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Published: in the February 23rd edition of the Wall Street Journal
Parents wonder if they jump to the wrong conclusion
A balanced article in the February 23rd edition of the Wall Street Journal ponders this question. Because the medical and psychiatric communities have so many different disorder labels, it’s very difficult to know whether your child is just developing normally or is suffering from some disorder or another.
A good example from the article:
“One of the doctors in his practice recently saw a child who had been licking his shirt in preschool. The teacher had told the parents that the child should be evaluated by an occupational therapist for a suspected sensory problem. The pediatrician ultimately convinced the parents that the child was developing normally, Dr. Cohen says.”
Parents often don’t want their child to be labeled as this stigma may be long lasting. However, if a correct diagnosis is made, it can be life changing as well.
Read the full article: http://online.wsj.com/article/SB10001424127887324338604578326112816120302.html?mod=WSJ_article_comments#articleTabs%3Darticle
Finishing tasks can be a problem for all of us, but for those with ADD or ADHD it’s a major issue. This applies whether you are an adult or child. Here are a few strategies to help:
1. Break the task down. Often times breaking a task into small doable segments will help you get the full project down.
2. Set a timer. During your task, set a timer to start and end. If you know you can clean your kitchen in a half hour, set the timer and stick to it. That way your kitchen gets cleaned in a half hour instead of three!
3. Prep! Place all materials needed for the job close to the job. For example, if you get all your cleaning supplies out the night before and leave them on your kitchen counter, you’ll be prepared for the full cleaning the following day. It also serves as a reminder and a little impetus to avoid procrastination.
4. Reward yourself. If you’ve done your prep and set your timer, your project will get done on time. Plan to give yourself a reward if you meet your goals. Remember to set reachable goals and appropriate rewards, i.e. don’t eat a whole container of Häagen-Dazs for just cleaning your kitchen on time.
The Journal Gazette posted an article by Dr. Rama Cousik. Cousik is an assistant professor of special education at IPFW (Indiana University–Purdue University Fort Wayne). The article is relevant and provocative.
www.journalgazette.net/article/20121223/EDIT05/312239978/1147/EDIT07
As I was preparing for a lecture on ADHD, one sentence in a 2009 UNESCO report caught my eye:
“A single ‘good’ quality study of methylphenidate (MPH) with 114 preschool children provided low SOE for improving child behavior. …Adverse effects were present for preschool children treated with MPH; adverse effects were not mentioned for PBT.”
We in academia are so fond of acronyms. Luckily, we are required to decode them: SOE means strength of evidence, and PBT means parent behavior training.
This quote is from a research report on treatments for children who are at risk for ADHD (attention deficit hyperactivity disorder). At risk means they are highly likely to be diagnosed with the disorder when they are older.
Methylphenidate is a prescription drug sold as Concerta, Metadate, Methylin and Ritalin – a drug as popular and as widely consumed as popcorn.
The researchers compared the effect of two treatment methods on children’s behavior: 1.) Prescribing methylphenidate to children and 2.) Training parents to manage their children’s behavior without medication.
Children with ADHD have problems paying attention, are impulsive and hyperactive. A diagnosis usually occurs at or after 7 years of age. Children who are younger than 7 years, at risk for ADHD, may be diagnosed with oppositional defiant disorder.
According to the Centers for Disease Control, “Parents report that approximately 9.5 percent or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.” And the number is increasing.
Having grown up in a world without ADHD, I struggle with the idea that many young children are increasingly being considered at risk for ADHD. I also struggle with the fact that medication is a part of the treatment package for many preschool children.
Like all drugs, methylphenidate has many side effects. According to PubMed, “Methylphenidate may cause side effects … nervousness, difficulty falling asleep or staying asleep, dizziness, nausea, vomiting, loss of appetite, stomach pain, diarrhea, heartburn, dry mouth, headache, muscle tightness, uncontrollable movement of a part of the body, restlessness, numbness, burning, or tingling in the hands or feet…”
While I am grateful that drug manufacturers are required by law to publish the side effects of all drugs in the market, one thing bothers me. How does one expect a preschooler to even begin to comprehend what symptoms she is experiencing, let alone communicate them to parents?
And as if these side effects are not serious enough, they warn you about serious side effects, including “…irregular heartbeat, difficulty swallowing, fainting, seizures, hallucinations and tics.”
Two statements at the end of the PubMed webpage were foreboding: “Methylphenidate may cause sudden death in children … (and) may slow children’s growth or weight gain.”
Naturally, the UNESCO study found that medication had adverse effects and hardly improved children’s behavior, whereas parent training programs improved children’s behavior and, most importantly, had no harmful effects.
Now what does that tell us about parenting? It is in our hands to prevent our children from being diagnosed with ADHD and protect them from harmful side effects of medication, unless extremely necessary.
As parents, we want the best for our children. However, their best will not evolve if we don’t do our best to raise them. And doing our best includes learning about the harmful effects of drugs before we force them on our children.
If your doctor has told you that your child has ODD, learn everything about the condition and treatment options before you agree to medicate him.
Learning how to manage your child’s behavior without medication is the most effective first option of treatment and causes no harm to your child. Ask your health care provider to give you information about parent behavior training program in your area. If there is none, get together with other parents who are concerned about their preschoolers’ behavior and demand that such a program be initiated in your community.
Let us make a concerted effort and learn to manage children’s behavior without resorting to Concerta.
Mothers beware of your diet
We’re all concerned about contaminants in our environment. We worry about drinking clean water, breathing clean air, and eating non-toxic food. A recent study published online Oct. 8 in Archives of Pediatrics & Adolescent Medicine reveals another possible concern: mercury hidden in fish. The study links mercury exposure in expectant mothers to ADHD symptoms in their children at the age of 8. Mercury is known to affect the human nervous system.
As with other studies of mercury and its possible link to ADHD, the current study “adds to concerns about mercury consumption and to evidence about the benefits of fish consumption,” said Dr. Susan Korrick. Korrick is the study’s co-author and an assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. Korrik’s team found that more mercury exposure leads to a higher incidence of ADHD symptoms. However, more fish consumption — the main source of mercury exposure — leads to a decreased risk.
“How much fish you eat is not equivalent to how much mercury you are exposed to,” said Dr. Korrick. “I think the public health conclusion that I would come to is that one can benefit from fish consumption, but it’s important to try to consume fish that are low in mercury.” Fish high in mercury include swordfish,shark, and fresh tuna. Fish with lower levels of mercury include salmon, haddock, shrimp, and cod.
Korrick and her reviewed data on children at age 8 from the New Bedford, Mass., area who were born between 1993 and 1998. New Bedford is on Massachusetts’ coast and is a fishing community where fish consumption is popular. Fish consumption is a primary source of mercury. Korrick’s team investigated whether greater mercury exposure before birth, prenatal exposure via mothers’ wombs, might lead to more behavioral problems in kids later in life.
The researchers tested the children and evaluated teacher reports. The researchers found that some children of mothers who had the highest levels of mercury before birth were 40 percent to 70 percent more likely to have the behavioral problems.
There are flaws to the research because of its design. It doesn’t prove that mercury is directly responsible for the behavioral problems or ADHD although prior studies have found links. Also, children in the study were not actually diagnosed with ADHD because the study only looked at ADHD symptoms. Better to be safe than sorry regarding mercury consumption.
A great article from Psychology Today (http://www.psychologytoday.com/blog/brain-sense/201207/is-it-adhd-or-typical-toddler-behavior).
10 Early signs of ADHD risk in young children.
Young children often have problems paying attention or concentrating, but when are these problems serious enough for parents and teachers to be concerned? According to estimates from the Centers for Disease Control, one in 11 school-aged children are diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), but research suggests that the warning signs often appear before a child first goes to school. Some experts estimate that as many as 40 percent of children have significant problems with attention by age four.
Why should parents be concerned about ADHD in their preschoool chidlren? “We want to catch ADHD early because it has such a profound effect on learning and academic development. Children whose symptoms begin in early childhood are at the highest risk for academic failure and grade repetition.” says Dr. Mark Mahone, director of the Department of Neuropsychology at the Kennedy Krieger Institute in Baltimore, MD.
In children ages three to four years, Dr. Mahone recommends looking for the following signs that are associated with an ADHD diagnosis at school age:
1. Dislikes or avoids activities that require paying attention for more than one or two minutes
2. Loses interest and starts doing something else after engaging in an activity for a few moments
3. Talks a lot more and makes more noise than other children of the same age
4. Climbs on things when instructed not to do so
5. Cannot hop on one foot by age four
6. Is nearly always restless — wants to constantly kick or jiggle feet or twist around in his/her seat. Insists that he/she “must” get up after being seated for more than a few minutes.
7. Gets into dangerous situations because of fearlessness
8. Warms up too quickly to strangers
9. Is frequently aggressive with playmates; has been removed from preschool/daycare for aggression
10. Has been injured (e.g., received stitches) because of moving too fast or running when instructed not to do so
“If parents observe these symptoms and have concerns about their child’s development, they should consult with their pediatrician or another developmental expert,” says Dr. Mahone. “There are safe and effective treatments that can help manage symptoms, increase coping skills, and change negative behaviors to improve academic and social success.”
I was a teacher for over 16 years in public schools. Many children I taught had attention problems. There really wasn’t an ADHD label at the time I started teaching; we labeled them with Minimal Brain Dysfunction. We had no idea why they seemed so easily distracted. However, we did know they drove us crazy.
Even with a graduate degree, I realized I had neither the knowledge nor resources to help these students whether they were adults or children. I went back to university to ask my professors what to do. They were somewhat puzzled too. Most hadn’t been in a classroom in over 30 years. So I attempted the good old standbys: moved the student closer to my desk, developed and individualized education plan (IEP), a behavioral plan, a rewards program, and communication with the parent. These are typically the accommodations still used today. Essentially, we modify environment. We do not retrain the child or adult. In other words, we don’t teach coping skills or cognitive skills, we just try to make their environment easier to muddle through.
Approximately 60% to 70% of all ADHD children will carry their problems into adulthood. As adults, research tells us they have higher rates of substance abuse, obesity, incarceration, traffic accidents, divorce, and commonly make less money than their peers. This is a truly sad commentary on our educational system and our treatment of ADHD medically and as a society. What we currently do is not working.
The next rational question is, “Why is this system a failure?”
Teachers are on the front line with the students and they are often responsible for the initial diagnosis. While they cannot legally make a diagnosis, they often recommend parents to take their child to a pediatrician for diagnosis. Frequently, with a 20 minute evaluation, a diagnosis is made.
Sometimes the pediatrician will be wise enough to send rating scales home and to the teacher. These checklists (often the Conners or the Vanderbilt scales) are assessed to determine symptom frequency and severity. These are sometimes evaluated pre and post, but commonly just post medication to determine medication’s effects to adjust the dosage accordingly.
The salient question seldom addressed: Why are we are treating symptoms and not the underlying cause? If I go to my doctor and tell him my leg hurts, he doesn’t just let me walk away with pain medication. Instead, he asks me what I’ve been doing. “Have you been running? Exercising on that leg?”
I tell him I’ve just started skipping rope regularly for aerobic exercise. He feels my leg.
“I’d like to take an X-ray to check for other problems as I can’t feel anything,” he says.
The X-ray shows I have a stress fracture in my shin bone. “We can see a stress fracture in your shin. That’s the cause of your pain. You’re going to have to cease the rope skipping for a while.”
Pediatricians and parents are asking the wrong question: “How do we control the symptoms?” This is tantamount to the doctor hearing about soreness in my leg and prescribing a couple of aspirin a day. It gets nowhere near the root of the problem.
The question needs to be: “What is causing the problems we’re seeing in this child?”
Are you in the middle of a divorce? Does your child get enough exercise? Has he/she had a full physical to rule out hearing, vision, or other health problems? Either parent suffering from depression? Is there a history of abuse in the family? Has a family member died in the recent past? Do we see any sensory processing problems? So many good questions can be asked to get to the root of the problem, they would be impossible to list here, and these rating scales don’t ask about family history or life stressors. Unfortunately, the current standard of care makes it possible to diagnose and treat ADHD without ever learning about any essential history.
As a society, and even medically, we have a propensity to disregard these questions because we have a notion that ADHD is caused, in part, by genetic factors. Research tells us that genes may play a role, but it’s still unproven. Irrespective of genetic involvement, should this be a rationale upon which we ignore vitally important questions? The answer it a resounding NO!
Genes are not the beginning and end all of our existence. I’ll give you a good example. The number two tennis player in the world (he was number one for quite a while) is Rafael Nadal. Genetically born right handed, his uncle Tony switched him to play left handed as a youngster. Lefties offer a greater challenge to most right handed tennis players which provides an advantage. Through deliberate practice, ‘Rafa’ beats virtually every other player in the world holding a racquet in his non-dominant left hand. Did he alter his genetic predisposition? Yes.
Before I elicit many negative responses from parents categorically denying any problems at home, I can say that over the last 20 years of educational experience, about 5% of the children I taught had true ADHD without family or environmental stressors. This included both symptoms and a family history of attention problems verified by their psychologist or pediatrician. Regardless, the next rational question is: “What can we do to help this child gain self-control and improve?”
The current answer is to remove control from the family to medication. Sometimes a therapist will be involved, but given current economic conditions and that the majority of diagnoses are given to minority children and children of low socio-economic means, therapists are usually not part of the equation.
Parents often believe that cannot make a significant change since they’ve been told ADHD is likely a genetic trait. Other excuses are:
“I don’t have enough time.”
“I don’t know what to do.”
“We already fight all the time. I need something else to help like medication.”
“His father doesn’t think he has a problem. Of course, he’s not here when I try to do homework with our son.”
Family is an undeniably important component to making significant change for a child struggling with self-control/regulation. The British have adopted this as the first line of treatment. Medication is only prescribed when all else fails.
In the US, once a child is placed on medication, short-term improvement is common and the motivation to address the cause and difficult cognitive and behavioral aspects is lost.
The answer to “What can we do to help this child gain self-control and improve?”
1) First and foremost, search for a cause. Correct it. Seek help if necessary.
2) In your search, be certain to include an evaluation from a qualified healthcare provider. But, don’t begin with an ADHD evaluation. Maslow said [paraphrased], “If the only tool in your toolbox is a hammer, all your problems look like nails.” Tell your healthcare provider about behavioral problems that concern you and get a full physical to rule out physical problems, sleep problems, diet, etc.
3) Schedule at least a minimum of two hour long visits for an evaluation that uses a variety of instruments or tests.
4) Be certain the initial evaluation details family history, social history, and environmental stressors.
5) It’s often a good idea for both parents to make the first visit with without their child as it’s less stressful and can often provide more insight into the problem.
4) Since most of the problems associated with ADHD are cognitive or behavioral, find out if these can be corrected through training.
5) Medication may be considered for an older child if he is struggling in an academic environment or function in a social environment without it. As the British suggest, preliminarily, attention should be given to cognitive and behavioral interventions. This is often difficult as immediate change is expected and pressured in great part by the school.
Don’t fold under such pressure.
We are discussing the life of your child. We know that if we don’t address the root cause, medication will work short-term or for years with adjustment, but it teaches nothing. Remember 60% to 70% will carry their problems into adulthood. Should we wait until something bad happens? Academic failure? Car accident? Impulsive criminal behavior? Substance abuse? As I’ve said previously, the current standard of care for ADHD is not working. And with the new diagnostic manual out, diagnosis is extended down to age 4. A revolution needs to happen, and no one is going to do it except those concerned. I’m greatly concerned.
The perceptions of over 1000 parents were revealed in an online survey conducted in a collaborative effort by Parents Magazine and New York’s Child Mind Institute, a treatment center for children with mental health issues (http://www.parents.com/kids/health/childrens-mental-health/child-mind-institute-survey-results).
While the perceptions often don’t reflect actuality, they do offer a glimpse into the average American’s mind regarding ADHD. Poor parenting does not cause ADHD. It can, however, exacerbate the condition.
Other interesting results:
96% of parents said… They would want their child’s pediatrician to tell them if he thought their child should be evaluated for a psychiatric or learning disorder.
83% of parents said… They would want their child’s teacher to tell them if he thought their child should be evaluated for a psychiatric or learning disorder.
74% of parents said… Kids are often put on medication as a quick and easy fix.
72% of parents said… Doctors and parents are too quick to put kids on medication for ADHD rather than looking for other solutions.
63% of parents said… Too many children are being diagnosed with ADHD when they just have behavioral issues.
52% of parents said… Starting kids on medication so young in life is dangerous.
50% of parents said… Many doctors downplay the risks associated with putting kids on medication to treat ADHD and depression.
45% of parents said… Normal children are being labeled as mentally ill or having learning disorders simply because their teachers can’t handle them.
45% of parents said… Kids with learning disorders tend to have other behavioral issues that hamper their learning.
32% of parents said… ADHD is sometimes more a result of insufficient or absent parenting rather than a true medical condition.
16% of parents said… Kids who take medication now are more prone to drug or alcohol addiction later in life.
13% of parents said… ADHD should not be treated as a medical condition, but rather as a behavioral issue that can be corrected with discipline.
10% of parents said… Extended time on standardized tests give children with learning disorders an unfair advantage.
6% of parents said… Psychiatric or learning disorders are more common in single parent families.
Obviously, true ADHD is not caused by poor parenting although poor parenting can exacerbate the problem.
However, I must agree, and research bears this out, that too many children are being diagnosed with ADHD when other problems are really the cause.
A recent study published in the journal PLoS ONE reveals how we can all look younger and decrease cognitive deficits like ADHD. The secret: exercise! That’s probably not what you want to hear, but it makes sense.
Scientists at Tel Aviv University found that “endurance exercises,” aerobic exercise like running or cardio kickboxing not only help burn fat, but can also make us look younger and decrease symptoms of cognitive decline.
The team at Tel Aviv University’s Sackler School of Medicine led by
Prof. Dafna Benayahu propose that their data reveal why older people who have exercised throughout their lives age more gracefully.
“When we age, we experience sarcopenia, a decline in mass and function of muscles, and osteopenia referrers to bone loss,” says Dr. Benayahu. So without daily exercise, the muscular and skeletal systems weaken and are more susceptible to injury. This may also play a role in the increased likelihood of falling as we age.
The key to staying young seems to lie in stem cells that get activated during endurance exercise. To determine this, Benayahu and her team studied rats. Basically, making the rats exercise actually increased the number of muscle stem cells that typically decrease as we age.
The results were quite compelling when contrasting rats that exercised against sedentary rats:
* The number of youth producing stem cells increased after rats ran on a treadmill for 20 minutes a day for a 13-week period.
* The younger rats showed a 20% to 35% increase in the average number of stem cells per muscle fiber retained.
* Older rats attained a 33% to 47% increase in stem cells meaning they benefited even more significantly than the younger rats!
* Endurance exercise prompted the older rats to get up and go more often!
Aging while embracing a sedentary lifestyle significantly contributes to the development of disease. Furthermore, it contributes to a decline in cognitive abilities.
In other previous studies, researchers have also found that exercise in outdoor or ‘green’ settings reduces the symptoms of ADHD.
What’s the future? Well, it’s likely that scientists will try to discover the chemical process behind stem cell activation to produce more youthful bodies. It can then be sold as a pill. It seems the world would rather do that than just get up and dance! And no side-effects except sore muscles that are getting stronger, more youthful, and defined!
How much has information and communication technology (ICT) affected our lives? Researchers say that the average teenager sends a total of over 3,400 electronic [text] messages every month or surfs the Internet at bedtime. Could texting and bedtime web time influence the severity of your child’s ADHD symptoms?
In a study by the JFK Medical Center in Edison, New Jersey, and presented at the 76th annual meeting of the American College of Chest Physicians (ACCP), lead author Dr Peter G. Polos and his team found that more than half of these bedtime kiddy texters or web surfers are not only prone to have problems falling asleep, but experience mood, behavior and cognitive problems during the day.
“It is significant that these children are engaging in stimulating activity when they should be in an environment to promote sleep,” says Polos.
Polos’ team analyzed questionnaire responses from 40 children and young adults aged between 8 and 22. This is a small group and the results must be considered preliminary. However, the researchers found that those who used electronic technology at bedtime (texting, game playing, email, surfing, etc.) also experienced sleep-related problems such as excessive movements, leg pain and insomnia, and also had a “high rate of daytime problems, which can include attention deficit hyperactivity disorder [ADHD], anxiety, depression, and learning difficulties,” said Polos.
According to Medical News Today (www.medicalnewstoday.com), the analysis of the questionnaire data showed that:
* 77.5 per cent of the participants had persistent problems falling asleep.
* On average, participants were woken once per night by an ICT device.
* On average, a participant sent 33.5 emails or texts per night when they were supposed to be asleep; and the average number of people texted each night was 3.7.
* The average number of messages sent via ICT per person per month at sleep time was 3,404 and occurred over periods ranging from 10 minutes to 4 hours after bedtime.
* Among the adolescent participants, the older they were, the later they went to bed, and the more time they spent with their ICT devices at bedtime.
* Boys were more likely to use ICT to surf the net and play online games, while girls were more likely to text and make cell phone calls.
* High rates of cognitive and mood problems during the day were linked with sleep time related use of ICT, including ADHD, anxiety, depression, and learning difficulties.
* There were also higher rates of nighttime problems such as excessive movements, leg pain and insomnia.
Polos and colleagues concluded that use of ICT at bedtime may have “an adverse impact on sleep hygiene and daytime function which may be significant”, and that questions about this should be included in routine evaluations of patients reporting problems sleeping.
“These data suggest that further studies are needed to evaluate the short and long term consequences of STRICT on sleep,” they wrote.
Polos explained that “sleep is largely habitual in nature”, and if “children begin this type of behavior, they may set themselves up for the need for external stimulation before sleep later in life”.
This could lead to problems like difficulty falling asleep, not having enough sleep, and feeling sleepy during the day, he said adding that:
“More research is needed to determine all of the short- and long-term consequences.”
Many parents know that healthy sleep habits are especially important to ensure progress at school and healthy development, and are concerned about how best to handle the growing problem of ICT devices in the bedroom.
Polos said that using cell phones or computers, to talk, text, surf the net, or play games, is “more addictive, seductive, and interactive than passively watching television,” because of the graphics, rapid responses and interactivity.
“The sooner parents establish appropriate times for children to use this technology, the better,” he urged, adding that perhaps they should also “move key items, such as computers, from a child’s bedroom into a common area”.
Dr David Gutterman, President of the American College of Chest Physicians said concern about insomnia and other sleep disorders in children is growing and that “research shows that the problem is increasing, so it is more important than ever for physicians to ask questions about technology use when evaluating children for sleep issues”.
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