ADHD Linked To Sleep Problems In Adolescents

ScienceDaily (May 6, 2009) — A new study shows that adolescents with a childhood diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) are more likely to have current and lifetime sleep problems and disorders, regardless of the severity of current ADHD symptoms. Authors suggest that findings indicate that mental health professionals should screen for sleep problems and psychiatric comorbidities among all adolescents with a childhood diagnosis of ADHD.

Results indicate that adolescents with a childhood diagnosis of ADHD, regardless of persistent ADHD were more likely to have current sleep problems and sleep disorders such as insomnia, sleep terrors, nightmares, bruxism and snoring. Of the total sample, 17 percent of children with ADHD were currently suffering from primary insomnia, versus 7 percent of controls; lifetime primary insomnia occurred in 20 percent of children with ADHD, compared to 10 percent of controls. Nightmare disorder affected 11 percent of children with ADHD and lifetime nightmare disorder affected 23 percent, versus 5 and 16 percent of controls. The presence of at least one psychiatric comorbid condition increases the risks for insomnia and nightmares.

According to principal investigator Susan Shur-Fen Gau, MD, PhD, associate professor at the College of Medicine and Public Health, National Taiwan University, symptoms and consequences of ADHD and sleep problems in children often overlap. Some primary sleep disorders are found to be associated with inattention, hyperactivity, behavioral problems and impaired academic performance, which are often mistaken for symptoms of ADHD.

"In some patients with ADHD, symptoms are caused or exaggerated by primary sleep disorders, and therefore treatment of the sleep disorder will improve ADHD symptoms," said Gau.

Data were collected from 281 consecutive patients (86.2 percent male) between the ages of 10 to 17 years who had been diagnosed with ADHD according to DSM-IV criteria at a mean age of 6.7 years, and 185 controls who did not have ADHD as a child or teen. Diagnosis of ADHD was made based on information obtained from parent and child interviews, observation of the child's behaviors, and rating scales reported by parents and teachers.

Findings of the study indicated that the rates of nightmare and lifetime nightmare disorder were more prevalent in girls and snoring was more prevalent in boys. Snoring may be more prevalent in boys due to an increased rate of sleep-disordered breathing in boys. Mothers were found to be more aware of symptoms related to ADHD in the presence of primary insomnia, sleep terror disorder or sleepwalking disorder, whereas teachers may be more sensitive to ADHD symptoms in the presence of primary hypersomnia and nightmare disorder.

According to the study, sleep problems in children with ADHD may be caused by a variety of factors, including internet addiction, hyperactivity, use of stimulants and the presence of other psychiatric disorders. Authors of the study state that the etiology of sleep problems and disorders need to be identified in children with ADHD, in order to create a modified treatment regime for sleep disorders and ADHD symptoms.

Journal reference:
Susan Shur-Fen Gau, Huey-Ling Chiang. Sleep Problems and Disorders among Adolescents with Persistent and Subthreshold Attention-deficit/Hyperactivity Disorders. Sleep, May 1, 2009 [link]

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Tuesday, August 4, 2009

Extreme Personality Poses Risk Of ADHD, Conduct Disorder

ScienceDaily (Mar. 26, 2006) — Children with personalities marked by aggressiveness, mood swings, a sense of alienation and a need for excitement may be at greater risk for attention deficit hyperactivity disorder or conduct disorder, according to a new Florida State University study.

FSU psychology professors Jeanette Taylor and Chris Schatschneider, FSU doctoral student Kelly Cukrowicz and University of Minnesota Professor William Iacono found that children with ADHD or conduct disorder had more negative emotions - aggressiveness, tension and feelings of being exploited, unlucky or poorly treated - and lower constraints - a tendency to break rules and engage in thrill-seeking behavior - than children with neither of the disorders. Not surprisingly, those children who have both ADHD and conduct disorder had the most extreme personality profiles.

"This helps us to understand that personality is part of the bigger picture of these disorders," Taylor said. "That could help with initial assessments or lead to unexpected discoveries or potential interventions. We're saying to researchers and clinicians, 'Think about personality when you look at these issues.' "

The study, published in the Journal of Child Psychology and Psychiatry, is the first to investigate personality trait patterns among children who have ADHD, conduct disorder or a combination of both. It is important to learn more about the co-occurrence of ADHD and conduct disorder because the consequences are so severe, Taylor said.

"It's more than the sum of its parts," she said, explaining that children and adolescents with a combination of the two disorders are at much higher risk of school failure, criminal activity, substance abuse and depression. Previous studies have indicated that between 15 to 35 percent of children with ADHD also have conduct disorder.

Between 3 percent and 5 percent of U.S. school age children are estimated to have ADHD, a disorder that encompasses symptoms of hyperactivity, inattention or impulsivity. Conduct disorder affects about 13 percent of children and adolescents and is characterized by severe misbehavior including chronic lying, setting fires, destroying property or hurting animals.

The researchers analyzed personality data from 1,438 sets of same-sex, reared-together 11-year-old and 17-year-old male and female twins who participated in the Minnesota Twin Family Study. The rate of ADHD, conduct disorder and the co-occurrence of both was about the same as is found in the general population, Taylor said. Those who did not have symptoms of the disorders served as the control group.

The connection between personality and the disorders is clear, but more research will have to be done to determine whether the personality traits are shaped by the psychological disorders or vice versa.

"Developmentally, it makes sense that the personality comes first," she said. "But to say that one causes the other is too simplistic. I think they become intertwined."

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For ADHD Children, Mother's Depression & Early Parenting Predict Conduct Problems

ScienceDaily (Apr. 12, 2007) — A mother's depression predicts whether children with ADHD (Attention Deficit Hyperactivity Disorder) will develop conduct problems such as lying, fighting, bullying and stealing, according to a new study from a University of Maryland researcher.

The study, published in the January 2007 issue of the American Psychological Association's journal, Developmental Psychology, also found that early positive parenting during the preschool years predicted fewer conduct problems as the children grew to early adolescence. The strength of the findings led the researchers to conclude that maternal depression may be a risk factor, whereas positive parenting may be a protective factor.

"This research gives us clear targets for early intervention to prevent conduct problems in children with ADHD," says Andrea Chronis, director of the University of Maryland ADHD Program and professor of psychology who served as lead author on the paper. "In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders."

The researchers say their study is the first to focus directly on the role of parent mental health and early parenting in the development of conduct problems among children with ADHD. Moreover, they point to previous research that shows the development of conduct problems to be quite common in children with ADHD. By one estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

"Parenting an ADHD child is very difficult for many families," Chronis says. "Often there's a growing cycle of negativity as parents' nerves fray and their children's behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle."

Findings and Method

Specifically, the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time, when other possible contributing factors were controlled. Also, children of previously depressed mothers had significantly higher levels of conduct problems over time compared to children whose mothers had never been depressed.

This research is part of an ongoing longitudinal study funded by the National Institutes of Health that follows ADHD children through their 18th birthday. Conducted by members of the research team at the Universities of Chicago and Pittsburgh, it consisted of a series of annual assessments of 108 children's behavior and development. Children ranged in age from four to seven at the start of the research. The parenting techniques were assessed using observational methodology during the first year of the study. Information on the mother's mental health was also collected annually.

The study focused on the mothers' health and parenting since they are most often the primary caretakers and are more likely to be depressed than men. Also, an earlier study by Chronis and the research team found that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids.

With a grant from the National Institute of Mental Health, Chronis and her research team at the University of Maryland are now developing and evaluating a 14-week behavioral intervention for depressed mothers of children with ADHD that targets effective parenting and reducing maternal depression.

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Comprehensive Treatment of Childhood ADHD

By John M. Grohol, Psy.D.

While learning of the diagnosis of attention deficit disorder (ADHD) makes many parents feel relief, the real work begins in finding the right treatment approach for a child or teen diagnosed with ADHD.

If the diagnosis was made by a pediatrician or family physician, the first thing you should ask for is a referral to a mental health professional trained in the treatment of attention deficit disorder. This should happen before any treatment is prescribed, because, as you’ll learn, the order and focus of treatment is important. Although the inclination may be to start medication treatment immediately (with drugs such as Ritalin or Adderall), you should not give in to this feeling that you need “do something.”

Since the diagnosis of ADHD requires the child to have inattentive behavior in at least two settings — the home and school most often — the obvious interventions to change the child’s behavior involve those two settings. Comprehensive, effective treatment of childhood ADHD involves four different treatment strategies, used individually or combination:

• Behavioral Parent Training
• Behavioral School Intervention
• Child Interventions
• Medication

Parents shouldn’t expect instant changes in their child’s ADHD or behavior. Improvement and learning is a gradual process that takes time, especially with the behavioral interventions and training. However, research has shown that such interventions are longer-lasting, while the effects of medications will fade over time.

Behavioral Parent Training

Parental training benefits the child with attention deficit disorder because most parents simply don’t know what to do when dealing with an ADHD child. Even if a parent has raised other, non-ADHD children, learning how to best help a child or teenager with ADHD is a unique situation most simply have never had experience with.

Parents of ADHD children also usually have significant stress, and sometimes they may simply lack basic parenting skills. Some parents are often grappling with their own mental health issues, such as depression, anxiety, or bipolar disorder. ADHD children unintentionally contribute greatly to parental
stress and disturbed parent-child relationships. Learning good parenting skills can actually mediate most negative outcomes and therefore it makes sense to make it one of the main focuses of treatment.

Parent training usually takes on a focused, behavioral psychotherapy approach. The focus is on parenting skills, the child’s behavior, and family relationships. In parent training, parents learn skills and implement treatment with child, modifying interventions as necessary based upon how the child is doing. One of the key components of parent training is creating ADHD behavioral interventions for the home. These are easy to learn and implement and are a must for virtually any parent. Parents should also consider implementing the home daily report card (PDF).

Parent training is often done in a group-based, weekly session with therapist initially that lasts from 8 to 16 sessions. Most therapists will continue being in contact with the parents once the group sessions are done, as the parents need it (often for years). If a parent needs additional help throughout that time, most therapists will be glad to see the parents to help them through difficult childhood transitions (such as becoming a teenager).

Training can also involve discussion about maintenance of the program and relapse prevention, especially when the parent is under increased stress from relationship issues, work, etc.

Parent training is most often offered through a private psychotherapist trained in such interventions, but can also sometimes be found in schools, churches, primary care physicians and other common community outlets.

Behavioral School Intervention

Why are school interventions important in the treatment of a child or teen with ADHD? 33 percent of children with ADHD have academic problems every year and 48 percent have at least one year of special education. 12 percent of children with attention deficit disorder get held back a grade and nearly 10 percent of teens with ADHD will drop out of school if left untreated. Teenagers with ADHD will often score a full letter grade lower than other teens, even when controlling for academic skills.


School interventions are a behavioral approach where teachers are trained and implement treatment with the child, modifying interventions as necessary based upon the progress of the ADHD child. School interventions focus on classroom behavior, academic performance, and the relationships the child with his or her friends.

School interventions are typically available in most schools. Such intervention programs are administered most often by teachers, who’ve received specialized training in how to work with ADHD children. A core part of the school intervention is the school daily report card (PDF). The daily report card servers as a means of identifying, monitoring and changing the child’s classroom problems. It also acts as an avenue of regular communication between the parents and the teacher. It costs nothing, takes only a little bit of the teacher’s time, and is very motivating to the child (as long as the parent has selected the right rewards at the home for positive report card reports).

As with parental training, school intervention programs allow for maintenance and relapse prevention and will provide treatment for the child as long as necessary.

Child Interventions

Children can be their own best keepers, especially when it comes to how older children and teens learn most from — their peers (friends). The measure of the severity of a child’s ADHD can be seen in how impaired their relationships are with their friends. ADHD children with no close friends are a sign of severe ADHD that, if left untreated, predicts negative adult relationships. Friends can help an ADHD child immensely.

Child interventions take a behavioral and developmental treatment approach. They tend to focus on teaching academic, recreational, and social/behavioral competencies, decreasing aggression, increasing compliance, developing close friendships, improving relationships with adults, and building self-efficacy in the ADHD child.

Child ADHD interventions can include intensive treatments such as summer treatment programs (9
hours daily for 8 weeks), and/or school-year, after-school, and Saturday (6 hours) sessions. Such programs can also help with relapse prevention (e.g., through integration with school and parent treatments, which can all be linked together through a home/school report card system).

Medication for Childhood ADHD

Since not all children will respond to behavioral interventions, medications may also be considered in the treatment of childhood attention deficit disorder (ADHD). Behavioral interventions, like those listed previously, may not always be sufficient for some children. Parents and teachers can also sometimes not implement the program correctly, or keep it up over the long-term (after the therapist’s contact has ended).

At such times, the prescription of an appropriate psychostimulant medication may be appropriate as medications often offer more immediate short-term benefits (allowing the child to be able to better focus on the behavioral interventions). Such short-term benefits include decreased classroom disruptions, improvement in teacher ratings of the child’s ADHD behavior, improvement in compliance with adult requests, improvement in peer interactions, and increase in on-task behavior and academic productivity.

However, medications rarely should be used as the first treatment implemented. Twice as many parents will refuse any additional type of treatment for their ADHD child when a medication is prescribed first (and is ineffective), than when a parent first tries their child on a behavioral approach. Research has also shown that most parents prefer a behavioral approach (or a combined behavior and medication approach) over medications alone. A combined treatment approach also has shown that children can gain as much value from medications at significantly lower doses. Since ADHD medications have been linked to stunted childhood growth (height and weight), lower doses are generally preferred.

The need for a medication prescription should be determined following initiation of behavioral treatments, and its timing will generally depend on severity of the ADHD and responsiveness of the child to the behavioral interventions.

An individualized, school-based medication trial should be conducted with your child to determine need and minimal dose needed to complement the behavioral intervention. The physician or psychiatrist should cycle through methylphenidate and amphetamine-based medications (such as Adderall, Ritalin or Concerta) before trying other drug classes with your child. Your doctor should begin by prescribing the minimal dose needed, and only increase if symptoms don’t decrease over time (1 to 2 weeks). Consider the long-acting versions of a medication if dosing schedule doesn’t allow for multiple doses administered throughout the day.

Keep in mind that ADHD medications generally only work for as long as they are taken, hence the reason a combined approach that involves both behavioral interventions and medications is nearly always preferred. Medications are not effective for all children, and there is uniform lack of research evidence for their long-term use (more than 2 years). Medication compliance has generally been shown to be poor the longer a child is on a medication, and medication alone will likely have little effect on academic achievement, family problems or problems with relationships with their friends.

This article based upon a presentation by Dr. William E. Pelham Jr., October 2008.

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Wednesday, July 1, 2009

The ADHD Child Can Play - Toys for Children with ADHD

By Sid Berger and Gwynn Torres

Childhood should be playful. Play is said to be the work of children. But, sometimes, the ability to play becomes strained when children have conditions such as Attention Deficit Disorder, with or without hyperactivity (ADD/ADHD).

Part of living with a child with ADHD is to understand the special needs of these children in order to maintain a happy and healthy balance. This includes the necessity of selecting the right playthings so playtime activities do not become more stressful by conflicting with what these children can comfortably manage and enjoy. One way we've heard ADHD described is that it's a performance disorder and not a deficiency of knowledge or skill. It is primarily manifested as a set of symptoms that interfere with the ability to focus on a task and get it completed.

Child psychologists and psychiatrists value the importance of play in therapy for children with ADHD. The right types of play allow children to express themselves in ways they can't do otherwise. Play within the right context and with the right supervision can also improve a child's focusing abilities and help him or her to learn the basics of getting along more cooperatively with other children. Medical attention for proper diagnosis and consideration of medication are certainly the core of treatment of ADHD. But in many situations, proper managing of a child's environment and activities can do a lot to keep the symptomatic behavior under control.

A toy doesn't have to be full of moving or electronic parts to stimulate a child's imagination. Children with ADHD often have difficulty with multi-step instructions and have an inability to stay focused on the task at hand. They frequently become frustrated with themselves in these situations. Toys can be very simple and still do a better job of keeping a child focused and entertained as well as giving them an outlet to express their feelings. Two such toy categories are pretend play and art supplies.

The flexibility of these traditional play activities can be as simple or involved as the opportunity permits. So, because these types of play are events of totally variable lengths, a child can complete the activity and feel a sense of accomplishment and build confidence.

Another advantage of pretend play and artistic activities for children with ADHD is that these categories of play allow parents and caregivers to provide positive feedback and reinforcement that is invaluable in keeping the child focused...and invaluable for the child's self esteem.

Pretend Play - Children of almost every age enjoy pretend play and benefit from the exploration of feelings that it affords. Dolls and action figures, puppets, costumes and even blocks are all toy categories that allow a child to fantasize and act out situations. Under the right supervision, children with ADHD can learn the value of considering the consequences of their actions. As they decide what happens next in their fantasy, they can get a better understanding of how others react to certain actions. In situations where you can encourage them to finish their story line, you
also can help them get used to following through on a task.


Drama - Dramatic activities such as skits, recitations, puppet shows and simple storytelling can let a child concentrate on being a different character for a short time. Put a costume on them and watch how quickly they start getting into character. However, it may take direction from you to keep them focused and enjoying the event.

Costumes need not be elaborate to let a child be another character. It need only be representational. A single feather in a headband, a necktie, a hat, sunglasses, scrubs or even just a sign or patch fastened to clothing is enough to let a child jump into another role. Let the child use his or her imagination to help find costume pieces as part of the dramatic play process. And don't restrict them to the costume box. Colanders make great space helmets.

When Sid's children were growing up, they had a "costume closet" with an assortment of coats, brightly colored shirts, hats and accessories such as scarves, belts, wigs and, of course, masks. If an article of clothing became outdated, before disposing of it, they'd consider its costume potential. Putting together a costume for Halloween was always a big event. On top of that, living in New Orleans offered them Mardi Gras as a second costuming event each year.

Playhouses and play tents - Giving a child a space of his or her own is a great way to encourage imaginative pretend play. Whether it's stretching a sheet over dining room chairs to make a house or a purchased indoor or outdoor playhouse or play tent with a theme, a child is free to role-play and make up scenarios that could happen in the space.

At The Creativity Institute, we carry several types of playhouses, play tents and tunnels in themes that include a teepee, theater tent, castle and military camouflage. We also carry puppet theaters that can double as play stores and other types of play spaces. Our big foam blocks are large enough to construct make- believe buildings and tunnels a child can climb over and under. We also have play panels that can be moved around to create an ever-changing mix of play environments. This type of pretend play is also conducive to playing with others, offering an opportunity for a child to develop those all-important socialization skills.

Puppet shows - Puppets allow a child to act out many different roles and have fun with character voices. There are many sources for skits that can be adapted to the puppet stage and even ready-to-perform scripts in your library and on the Web. At The Creativity Institute, we have a section devoted to puppetry with puppets and puppet theaters. You'll find links to script resources on the Internet, puppeteer tips and even a free sample scripts we adapted for the puppet stage. To make it easier to get started, we've bundled together puppets and puppet theater packages and even grouped puppet casts with accompanying scripts, ready to perform. There's an Aesop's Fables Puppet Starter Set with five puppets and four fables adapted to the puppet stage. There's also an Old MacDonald Puppet Starter Set with Farmer MacDonald and seven barnyard animal puppets and an accompanying script of the song. Again, your direction will be invaluable in providing enough structure for the event that will let the children have a greater sense of accomplishment and stay interested longer.

And because puppets offer a degree of separation from real issues, they can offer lots of opportunities for learning about inappropriate behaviors. For example, if a child with ADHD has been overly aggressive with other children, acting out the consequences with animal puppets can offer a more painless and effective lesson.

Record it - Getting the performances down on tape gives everyone more opportunities to laugh and enjoy it all over again. There's a difference between taping the children playing at creating the performance and "making a movie" of the show, and both are wonderful to watch again and again. Taping the children at play shows their performance, as well as the behind-the-scenes preparation. Making a movie is just a matter of trying to capture what the audience would see. All you have to do is prepare the children for the scene and start and stop the camera at the right
times - and move on. You can even start with a title card the children can make for the show - using their own artistic skills.

If the child acts out while taping is underway, continue shooting, but keep your reprimands to a minimum. Put your energy into trying to refocus the child's attention toward continuing the performance or easing into a hastier conclusion. Later, when viewing the tape, the child may be able to see problem behaviors more clearly, rather than focusing more on your anger.

Dollhouses and activity sets - Playing with dolls and action figures is another valuable opportunity for pretend play. Dollhouses, toy pirate ships, castles, firehouses, farms and other traditional activity sets have the magic to let children get lost in their imaginations. Even the more popular activity sets based on movies and TV shows allow the same opportunities. And don't forget what imaginations can do with boxes, blocks and anything that can become the setting for a creative play session.

Blocks - Toys for children with ADHD should be simple and encourage the use of their imaginations, and one of the most basic of toys is building blocks. Block play can be great for many ages. From simple stack-up and knock-over fun to imaginative building. Blocks teach problem-solving skills, because a child discovers how stacking and matching can produce different results. They can also become components of pretend play, because a child can fantasize what the structures are. There are also big foam blocks that are almost "life size" and let children create their own fantasy playhouses. These lightweight blocks are so versatile, they can be climbed on or tunneled under. Magnetic block and construction sets have pieces that connect in more ways than can conventional plastic snap-together blocks and allow even more imaginative opportunities. We also carry a selection of traditional and colorful wooden blocks that are full of fantasy building opportunities.

Blocks, like many traditional toys, have other educational advantages for a child with ADHD. The number of positive outcomes is limitless, so children can continue playing until they've reached a level of personal satisfaction. Whether the child is building with traditional blocks or shoeboxes, try to show interest in every structure. Encourage the child to name creations, even if it's simply Wobbly Land or Crazy Tower. Showing interest without criticism offers your child valuable, long-
lasting affirmation.

Art Activities - Any medium such as crayons, markers, chalk, paint and clay can give a child a wealth of expressive opportunities. Sometimes you may want to suggest a subject idea to get them started. Art supplies are some of the least expensive educational toys you can provide. Gwynn used to bring home old stationery and unused printed samples to give her children a virtually unlimited supply of art paper. She'd also purchase low-end copy paper, offering the kids free rein on a giant stack of blank paper.

And here's something you can try on a big scale. Sid used to get leftover paper billboards from the local outdoor company and tack them on his backyard fence, backside out, to give the children blank giant-size panels for murals. The change in scale of their artist's canvas gets them thinking of possibilities in a different perspective and keeps them intrigued for hours. Another way to give structure to art activities is with their own easel. We carry a selection of folding, double-sided and adjustable easels that provide a convenient supply of paper and drawing surfaces in a self-contained, accessible environment.

One rule of thumb to follow to help inspire your kids to express themselves is to encourage all efforts. Today's crooked stick figure could lead to tomorrow's Picasso. Most important, artistic expression is highly therapeutic to your child, even if it doesn't happen to please your eye.

Books - There are many books that can hold a child's attention. The public library is a great start and your librarian can help you. Garage sales and community book fairs are a great way to build a library of your own. Collections of rhymes, poems or short stories are a good way to start with a child who is easily distracted.

The Oppenheim Toy Portfolio listed the top toys for children with attention-deficit/ hyperactivity disorder (ADHD) and included, among other things, a magnetic construction set, a tree-house-theme dollhouse play set, a decorate-it-yourself birdfeeder, board games and a simple, basic rubber ball. Oppenheim also suggested the toy general categories of dramatic play and artistic activities.

*The National Institute of Mental Health recommends that if ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/behavioral pediatricians, behavioral neurologists and clinical social workers. After ruling out other possible reasons for the child's behavior, the specialist checks the child's school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered.

After a combined six decades of developing award-winning advertising, creative directors Gwynn Torres and Sid Berger decided to spread creativity beyond the world of marketing. They founded an online educational toy store specializing in toys that nurture creativity in children. They handpick each toy for its potential for developing vital creative resources in your child. The benefits of nurturing creativity can be profound, offering children tools for success in all endeavors athletic, artistic or academic. Gwynn and Sid are also accomplished musicians and songwriters, and between them they have managed to produce five wonderfully zany and significantly creative children.

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Saturday, June 27, 2009

ADHD Symptoms? In Search of Alternative Treatments

By Elisha Goldstein, Ph.D.
March 30, 2009

According to the National Institute of Mental Health “ADHD is one of the most common mental disorders in children and adolescents and also affects an estimated 4.1 percent of adults, ages 18-44, in a given year.” Now, with that said, psychology also has a “flavor of the day” diagnosis that gets put out in the media and when that happens it’s on people’s minds more and therefore it is looked for more often. When a person is looking for a diagnosis of ADHD, they may be more likely to spot the actual symptoms of difficulty focusing on organizing and processing information, seeking stimulation and experiencing moodiness. Therefore, they may actually be more likely to spot ADHD and this can be wonderful for someone who actually has ADHD. However, diagnosis can be tricky as many people may show these similar symptoms with underlying issues may be stress, family conflict, grieving, addictive behaviors, or feelings associated with anxiety and depression.

If people are misdiagnosed, they are usually treated with stimulants which may be helpful, but is not healing for the underlying issues. Whether the diagnosis is ADHD or another underlying issue, I often recommend that the person who is struggling seek alternative treatments to medication only. There are a number of good alternative suggestions people give to support the diagnosis of ADHD such as exercising, eating the right foods, moving, and even being exposed to blue light which arouses the frontal lobe of the brain, the area that is dampened in true diagnoses of ADHD.


Lydia Zylowska , M.D., is a Psychiatrist in Los Angeles who created a mindfulness-based intervention for adolescents and adults who suffer with ADHD (ADDitudes Magazine Article). In an initial pilot study, she brought participants through an 8-week program of cultivate a mindfulness meditation practice in daily life to help focus and retrain the mind. Here study included 24 adults and 8 teens, two thirds of who continued on stimulant medication and a majority of who struggled with comorbid conditions, mainly mood disorders. Seventy eight percent of participants reported a reduction in total ADHD symptoms above and beyond the use of medications. Thirty percent reported at least a 30% reduction in ADHD symptoms which is the number used in ADHD medication trials to measure clinical significance. In other words, 30% reported the same or better improvement than the medications. There were also significant improvements on tests associated with attentional conflict, a key symptom in ADHD. Participants also reported a significant reduction in symptoms associated with depression and anxiety. So, even if the person was misdiagnosed, they still received benefits from this practice.

These results are promising and support the notion that using mindfulness meditation to begin to train the mind can support people to become more focused, productive, and happy in day to day life. There is something about a practice that has you come down from the busy-ness of the mind to focus on the present moment in a non-judgmental way. The effect is often a calming of the nervous system and a break from the barrage of self-judgments that we inflict on ourselves all-too-often. The other effect is a realization of how hard we are on ourselves which often incites feelings of compassion and in the field of mental health, this is considered a strength and supports resiliency.

As always, please share your thoughts, comments, and questions here. Your interactions here provide a living dialogue for us all to benefit from.

Elisha Goldstein, Ph.D. is a Clinical Psychologist and conducts a private practice in West Los Angeles. Check out Dr. Goldstein's acclaimed CD's on stress prevention, depression, and addiction -- "They are so relevant, I have marked them as one of my favorites on a handout I give to all new clients" ~ Psychiatrist. If you're wanting an interactive program to find relief from anxiety and stress, check out Dr. Goldstein's progressive online behavioral change program in Aliveworld. If you're wanting to integrate more mindfulness into your daily life, sign up for his Mindful Living Twitter Feed. Dr. Goldstein is also available for private psychotherapy.

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Saturday, June 20, 2009

What is ADHD (Attention Deficit Hyperactivity Disorder)?

Health experts say that ADHD (attention deficit hyperactivity disorder) is the most common behavioral disorder that starts during childhood. However, it does not only affect children - people of all ages can suffer from ADHD. Psychiatrists say ADHD is a neurobehavioral developmental disorder.

An individual with ADHD finds it much more difficult to focus on something without being distracted. He has greater difficulty in controlling what he is doing or saying and is less able to control how much physical activity is appropriate for a particular situation compared to somebody without ADHD. In other words, a person with ADHD is much more impulsive and restless.

Health care professionals may use any of the following terms when describing a child (or an older person) who is overactive and has difficulty concentrating - attention deficit, attention deficit hyperactivity disorder, hyperkinetic disorder, hyperactivity.

North Americans commonly use the terms ADD (attention deficit disorder) or ADHD (attention deficit hyperactivity disorder). In the UK hyperkinetic disorder is the official term - however, ADD and ADHD have become widely used.

ADHD in children is completely different from normal childhood excited and boisterous behavior. Many children, especially very young ones, are inattentive and restless without necessarily being affected by ADHD.

The Centers for Disease Control and Prevention (CDC) estimates that approximately 4.4 million children aged 4 to 17 have been diagnosed with ADHD in the USA by a healthcare professional. As of 2003 two-and-a-half million American children aged 4 to 17 are being treated for ADHD with medicines. The CDC adds that in 2003 7.8% of all school-aged American children were reported to have an ADHD diagnosis by their parent.

Three types of ADHD

According to the CDC, there are three types of ADHD. They are defined according to which symptoms stand out the most.

1. Predominantly Inattentive Type: The person finds it very difficult to organize or finish a task. They find it hard to pay attention to details and find it difficult to follow instructions or conversations.
2. Predominantly Hyperactive-Impulsive Type: The person finds it hard to keep still - they fidget and talk a lot. A smaller child may be continually jumping, running or climbing. They are restless and impulsive - interrupting others, grabbing things and speaking at inappropriate times. They have difficulty waiting their turn and find it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others.
3. Combined Type: A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally.

What are the general signs of ADHD in children?

• the child is restless, overactive, fidgety
• the child is constantly chattering
• the child is continuously interrupting people
• the child cannot concentrate for long on specific tasks
• the child is inattentive
• the child finds it hard to wait his/her turn in play, conversations or standing in line (queue)

The above signs may be observed in children frequently and usually do not mean the child has ADHD. It is when these signs become significantly more pronounced in one child, compared to other children of the same age, and when his/her behavior undermines his/her school and social life, that the child may have ADHD.


What causes ADHD?

We are not sure. Studies reveal that a person's risk of developing ADHD is higher if a close relative also has/had it. Twin studies have indicated that ADHD is highly heritable. We also know that ADHD is much more common in boys than girls. The scientific community generally agrees that ADHD is biological in nature. Many reputable scientists believe ADHD is the result of chemical imbalances in the brain.


Some studies have indicated that food additives, specifically some colorings, may have an impact on ADHD behaviors. In July 2008, the European Union ruled that synthetic food colorings (called azo dyes) must be labeled not only with the relevant E number, but also with the words "may have an adverse effect on activity and attention in children".

A 1984 study by Benton and team, demonstrated that sugar has no effect on behavior. A study in 1986 by Milich and Pelham, and another by Wolraich and team in 1985, also found no link between sucrose (sugar) and behavior impact on children with ADHD. However, most sugars found in sugary foods and sweets (candy) consumed by children are corn syrup and high fructose corn syrup - these sugars were not used in any of the above-mentioned studies.

How do I know if I, my child, spouse or relative has ADHD?
ADHD cannot be diagnosed physically, i.e. with a blood test, urine test, brain scan or a physical check up. As most children have problems with self-control anyway, a proper diagnosis can be quite challenging.

An ADHD diagnosis has to be carried out by a specialist - usually a psychiatrist, psychologist or pediatrician. The specialist will observe the child and recognize behavior patterns. Data regarding the child's behavior at home and at school will also be studied. Only a specialist will be able to accurately detect whether other problems and/or conditions are resulting in ADHD-like behavioral characteristics.

When does ADHD start? How long does ADHD last?

According to New Zealand's ADHD Online Support Group, the onset of ADHD usually occurs before the person is 7 years old. For about 75% of ADHD sufferers, symptoms continue into adulthood. However, levels of hyperactivity tend to decrease as the person gets older.

Adult ADHD

It was not until the 1970s that researchers began to realize that what we today know as ADHD did not always go away during a person's teen years. It was during that decade that it was also noticed that some ADHD symptoms were identified in the parents of children undergoing ADHD treatment. In 1978 ADHD was formally recognized as a condition that also afflicts adults, and the term Adult ADD began - the 'H' of ADHD was dropped because it seemed the adults were not as hyperactive as children.

According to uspharmacist.com, approximately 8 million adults in the USA have ADHD. An adult with ADHD who is untreated will tend to have a chaotic lifestyle - they may seem more disorganized compared to people who are not afflicted with ADHD. Healthcare professionals believe there are millions of adults who have ADHD but do not know and remain untreated. Studies indicate that adults with ADHD benefit enormously from a combination of medication and behavior therapy.

When does ADHD start? How long does ADHD last?

According to New Zealand's ADHD Online Support Group, the onset of ADHD usually occurs before the person is 7 years old. For about 75% of ADHD sufferers, symptoms continue into adulthood. However, levels of hyperactivity tend to decrease as the person gets older.

Adult ADHD

It was not until the 1970s that researchers began to realize that what we today know as ADHD did not always go away during a person's teen years. It was during that decade that it was also noticed that some ADHD symptoms were identified in the parents of children undergoing ADHD treatment. In 1978 ADHD was formally recognized as a condition that also afflicts adults, and the term Adult ADD began - the 'H' of ADHD was dropped because it seemed the adults were not as hyperactive as children.

According to uspharmacist.com, approximately 8 million adults in the USA have ADHD. An adult with ADHD who is untreated will tend to have a chaotic lifestyle - they may seem more disorganized compared to people who are not afflicted with ADHD. Healthcare professionals believe there are millions of adults who have ADHD but do not know and remain untreated. Studies indicate that adults with ADHD benefit enormously from a combination of medication and behavior therapy.

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Pseudoscience, Candy, and Lamar Odom: Brought to you by Daniel Amen

If you follow professional basketball, you've probably noticed that LA Lakers forward Lamar Odom has a well-deserved reputation for inconsistent play. When he's good, he's close to amazing, and when he's bad, he's of little use to his team. So how is this related to mental health? Does he have social anxiety disorder? No, get out of Ricky Williams mode and pay attention...

Odom eats candy. Lots of it. And that's why his play is inconsistent. At least that's the story according to Dr. Daniel Amen, who, according to the Los Angeles Times stated:

Odom freely confesses that he just can't help himself when it comes to the sweet stuff and always keeps a stash on hand of Gummi Bears, Honey Buns, Lifesavers, Hershey's white chocolate, Snickers bars, cookies and more. He eats the sugary snacks morning, noon and night, and even says he sometimes wakes up in the middle of the night, chows down on some treats, then falls back asleep.

This is bad news for the Lakers. I've been telling my patients for years that sugar acts like a drug in the brain. It causes blood sugar levels to spike and then crash, leaving you feeling tired, irritable, foggy and stupid. Eating too much sugar impairs cognitive function, which may explain why Odom doesn't always make the smartest decisions on the court. . . .

As a fan and a physician, it concerns me that our professional sports organizations and players are not more concerned about brain health, which includes nutrition. My advice to Odom and to all sugar addicts is to get your sugar consumption under control. You'll feel so much better and your brain will function better too. And, maybe the Lakers can get their 15th championship and Odom can get his first.

Now, remember that Odom's play is inconsistent, not consistently bad. And if he is eating sugar all the time, shouldn't his play be consistently poor? Oh, and is there any science at all to support the idea that eating sugar impairs athletic performance...? I'll admit to not being a top expert on this, but my brief search of PubMed did not bring up anything to support Dr. Amen's suggestions.

So who is this Amen guy, anyway? He claims that Alzheimer's can be detected early through the use of SPECT brain imaging (single photon emission computed tomography). And he sells vitamins/nutraceuticals on his site which, of course allegedly help to prevent cognitive deterioration. There is sooooooooo much more to read about Amen, and I encourage y'all to head over to Salon to read an excellent debunking of Amen's many pseudoscientific claims.

I've rolled my eyes at this guy for years, but now that he's trying to shoot his witchcraft at the fine sport of basketball, I've hit my breaking point. But what do I know... I mean, Amen apparently wrote that

From the first month that I started to order these (SPECT) scans, I felt that they had a special place in science and that I was led by God to pursue this work

And who am I to argue with a guy who was sent by God to practice medicine. But back to Lamar Odom; he insists that he ate candy for breakfast on the game days in which he played well against the Denver Nuggets. Well, maybe, but I bet a SPECT scan or two would figure out why his performance is inconsistent.

Dr. Amen also has some hot, hot science about the men, sex, and the brain. On The View, of all places. Get ready to cringe.



OK, fine. One more. Dr. Amen can target treatment for ADHD appropriately by... yes, using pricey and unproven brain scans! See below...

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Wednesday, June 3, 2009