The word “disorder” conjures up images of illness, disease and serious disabilities. All parents want to see their child as the smartest, most capable and best liked boy or girl on the block. So why would they want to have a label attached to them that often coveys just the opposite–such as slow learner, under-achiever or Attention Deficit Hyperactivity Disorder?
What a difference one word can make. Suppose we changed the last D in ADHD from “disorder” to “difference.” We could then say that a child with ADHD has some significant differences in his cognitive ability, emotional sensitivity and activity level when compared to other children. This difference is probably inherited. His “skill set” is different from 95% of the children in his class.
Unfortunately, the environment in which he spends most of his time is geared toward the other 95%. However, we then could look at helping him to adapt successfully to this environment, using his own set of strengths rather than helping him to with this environment due to his weaknesses. We then might say that this child may need psychostimulants and/or psychological intervention to enable him to concentrate on boring tasks and control spontaneity in a highly regimented environment.
I fully understand the concerns of parents regarding medication for ADHD. My wife and I struggled with this when my son was 5. He had a great response to stimulant medication and remained on medication until he was 14. He suffered no observable side effects. He is a 6’4” guy who completed college with honors and has been employed for 5 years in the film industry and currently is an editor for a top rated cable network show. We were at our wits end and what we called “the small vitamin” was a miracle drug. At home we also used psychosocial interventions from time to time during his formative years.
During my years as a child psychologist, I have been able to help many children with mild to moderate symptoms of ADHD do well at home and school without medication using psychological interventions. However, children with more severe symptoms benefit greatly from medication. Current guidelines now state that behavioral interventions should be tried first for mild to moderate symptoms and also should be used for more severe manifestations along with medications which may reduce the dose needed to control symptoms and may reduce the length of time required to remain on medication.
I have long believed that behavioral therapy is the key to helping kids with ADHD. In fact, a new study on ADHD said that comprehensive behavioral therapy works as well as medication over the long haul. Also, earlier studies showed that after 14 months, 30% of the behavioral therapy group did just as well as those with medication. Of course, there are no side effects to behavioral therapy—except, perhaps, much happier parents and kids.
The results of this research show that 3 years from the start of the study, there was no difference in the amount of improvement between four different treatment methods. Three of the methods used medication alone or in combination with behavioral therapy, one used behavior therapy only. All four groups demonstrated significant improvement in symptoms, but the amount of improvement was the same for all of them. The research also showed slight reduction in predicted height and weight for those taking medication. I developed The Total Focus Program, after having worked with kids with ADHD for more than 20 years and parenting my own son with ADHD.
I think it works because it’s a comprehensive behavioral intervention package that helps both parents and kids learn to not only cope with ADHD, but to overcome it. The format makes it easier for parents and kids to work on getting the help they need into their busy schedules
In a commentary in The Boston Globe, pediatrician Claudia Meininger Gold wrote, “medication can’t fix a broken childhood.” She goes on to say, “with our over-reliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff’s investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.”
Also, US News & World Report also provides in-depth coverage of this topic, starting first by citing the recent recommendation of the National Institute for Health and Clinical Excellence of the UK. They recommend the trial of behavioral intervention prior to medication for the treatment of children diagnosed with ADHD.
Many of you have been talking about the effects of diet and food additives on kids with ADHD, so I wanted to weigh in on this topic.
In a well-known UK study last year, the effects of artificial food color and additives (AFCA) on kids found that food additives make hyperactive behaviors more pronounced in children as young as 3 and up to middle childhood, around 9 years of age. The study found that a significant though small group of children exhibited hyperactivity as a result of drinking a specially concocted drink containing food colors and preservatives.
What this means is that some children react to substances found in many processed foods that may increase hyperactivity and inattention–to the extent of causing problems at school. In the study, 18% of the children were adversely affected by the drink.
So it appears that up to 18% of the child population may exhibit hyperactivity symptoms as the result of consistent exposure to food additives. The question is: Do these kids have ADHD, or something else?
In order to be diagnosed, the child must meet the criteria for the disorder plus not have any other conditions that might cause the symptoms. One could make that point that these kids have an allergy to these substances and should not be diagnosed as having ADHD. (There are other substances, such as lead, that can also cause these symptoms.)
If you suspect an allergy, it should be treated by an elimination diet. A well known program for this purpose is the Feingold Diet. I have always told parents who ask to go ahead and try this approach as it is not harmful at all. (One note of caution: It’s very time-consuming and has not yielded significant results when used with children who already havebeen diagnosed with ADHD.)
The earlier you can diagnose ADHD, the better. Kids often struggle in school and in the community due to a lack of help and from a misunderstanding of their condition. This often leads to frustration, increased inappropriate behavior, poor academic achievement, and eventually low self-esteem and depression, not to mention an increased likelihood for substance abuse. Early and appropriate intervention can prevent these serious consequences, and instead promote healthy development with the prospects for a more satisfying life in childhood and as an adult. If you suspect that your child may have ADHD, start with a trip to a trusted pediatrician and go from there.
And if your child is diagnosed with ADHD, I would recommend that parents look into the type of cognitive behavioral therapy or program that provides cognitive exercises and simple biofeedback to improve attention, concentration and executive functioning that leads to improved academic achievement and success in other activities. Make sure it helps children to understand the difference in brain function, and to learn coping strategies that foster a positive self-image, as well.
When it comes to your ADHD/ADD child and school, remember: you are your child’s best advocate. I think to be a good advocate for your child, it’s important to learn as much as you can about ADHD and how it affects your child at home, in school, and in social situations.
Many children with ADHD also have specific learning disabilities which need to be identified so they can be addressed along with the ADHD. You can use the Learning Disabilities Check List as an indicator of whether your child may have learning disabilities. (You may want to share this information with your child’s school and doctors.)
If you feel that your child has ADHD and isn’t learning in school as he or she should, you should find out just whom in the school system you should contact. Your child’s teacher should be able to help you with this information. Then you can request—in writing—that the school system evaluate your child. The letter should include the date, your and your child’s names, and the reason for requesting an evaluation. Keep a copy of the letter in your own files.
Until the last few years, many school systems were reluctant to evaluate a child with ADHD. But recent laws have made clear the school’s obligation to the child suspected of having ADHD. This is because it often may be adversely affecting his or her performance in school. If the school persists in refusing to evaluate your child, you can either get a private evaluation or enlist some help in negotiating with the school. Help is often as close as a local parent group. Each state has a Parent Training and Information (PTI) center as well as a Protection and Advocacy (P&A) agency.
Once your child has been diagnosed with ADHD and qualifies for special education services, the school, working with you, must assess the child’s strengths and weaknesses and design an Individualized Educational Program (IEP). You should be able periodically to review and approve your child’s IEP.
Never forget the cardinal rule—you are your child’s best advocate.