Treating Young Children for ADHD
http://thedianerehmshow.org/shows/2011-10-19/treating-young-children-adhd
Earlier this week the American Academy of Pediatrics released new guidelines for treating and diagnosing ADHD. The disorder, often characterized by hyperactivity and an inability to focus, is thought to affect about 8 percent of all kids. The new guidelines aim to help pediatricians identify ADHD in children as young as four. Previous recommendations applied to children six and up. Many pediatricians agree that attention deficit problems can be apparent in preschool age children, but there is debate over what treatments, if any, are appropriate. Join us to talk about diagnosing and treating ADHD in young children
Guests
Dr. Mark Wolraich
professor of pediatrics, University of Oklahoma Health Sciences Center
lead author, ADHD clinical practice guidelines
Dr. Mark Batshaw
executive vice president and chief academic officer, Children’s National Medical Center; professor and chairman, Pediatrics, George Washington University School of Medicine and Health Sciences.
Rick Ostrander
associate professor and director of Pediatric Medical Psychology, Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences.
Dr. Claudia Gold
pediatrician and author of "Keeping Your Child in Mind"
Comments
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I live on BOTH sides of this "issue".
I am one, and I parented one.
Both with successes based NOT on pharma-dose management, but thru practices like a caller described. Good nutrition, lots of outdoor activity, adhesion to basic living skills. Daily routines. Instead of a pill, when "IT" all gets too much (daily) I "throw a bag of letters" in a round banagrams. I make patterns in the controled chaos of random letter tiles. Give my brain time for the naturally occuring chemicals to settle, subside, run their course. And me a place to stand still while my body catches up to my mind, again.
I can only speak for me - but I absolutley DO see, experience things in a way that the so-called "normal" folk don't.
I am NEURO-SPECTACULAR!!!
I live in the real world but experience it AMPLIFIED.
My life is saturated with input!
Stimuli at a volumn that goes unnoticed by the main stream population. the so-called "neuro-typicals" of Taylor Grahams tellings.
I am one of the NEURO-SPECTACULARS!!!
(my own label and celebration for my weird, wonderful brain!)
Don't medicate me into some easier to deal with "typical".
YOUR LIVES, you neuro-typicals, ARE MADE brighter by the inclusion of us
NEURO-SPECTACULARS in your work a day worlds.
Thank us for bringing you art, music, brilliance, color, humor, authenticity, deep emotional connections and, at least in my case, an enviable lifestyle.
My dis-ease was mainly from attempts for force my amorphous peg to fit and stay in a square hole.
My parents were over whelmed by my energy and quirks and essentially
locked me out of the family for my diagnosis.
I am NEURO-SPECTACULAR!!! !!!
I found my "family" elsewhere.
WE EACH of us HAVE SOMETHING out of typical!!!
Am i right?
My experience makes me more open and tolerant to differences in humans, cultures and individual experiences.
I am NEURO-SPECTACULAR!!!
WONDERFUL!!!!!!!!!!!!! I too was diagnosed late in life and have 2 kids with this. I agree with you soooo much. We all have fabulous brains. Dr Edward Hallowell has written wonderful books about ADHD. I especially foudn helpful "Superparenting the child with ADHD". He tells kids that they have race car brains with the brakes of a Pinto, and that meds often help improve the brakes to help drive the race car brain better.
[witch hunt? don't surrender clarity of facts] Nature vs Nurture is the intriguing sociological angle or rather selection -by fact.
If a child is 1st gen to a remote and different location, the reflection of normal vs traditional that [may] incites whole nations to confront/confound normal-society against traditional-society under the fog of geography and the absence of history, the vacuum of ignorance?
If a person/human is nature-ally prone to self destruction, and you put medicine on the scales, the balance of reactionary normative actors/victims, needs a balloon to escape, and get those scales spinning!
I think that in traditional/old world cultures, children drink [caffinated {not meth}] tea regularly, but also are exposed to pragmatic role models.
Do persons who require medicine then degenerate the/that process? medicated competitions, and naturally insensitive/ambivelence? would a transplant Dr with a transplant parent encourage such spinning and medicating, like geographically they "would've" been [the hammer and/VS the nail!]. and the sonar [c-t] of true confoundation and the creatures who live there.
I know many school psychologists have helped many parents and students, however I have found the ones I have dealt with (in our very good schools, no less) largely unhelpful, other than confirming test results. The majority of information and help I have recieived for my children has come from my own endless research and insistence on help, referrals, therapies etc. You must constantly ask doctors, teachers, friends, clinicians for help, referrals info and then use the internet as well.
The best help unfortunately is being a good detective and advocate yourself. It is sad that this is still the case in this day and age.
Diane,
It would be very interesting and educational to have Robert Whitaker - author of Anatomy of an Epidemic interviewed about the use of these drugs. I am sorry this view was not present on your panel today.
As an occupational therapist I have had experience with many children who were medicated "ADHD" on a long term basis. My view is that there are more effective non drug interventions. I have not been impressed that there are long term benefits of drug therapy. Additionally, I have had experience with depression in adult patients who are medicated with antidepressants. I do not see changes in depression without behavioral intervention.
I would like to hear the evidence based documentation of the benefits of both uses of these drugs. I have also witnessed the long term disability and dysfunction in both children and adults when they become psychologically drug dependent. This drug use popularity may just be the result of effective advertising by drug companies to parents, teachers and physicians.
PCIT (Parent Child Interaction Therapy) has been shown to effectively deal with probelm behaviors in children under 5 years of age. It is an evidence based mode of therapy being practiced in Southern California.
My son was diagnosed with ADD at 7yrs. old and began taking medication shortly thereafter. He has never been particularly hyperactive, and IMO, this label is sometimes over emphasized. What links the two is inattentiveness and distractibility. He is now in his early 20's. In addition to taking medicine, he began seeing a psychologist while in elementary school, and she played an integral role in helping us navigate many difficult situations dealing with teachers and administrators in the public school system. Most of these kids "standout" in the classroom, and their peers react by teasing and in some cases bullying. ADD kids have a hard time picking up cues, so oftentimes, they are quite surprised by the (negative) reactions to their behavior by adults and peers.
My son continues to take medication and knows that it is a great benefit. Its sort of like the fog lifting. I am glad that so many more families will have a diagnosis earlier and can begin treatment.
As the author of the American Academy of Pediatrics publication, Mental Health Naturally, I was disappointed that the authors of the recent guideline ignored the advice of the AAP members of the Section on Complementary and Integrative Medicine about this guideline. It ignores much of the published data and overly focuses on medications. We should acknowledge families' concerns, avoid using medications that are not FDA approved for children under 6, and focus mostly on promoting healthy lifestyle, ensuring that children have adequate nutrients, sleep, activity, exposure to nature, and recognition of their strengths, avoiding toxins such as artificial colors, flavors, sweeteners, and food triggers, as well as excessive screen time. This is a huge and complex topic that deserves more than drugs.
These kids are often enormously creative and socially aware. We need to build on their strengths.
Kathi J Kemper, MD, MPH
Dear Dianne,
"More questions than answers"? I respect your work generally but wow, that was a harmful sentence that sowed the seed of doubt where little exists. Much like the intelligent design theory, the science is pretty clear that ADHD is a neurological based disease which arises from the underfunctioning of prefrontal cortex. Period. Like depression, another disease targeted by the moral police, there is a lot of morphological, neurological, and epideological studies that "prove" its existence.
And like all neurological conditions, the interaction between the underlying genetic component and its behavioral expression is complicated. But, medication such as Ritalin is extremely helpful in making the underlying condition manageable so that the behavioral component can be worked on.
Because of this association with some moral failure, many parents and sufferers themselves reject what is an effective intervention to "tough it out." The cost of that strategy is also high. Failed grades. Low self-esteem. A sense that you are not reliable because you forget stuff that for others so easy to remember. (There are also high correlation between ability to perform certain visual/brain tasks like reading and map reading)
So the cost of undertreatment is high.
I am sorry. Sugar? sugar? That sounds a bit like the anti-vaccine crowd. Please do not spread more of this anti-science stuff. Sugar can exacerbate underlying condition but cannot produce the life-long chronic condition. Jeezz.
I hear so many parents saying things like "I knew there was something wrong with him when...". Children are extremely perceptive, especially when it comes to their parents and labeling this as "something wrong" creates an unfair self-assessment in the child. When I was a kid, there was no such thing as ADHD so I was just plain old lazy and stupid. I did terribly in classes in which I had no interest and very well when I had a great teacher (whether or not I was interested in the subject) and yet the label "stupid" has stuck with me my whole life. I was very lucky in that I found something that I loved to do and did very well at it. It's not something that could be learned by sitting and reading a book by the way. It's one of those things that I learned by getting up and doing it. I guess it would be termed as learning kinesthetically.
I think every parent that has a concern should about their child should read up on Gillian Lynne and how she became a dancer. At the risk of sounding all "new age-ish" and liberal, this isn't about something wrong, this is about something different, processing differently. If my kids were able to sit patiently and excel in all their classes, unlike me, should I think there is something wrong with them?
@GracieB
Well said! I think all artists are neuro-spectaculars. They have to be. So many excel at some form of art and not the typical mundane bean-counting functions. Bean-counters don't get it and as a result, arts are being cut or underfunded in schools. Could this be the reason ADHD is more prevalent these days? With no "neuro-spectacular" outlets in schools, these students have no way to develop and share their gifts. What would John Lennon have been if he didn't have music? And what would the world have been without his gift?
The discussion yesterday was very timely in light of the one with my colleague, Don Campbell, last week. As mentioned in previous comments, diet and exercise are important. However, no mention was made today of the utilization of music to treat attention issues. In our office, we have made huge differences for both children and adults suffering from attention issues with a combination of Tomatis auditory training and EEG biofeedback (neurofeedback). We train these clients to transform their attention issues into a creative asset. In my ten years of experience, there is one thing that I see with every single client: the music creates a much more deeply restorative sleep to enable better brain function. There are a number systems available today in the US for both auditory training and neurofeedback. Interested readers can search on Google for: Tomatis, auditory training, integrated listening, neurofeedback, etc. to find people nearby to help.
I was interested to hear about this story from http://healthymind-healthybody.org/2011/10/20/political-correctness-and-...
I was surprised that no one mentioned the possible correlation between ADHD and lack of exercise.
I wonder if any studies have been done to see if the increasing incidences of ADHD are inversely proportional to the reduced amount of exercise that this generation of children achieve?
As a mother of a 7 yr. old with ADHD (diagnosed at 6), I am VERY concerned with the changes in guidelines. With friends and family with ADD, we saw the signs in our son when he was about 4, and started researching then.
Diagnosing earlier is only helpful if the treatment starts with in-depth looks into sleep, structure, diet, exercise, behavior management, and allergies, along with educating the family. Only after these have been thoroughly addressed -- perhaps after about a year, or even two -- should medication be looked at.
If you suspect or see symptoms of ADD/ADHD in your child, (1) start educating yourself as much as possible now! Start reading, talking to other parents, making your own observations and changes at home. Don't rely solely on professionals. My son's doctor never investigated his sleep, eating or exercise habits, which we've seen repeatedly how important they are. (2) Cover the basics.
Things we consider the basics for my son:
good sleep
sound nutrition -- high protein
positive interactions
exercise
stress management
excitement/stimulation
structuring/routines
music
outside time
Books I recommend:
Power of Positive Parenting
1-2-3 Magic
Feeding the Brain
Healthy Sleep Habits Happy Child
Driven to Distraction
Our son also has ODD, and paired with ADHD, it is a big challenge sometimes. We have made some changes in our approaching him and his homework went from a struggle everyday to almost no problems. Then he started drinking protein drinks in the morning and at lunchtime, and his teacher said he's not the same child as he was at the beginning of the year.
Medication can be PART of the treatment for some people, and I'm grateful that it's an option that helps so many. But don't underestimate the power of other non-medical treatments as well. Every child is different and there are different types of ADD. Do what's best for your family.