional Therapy, (b) Supplementation Therapy, (c) Detoxification Therapy and (d) Medication. While the program may not work for all children with ADD / ADHD symptoms, existing evidnce along with anecdotal reports indicate that a subset of children do show benefits and from a cost-benefit analysis the cost of being wrong (ie., good nutrition, good diet, etc.) is minimal relative to the potential benefits. Will it work for your child? I do not know nor is there any evidence that anyone can identify children who will be responders.

Environmental interventions: Unfortunately there are no magic program or McDonald’s drive-through solutions. But we do know that providing high levels of structure within the home is beneficial … structure the child’s room, desk, backpack, etc… structure the child’s time with schedules… daily schedules (ie., posted on the refrigerator) including homework and play times. Reduce the pace of life… children exposed to frantic paces elevate their own activity levels to match the pace required… and the number one internvetion? SPEND MORE 1:1 TIME WITH YOUR CHILD! This does not mean dropping the child off at soccer practice, but more like 1:1 coloring, drawing, walking, hiking, throwing a baseball, reading, fishing, playing board games. Your time is the best intervention and to the extent that you slow down the pace, your child will match your pace (remember the “mirror neurons”)!

Other avenues? Hmmmm… let me get back to you on that one.

_______________________________________________________________

Dr. Richard Dowell is a Neuropsychologist located in Pennsylvania. Dr. Dowell evaluates upwards of 400 children and adolescents each year. In addition, Dr. Dowell is recognized as one of the top Forensic Neuropsychological witnesses in the North East.

Dr. Dowell can be contacted at DrDowell@NeuropsychologicalServices.net

For more information on Neuropsychology visit NeuropsychologicalServices.net