Born to Explore!   The Other Side of ADD


Home
What is ADD?
Causes
Positive/Alternative
Books
Discussion Board

Links
About BTE

stars-5-0.gif (240 bytes)

Books I recommend:

edtrait

The Edison Trait: Saving the Spirit of Your Nonconforming Child (Dynamos, Discoverers and Dreamers)

 

BEYOND.GIF (8227 bytes)

Beyond ADD: Hunting for Reasons in the Past & the Present by Thom Hartmann

 

The Minds of Boys:
Saving our Sons from Falling Behind in School and Life

The ADD Nutrition Solution

More   books...

 

 


Children: Diagnosis, "Treatment" and Alternatives

Children are most often referred for a diagnosis by the school system.  In some cases, schools actually give parent ultimatums: Medicate your child or he will be expelled.  If you are in a situation where you do not believe your child has a disorder and feel pressured by the school, please contact your state Board of Education and tell them about your experience.   Some states have begun taking action.  The Colorado Board of Ed passed a non-binding resolution in 1999 to prevent teachers and school administrators from recommending Ritalin and other psychotropic drugs.  This is not to say that all schools push Ritalin, because there are schools where none of the kids are taking meds.

If your child ONLY has problems in school, then, by definition, your child does not meet the DSM IV diagnostic criteria for ADD.  A child must exhibit ADD behavior in two or more situations to a degree that is "maladaptive" in order to be diagnosed ADD. 

If you feel your child is not disordered, but school personnel are pressuring you, then I suggest you get the book "Nurture By Nature" and determine your child's MBTI temperament type. Chances are very high that the very behavior problems or inattention that the school is complaining about will be noted in the description of your child's temperament type.  These are considered NORMAL behaviors by temperament experts and are tradeoffs for other talents.   Show the description to the school administrators.  This book also provides strategies for dealing with each type of child.  If your child is very bright and creative, then I also recommend The Edison Trait.  I've heard back from one reader who said the book made the difference between failure and achievement at school.

Getting a Diagnosis

If you decide to have your child assessed for ADD, do NOT use any school personnel or anyone connected with the school system because they are biased.  Unfortunately, the public school system is rewarded by having difficult children labeled ADD in three ways.  First, the medicated child is easier to handle and less disruptive.  Second, the school receives money for each child thus labeled if special ed services are requested (that's why you probably can't get special services like tutoring unless your child is officially diagnosed with a learning disability). And third, medicated children may do better on standardized test exams, making the school administrators and teachers look better.  Long-term studies, however, show that medicated children do not actually learn more in the long run, even though they get better grades.  So while it is in the school's self interest to have your child diagnosed ADD and medicated, it may not be in your child's best interest.  Parents should ultimately make this decision, not the school or even the doctors.

In some school districts up to 20% of white 5th grade boys are taking meds in school, while in others NONE are taking meds.  If the school has suggested ADD, you might ask the school nurse how many of the kids are taking meds in your school.  If the number is high, then be very suspicious.  The suburbs tend to have the highest rates of diagnosis. I personally think this information should be made public so that people can compare school districts.   How many people would want to move to a school district where 20% of the grade school boys were on meds?  What does that tell you about the school's ability (or lack thereof) to really engage the student?

Do not use a pediatrician.   As a group, pediatricians know less about ADD and are more inclined to simply prescribe medications without really doing a proper diagnosis.

Psychiatrists can prescribe medication and many do so VERY quickly.   Most seem to be really enamored with the idea of how absolutely wonderful meds are for as many people as possible.  They have a high tendency to view all behavior as just a symptom of a chemical imbalance that can be fixed with the right drug.   I think I know what some of these people were doing in the sixties!

Neurologists are highly inclined to see brain abnormalities because that is their training and background. 

Psychologists are not medical doctors and cannot prescribe medication, but if necessary will write a letter recommending medication to your pediatrician.  I personally would start with a psychologist because their focus is more holistic than medical doctors.  A good psychologist is more likely to consider issues like giftedness, temperament, family problems, peer problems, discipline strategies, and other issues which can affect behavior and concentration.

Before you take your child in for a diagnosis, make sure you have a clear understanding of what ADD is and are familiar with the diagnostic criteria. Some practitioners are not doing diligent assessments.  See my pages on What is ADD? and A Closer Look at the DSM IV Diagnostic Criteria.  I highly recommend getting a few books as well (my recommendations are described on my page on ADD books).

Before you make the appointment, ask what an ADD assessment entails. You want one that is thorough and will include IQ tests and preferably the Torrence test for creativity (since many ADHD children are actually creative-gifted).  My assessment took four hours.

Be aware that an assessment for ADHD is extremely subjective.  If your child is diagnosed ADD and you don't feel comfortable with that, then get a second and third opinion.

"Treatment" Options  and Alternatives

You have several options for how to handle the child who acts like an ADHD child. Physicians usually want you to medicate immediately.  I advise against moving that fast. Here's a checklist of items for you to research first in order to rule out things like nutritional deficiencies or food sensitivities.  After all, if your child is simply reacting to a food, wouldn't it be better to remove the food than to give your child a mind-altering substance?   Sometimes a parent can work carefully through the checklist and still find medication necessary.  On the other hand, many parents have had miraculous results.   You will never know unless you try.  Your goal should NOT be a perfectly obedient, compliant child who focuses well on things he or she finds boring. It is normal from some children to be difficult and to daydream. But a child should not be failing out of school and totally friendless, either. And even if you do use meds, you may find the meds work better in conjunction with some of the following:

1. Does your child have a fatty acid deficiency?  Studies have linked fatty acid deficiencies to ADD, behavior problems and learning disorders, and I have heard from quite a few parents who found that fatty acid supplements dramatically affected their child's behavior.  Test:  Try a supplement of Effalex, a good blend of fatty acids, for 3 months.  If you can't find Effalex, try DHA or fish oil (for omega-3 fatty acids) AND primrose oil (contains GLA Omega-6 fatty acids).  You should be giving about 1 gram of DHA each day for the first 3 months.  If this works, then try switching to flax oil, which doesn't contain the environmental contaminants often found in fish oil. Side note: Japanese parents have been giving their kids DHA supplements for years so they get better grades. See my page on fatty acids for more information, also Nutrition for ADD Kids.

2. Is your child sensitive to certain foods or food additives?   The Center For Science in the Public Interest reviewed 25 years of scientific studies and concluded that some kids react to foods and food additives in a way that causes behavior problems or problems concentrating.  This reaction can be severe.   It is most likely in children who: 1) have allergies, eczema, ear infections, or asthma; 2) have sleep disturbances; 3) seem unhappy, irritable and generally not well; 4) have bizarre swings in mood not related to what is going on around them.   Food colors such as Tartrazine (yellow #5) cause problems in such children, especially sleep disturbances. I personally have banned all the processed foods from my house which contain colors and lots of additives.  Stick to food that is REAL. You should also see a pediatric allergist if your child has allergies.  Through testing, I found that my son is allergic to soy, an otherwise healthy ingredient in many packaged foods, including Spaghettios and tuna fish.  Some parents discover their children's allergies by reducing their diet to a few non-allergenic foods and gradually increasing the variety while they keep a careful diary of food vs. behavior. This is a lot of work but many payoff well. By the way, sugar does not normally make kids hyper, except in a few instances when the child is allergic to a certain type of sugar. If your kid reacts to junk food it's probably the colors, not the sugar. Read my page Can Allergies Cause Behavior Problems? Other Resources: "Is This Your Child? Discovering and Treating Unrecognized Allergies in Children and Adults" by Doris Rapp, M.D.; Why Can't My Child Behave? The Feingold Diet updated for today's busy families; The Feingold Association website; and the online report Diet, ADHD & Behavior - A Quarter Century Review by the Center For Science in the Public Interest.

3. Is your child gifted and bored in school?  Gifted children who are bored can display lots of negative behavior AND get low grades in school.  They don't pay attention and can cause lots of mischief.  They'll argue with teachers and may have peer problems. In fact, lists of "gifted" behavior are similar to the diagnostic checklist for ADHD.  If this is your child, then please change the environment, not the child!   If your child acts out because of boredom, then find a way to stop boring your child.  Would you give a gifted child Valium in order to tolerate a boring class?   Then why give him or her Ritalin for the same reason?  I personally do NOT like official "gifted" assessments because they are somewhat arbitrary and can give a child a complex, but if you do go for one be sure to have them include the Torrence test for creativity. A child can be gifted even if his or her IQ is less than 130 if the creativity score is high.  If your school cannot accommodate your child's needs, then try homeschooling or a private school.  See my page on Alternatives in Education.  And never tell your child he or she is smart, because it gives these kids a complex.  Always give praise on the basis of hard work and effort.   See Potential Negative Creative Traits and Praise Children for Effort, Not Intelligence.

4. Is your child a "visual" learner? Many kids labeled ADD are visual thinkers.   Average kids are verbal thinkers, as are the teachers.  Bright kids who have problems with reading, spelling or handwriting are usually extremely visual thinkers. Get the book "Left-Brained Children in a Right-Brained World."  It describes how visual thinkers learn differently and gives practical tips.

5. Is your child's natural temperament a factor?  Is there a temperament clash between you (spouse, teachers, etc.) and your child?   Usually the answer to this question is "yes."  For example, a quiet and reserved adult is far more likely to see a "disorder" in a high-energy extraverted child, even when the child's behavior is normal for his or her type.  And an adult that focuses naturally on what is concrete and "real" is more likely to view a daydreaming child as having attention problems.    In each case, the adult is likely to give off vibes that he or she does not like the child, and the child may act out or get depressed and anxious.   Please find out what your child's natural temperament preferences are, as well as your own, and learn about temperament biases.   There are no right or wrong preferences: each preference has positive and negative aspects. In "real life" I frequently see high-energy extraverted kids being medicated by quiet, reserved mothers or fathers who are overwhelmed by their child's energy level.    I have a lot of information about MBTI temperament types on this website (see Temperament).  I also highly recommend the book Nurture by Nature which lets you understand better how your child's mind works and how best to interact with him or her. 

6. Is your child over- or under-stimulated?  I have found this factor to be absolutely critical on a day-to-day basis at our house. Some kids act out when they are bored (understimulated), but also become easily overstimulated if there is too much going on around them.   Lack of sleep constitutes overstimulation.  Our rule at home is that a string of bad behavior means my son goes to bed early on the grounds that he is probably tired, and this usually works well.   Extreme extraverts (like my son) have a strong tendency to become really wound up and spin out of control after they are around other people for too long (they are "energized" by being around people).  Conversely, introverts can become overwhelmed and shut down if they are in a busy classroom all day.  My friends' daughter, a bright introvert, covers her ears when people clap and says "Mom, tell them to stop making so much noise!"   The girls' teacher has noted that she sometimes doesn't pay attention.  When her Mother informed the teacher that there was probably too much noise in the class, the teacher said "I never thought of that."

7. Try Alternative Discipline Strategies:  For kids with behavior problems, try some    alternative discipline strategies.  These kids don't respond to punishment the way average kids do.  Instead, they usually respond in an equal and opposite fashion, so the more you punish them the more they act out. I have found such strategies to be absolutely critical. See my section on Teaching Self Discipline.  Also extremely important is to designate a specific amount of time each day for giving your child positive attention. In one study reported in Science News, 37 ADHD children were taken off of medications while their parents received special training. After one year all the children were still off of their medications - a success rate of 100% without any side effects or damage to the child's self esteem.  You will hear of studies that show medications are more effective, which is true.  Drugs can turn a spirited, wild child into a robotic, compliant child, but should that be the goal? 

8. Is this all about grades? Do you have a child getting Cs and D's and you want your child to get A's and B's and THATs why you're looking at an ADHD assessment?  Medications can work wonders in achieving higher gradepoint averages.  But why bother? There is no correlation between grades and later success in life.  So what's the point?   Your child will still be able to get into a college, maybe not Harvard, but he or she will certainly be able to get into some college.  Success will depend on job performance, not grades in school.  I have never once regretted my average performance in school, including college. 

9. Is your child socially clueless? This is actually pretty normal for some temperament types.   Very logical children, for example, are mystified by the idea that they should consider people's feelings.  They have to be TAUGHT. Very extraverted children will often interrupt other children and talk too loud and too much.  An extraverted logical type will want to be in charge and may be very bossy.  The answer to these problems is simply to teach, teach and teach some more.  You have to explain social rules over and over to them.  An effective trick is to camcorder your child with other children.  Later, when the child is away from other children, play the tape back and critique your child's social skills together with your child.

10. Does your child need to move? Extraverted kids in particular need to move in order to think. See if the teacher will allow your child to have two desks and let your child get up at will and move from desk to desk.  And make sure your child has lots of opportunity to get up and move around throughout the day.  This type of child may have trouble doing homework in a quiet corner. Believe it or not, the kitchen table may be best. Extraverts need lots of activity to stay alert.  Turn on the radio!

11. Do distractions keep your child from getting ready for school, eating, or cleaning his or her room?   This is normal for kids with a strong preference for divergent thinking.   Think of it not as lack of focus, but as an alertness to new information. Follow-through is critical on your part. Create some simple rules and stick to them. If your child is not ready for school at a certain time, then he or she must go to bed early that night.  If he can't clean his room, then there are too many toys: box a bunch of them up and put them in the attic until he shows he can handle cleaning them up.   Your child must learn consequences, or he will never learn to overcome his natural tendency to procrastinate (and he CAN learn!).  Especially useful is a timer and an effective ultimatum.  "I'm going to set the timer for 10 minutes.  If you are not in your pajamas with your teeth brushed when it goes off I'm going to take your new Pokedex away for one day." The timer and ultimatum keep him focused so he can complete the assignment.  As an adult, this type of person often works best in a crisis atmosphere.

12. Is caffeine a problem?  Some people don't realize that some orange soda and root beer contain caffeine, as well as colas.  It's possible that a few kids are simply being drowned in caffeine and that's why they are hyper.  This may be especially true of teens who stay up late and then can't wake up the next morning.  Caffeine metabolism varies considerable from one individual to another, and it can take up to 12 hours from caffeine to leave the body. Caffeine can cause anxiety as well as irritability as it wears off.

13. Is there a problem with a specific teacher?  Challenging kids can be hypersensitive to whether or not their teacher seems to like them.  Outgoing, cheerful and non-judgmental teachers seem to do the best with high-energy kids.  If there's a problem in the classroom, try and find out how the teacher interacts with your child.  Does the teacher take challenging behavior in stride or does she act annoyed with your child?   Are the teacher's expectations reasonable, or is she setting your child up for failure by expecting him to sit perfectly quiet?  Does the teacher LIKE your child?   Does she have a sense of humor? If not, you child will know it right away and will probably act out.  You may not be able to get a different teacher (kids need to learn to deal with teachers they don't like anyway) but it's good to know if this is a factor.   This is especially important if this particular teacher happens to be telling you your child needs Ritalin.  A child who is trouble for one teacher can be an angel for another. 

Medications:

Stimulant medications are extremely effective in most (but not all) children.  Ritalin is the most common and the most powerful, but it also has the worst side effects.  I tried it out and though it allowed me to organize my son's toys for 5 hours straight, I definitely felt like I was "on" something.  And as it started to wear off I got a splitting headache and became highly irritable and emotional.  This is called the "rebound" effect.  I hate to think of kids going through this, and yet they do. Parents complain about how impossible their child is to deal with during the rebound.  I can see why. When I complained to the doctor about it, he switched me to a much higher dose in an extended release form (that's a psychiatrist for you).  This made me sick within a few days and I even missed a day of work because I felt so terrible.  I also developed an annoying eye twitch.  I threw out the Ritalin.  The eye twitch stayed for six months afterwards, until I stopped drinking my two cups of coffee each day.  I know now that Ritalin induced an anxiety reaction in me, which is something any stimulant can do. The anxiety reaction included a complete inability to concentrate, forgetfulness, fogginess, muscle stiffness, the jitters and problems sleeping. The reaction did NOT end as soon as I stopped taking the Ritalin.  Someone can take stimulants (including caffeine) for decades without a serious problem and all at once develop an anxiety disorder because of it.  Many people write to me and say their medication worked wonderfully for years but all the sudden they cannot concentrate or remember anything, and I wonder if they are developing an anxiety reaction like the one I had.

Many people have told me they prefer Adderall because it is "smoother" with less of a rebound effect.   Ritalin is prescribed most often primarily out of habit.  I suggest that if your doctor recommends Ritalin you ask about Adderall.  There are other stimulant medications, but these two are the ones I hear about most frequently.  Wellbutrin is classified as an antidepressant but is really more of a stimulant.  I tried it and couldn't sleep for four days.

The website Rx List - The Internet Drug Index has a lot of specific information about medications, including a message boards for some medications such as Ritalin.  Because there is already a good source of this info online, I'm not going to repeat it here.

Don't try using herbal remedies on kids.  Herbs are drugs.  They have not been tested and you don't have any idea what they might do to your kid in the long run.  And there's no quality control, so fillers might include toxic ingredients like lead.  Don't use a homeopath or naturopath.  They'll give your child herbs or other substances that have not been tested for safety.  One mother I spoke to was giving her child "arsenica album, tarantula, and a calming herb" per the homeopath she was using.  That's arsenic, spider venom and an unknown sedative.  I'm surprised she didn't throw in some rat poison as well. A possible exception is pine bark extract (or "Phycogenital"), which is said to contain natural bioflavinoids that act as antioxidants.   If so, it's closer to a nutrient than a medication. I've heard from a couple of people who had a good experience, and one reader has suggested that it may work best with inattentive types rather than hyperactive types.   It's also supposed to act as a natural antihistamine.  Herbal information is listed at  Rx List - The Internet Drug Index.  (Note that the following are nutritional rather than herbal supplements: essential fatty acids from flax oil, Effalex, fish oil or primrose oil; and vitamins and minerals like calcium and magnesium.  All people should make sure they get enough of these nutrients.)

Sometimes doctors prescribe a stimulant along with an antidepressent, such as a Ritalin/Prozac combination.  In some cases the anti-depressant is given to counteract the anxiety reaction that the stimulant is causing, which makes me wonder what they give to counter the side effects of the anti-depressant.  Be aware that both drugs act on the brain's neurotransmitter system and these drugs have not been tested together for safety.  I bring this up because of the Phen-Fen fiasco, an "ultra safe" drug combination for dieters that was later found to cause heart valve problems.  Each drug is very safe when taken separately.  One theory for the problem is that each drug works on the serotonin system, and people were effectively getting a double dose.  DRUG COMBINATIONS HAVE NOT USUALLY BEEN TESTED TOGETHER FOR SAFETY. If a doctor wants your child to take two or more medications simultaneously to treat ADD, your child is being used as a guinea pig.  I've also heard of doctors prescribing sleeping pills to children who could no longer sleep because of the Ritalin they were taking. I strongly advise parents to get a second opinion if it seems that medications are being prescribed flippantly.

Safety: Medical people say Ritalin and similar meds are safe.  Ritalin has been used for decades.  For people who really truly need meds, I wouldn't worry too much about the safety issue.  There are risks with all medications, but if you really get a lot of benefit from a medication, then the benefits usually outweigh the risk. 

However, there ARE safety concerns as well as serious potential side effects, so if your child does not absolutely NEED medication, then don't give it to him.  Deaths HAVE occurred, as well as other serious problems.  The makers of Ritalin are currently being sued by a parent whose child died from an irregular heart beat brought on by Ritalin.  Another child died recently from cardiac arrhythmia because the pharmacist misread the prescription dosage for imipramine1. Before you give your child any medication, do a very thorough search on the potential side effects so you know what they are.  There have been NO long term studies for safety.  It is now believed that most people do not outgrow ADD and may very well need medication all their life, and no one knows what taking Ritalin for 70 years will do to the brain and body. It is not known whether the brain somehow adjusts to the presence of Ritalin, so that once the Ritalin is stopped the child is more ADD than they were before.   Sometimes Ritalin (or other meds) suddenly stop working, requiring a switch to a less effective drug. Again, no one knows why.

And consider carefully the medical community's idea of "safe."  A 1998 study estimated that 2,000,000 Americans a year are seriously injured and about 100,000 die from properly prescribed and administered medications taken at their recommended dose2.  So their definition of "safe" may differ from your definition of "safe."  Again, if your child really needs the meds, then don't worry too much.  But if your child doesn't absolutely need them, then don't let anyone give you the impression that Ritalin or other meds are as safe as candy.

Stimulants were NOT approved for flippant use, but only as a last resort.  Read this section from the Internet Mental Health article on Methylphenidate (Ritalin):

    "Drug treatment is not indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors....Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician's assessment...Long term effects of methylphenidate in children have not been well established."

Ritalin:  I've taken the following information from "Prescription and NonPrescription Medications For Children" by Max Van Gilder, M.D. and Shelagh Ryan Masline.

The initial dose is 5 mg two or three times a day, which can be increased by 5 mg per dose every three or four days until it becomes effective but without too many side effects.  Note that very often doctors prescribe too high a dose.  Every child responds differently so the dosage MUST be tailored to the individual.  The dosage should be reduced or stopped if your child becomes "withdrawn, tearful or suspicious." The most common side effects are loss of appetite, followed by a hearty appetite when the drug wears off, dizziness, headache, rash, heart palpitations, changes in pulse rate and blood pressure, and nausea.  In addition toxic psychosis has been reported, and depression, anxiety or mood disorder may also occur.  Ritalin is not recommended for children who "exhibit extreme anxiety, tension, or agitation, as it may aggravate these conditions."

Ritalin as a Street Drug: Some kids are selling their Ritalin to classmates who crush the tablet and then either snort or inject it.  Street names include "speed" and "west coast".  When snorted or injected it may cause paranoia, hallucinations, delusions, tremors, fevers, convulsions and other problems.  (Source: "Growing up Drug-Free: A Parent's Guide to Prevention" by Partnership For a Drug-Free America, a booklet the school sent home with my son).  I'm curious as to why so many ADHD kids are selling their Ritalin. 

 


Other Sources:

1. "Faulty Warning Labels Adds to Risk in Prescription Drugs" New York Times, June 4, 1999.

2. Consumer Reports article "Are you taking too much medicine?" March 2000.  I'm looking for the original source of the 1998 study regarding serious injuries and death from taking meds as directed.   The study was well publicized but I can't remember where it was published.  If you know, please drop me a note.

 

All BTE pages were written by Teresa Gallagher unless otherwise noted and may be photocopied (but not reprinted) without permission.  BTE Web Design now creates websites for small businesses. Perhap "BTE" really means "Born to Entrepreneur..."