ADHD: Knowledge Is Power
by Diane Riggs
In his review of 2000, humor columnist Dave Barry fabricated news that the American Academy of Pediatrics had tracked down the last U.S. boy not being treated for attention deficit hyperactivity disorder (ADHD). A team of doctors, the story goes, was finally able to "creep close enough to the youngster to bring him down with Ritalin-tipped blowgun darts." As Barry´s spoof shows, debates about ADHD have gained widespread attention. Fortunately, as time passes, we are learning more and have better resources than ever for making the best of ADHD.
The largest attack on ADHD began May 2000 when lawyers sympathetic to the Citizens Commission on Human Rights´ (Church of Scientology) anti-Ritalin crusade filed a class-action lawsuit in Texas against the American Psychiatric Association (APA), Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), and the maker of Ritalin. The suit alleged that the three organizations conspired to invent and advertise ADHD to promote Ritalin sales. By early 2001, cases were also pending in California, New Jersey, Florida, and Puerto Rico.
Parents and professionals were stunned. Coined as attention deficit disorder by a Canadian researcher in 1972, the disorder gained broad acceptance in the U.S. and Canada over time. By the 1990s, even the U.S. government was involved in learning more about ADHD. Ultimately, as expected, attorneys could not prove fraud or conspiracy claims. The last lawsuit was dismissed on January 31, 2003.
Meanwhile, battles over ADHD treatmentin particular the use of psychotropic drugsare still being waged. In 2000, the U.S. Drug Enforcement Administration estimated that during the 1990s prescriptions for ADHD increased 500 percent. And last September, a U.S. House committee hearing on ADHD asked, "Are Children Being Over Medicated?"
Diagnosis and prescription trends suggest that some educators, parents, and doctors may too quickly seek drug-based solutions for over-active kids. An ongoing study to determine the efficacy of generic Ritalin in 3- to 5-year-olds with ADHD (run by the National Institute of Mental Health) has also raised concerns about patterns of treating increasingly younger (and harder to diagnose) children with serious drugs. Still, as many parents could testify, medicationRitalin, Adderall, or another substanceis a big part of what makes school and life bearable for some children.
Recent ADHD News
The pace of ADHD research has been furious in the past decade. Below are a few of the more recent events and findings.
A New DrugIn January 2003, pharmacies began stocking a new ADHD drug. Called Stratteraª (amoxetine), it is the first new FDA-approved ADHD drug to come on the market in three decades, and unlike competitors, it is not a stimulant.
New CentersLast summer the Centers for Disease Control and Prevention (CDC) announced a new National Resource Center on ADHD. Starting this spring, thanks to a $750,000 three-year grant, CHADD will run the newly established center.
Through the grant, the Center will establish and operate a national library on ADHD, and create new ADHD fact sheets in English and Spanish. Four new information specialists will also join the staffat least one who speaks Spanish.
In Canada, a child psychiatrist at the Children´s Hospital of Eastern Ontario is head of the Ottawa ADHD Network. At their February 20th meeting, the network discussed plans for creating a new local information center on ADHD.
New Research FindingsWithin the past year, several new reports have made headlines:
- In May 2002, the CDC released a report in which it estimated that 1.6 million elementary school-age children had been diagnosed with ADHD and half of them also had a learning disability. Diagnoses appeared to be three times more common in boys than girls, and two times more common in white children than Latino and black children.
- An article in the October 9, 2002 Journal of the American Medical Association reports that a 10-year study has found that brains of children and teens with ADHD (including those who have not taken stimulants) are 3 to 4 percent smaller than in children without the disorder, but develop at the same rate as othersÐeven with ongoing medication.
- Two studies published in the January 2003 Pediatrics offer more evidence that children who take stimulants to control ADHD are not at risk for drug addiction later in life. One study followed almost 150 children for 13 years, and found no increased risk for trying, using, or abusing drugs in adulthood.
What You Need to Know
As stated in the January 2002 International Consensus Statement on ADHD (signed by 75 scientists from the U.S., Canada, and seven other countries), "Among scientists who have devoted years, if not entire careers, to the study of this disorder there is no controversy regarding its existence." What remains is each family´s journey toward diagnosing, treating, learning, and living with ADHD.
DiagnosisAPA´s diagnosis criteria clarifies that specific symptoms of a certain severity must be present in at least two settings for a certain duration before ADHD can be diagnosed. The American Academy of Pediatrics (AAP) recommends that feedback be obtained both from the child´s caregivers and school personnel who know the child. In other words, ADHD cannot be fairly diagnosed without a relatively complete history of the child´s experiences and behaviors.
If you are fostering or have adopted a child, it helps to know birth family history. Did birth mom or dad have ADHD? Many scientists believe the disorder has a genetic link. Was the child neglected or abused as an infant? Many disorders that are caused by abuse and neglect have ADHD-like symptoms.
For instance, Todd Nichols, president of ATTACh (the Association for Treatment and Training in the Attachment of Children), says there is a definite "overlap in behavioral criteria" for attachment disorders and ADHD. Like children with ADHD, children who have attachment problems may act impulsively, have poor peer relationships, and talk excessively.
Children with post-traumatic stress disorder, to give another example, are conditioned to be hyper vigilant. Is it any wonder that they are distracted by noises and movements and have a hard time concentrating? Many children affected by fetal alcohol syndrome have reduced attention spans, difficulty learning, and a lack of cause-and-effect thinking. Sensory integration dysfunctions can cause frequent fidgeting, inattentiveness, and acting-out behaviors.
Researchers also know that conditions can co-exist with ADHD. Learning disabilities are very common, and depression and anxiety are frequent co-conditions as well. By knowing your child and sharing your child´s history, you can greatly help medical professionals to more accurately diagnose and treat disorders that may arise.
TreatmentADHD treatment guidelinesfrom CHADD, AAP, and other organizations in the U.S. and Canadaemphasize that every child and family is unique and that treatment objectives should involve specific goals, not a cure. ADHD is a chronic condition, and should be carefully managed through a customized combination of therapies. Medication is one option among many, and no single drug works for every child. If a medication does not work, the diagnosis and treatment should be re-evaluated.
For those seeking alternative treatments, options are endless (though not always studied or proven). One computer-based program reportedly improves attention and focus by requiring trainees to anticipate a series of rhythms with hand and foot exercises. Computer software that highlights and speaks text claims to improve ADHD students´ reading ability. Other suggestions include everything from changing the child´s diet to enrolling the child in a handwriting course.
EducationIn several recent cases, school personnel have reportedly told parents that their children cannot attend school unless they are on medication. Quite obviously, ADHD behaviors are often at direct odds with most schools´ codes of conduct.
The disorder is, however, included in the Individuals with Disabilities Education Act as a condition that may warrant accommodation. And, if you live in Connecticut, a 2001 state law prohibits school personnel from recommending psychiatric drugs for any child. In November 2002, the National Foundation of Women Legislators passed a resolution urging Congress to pass federal laws to keep children from being "forced onto psychotropic drugs as a requirement of their education."
In the classroom, teachers can make the learning environment more friendly by:
- placing children with ADHD front and center in the room
- keeping the classroom door closed
- keeping decor simple and uncluttered
- writing assignments on the board
- monitoring children who are likely to be distracted, and pulling them back into learning when they start to drift
- working hard to accentuate the positives in every student
- using a variety of learning activities every dayincluding hands-on creative work and open discussions where active participation is encouraged
If you are parenting a child with ADHD, discuss educational goals with his or her teacher. By working closely with schools, you can help to make your child´s school experience much more rewarding.
WhatÕs Good about ADHD
One key to promoting children´s self-esteem lies in encouraging them to make the most of their natural abilities. And, says Susan Pye Brokaw, "ADHD kids do have a lot of positive qualities." Susan is an adoptive parent, ADHD expert and trainer, and founder of Attention Deficit Support Services in Minnesota. Both she and her son have ADHD.
Admittedly, she says, people with ADHD are not the best at effectively managing their time. They are, however, great in emergency situations because adrenaline can have a calming effect on people with ADHD. Jobs as emergency room doctors or technicians, paramedics, firefighters, and soldiers suit this trait well.
Children with ADHD can also be very creative, perceptive, and imaginative. Talents in music, athletics, and artparticularly pursuits that involve hands-on workare also associated with ADHD.
To help children with ADHD, parents and teachers should facilitate children´s ability to make the most of their skills and to adapt in situations that favor traits less native to the ADHD brain. New information and resources can help. Living with ADHD can also be highly stressful, so take care of yourself and look for ways to stay positive. With a healthy perspective, you´ll no doubt agree that at least life with ADHD is never boring.