In a study of the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in early school-age children (four to eight years old), researchers at the Kennedy Krieger Institute found that nearly one-third of children with ASD also have clinically significant ADHD symptoms. Published in Autism: The International Journal and Practice (Epub ahead of print), the study also found that children with both ASD and ADHD are significantly more impaired on measures of cognitive, social and adaptive functioning compared to children with ASD only.
Distinct from existing research, the current study offers novel insights because most of the children entered the study as infants or toddlers, well before ADHD is typically diagnosed. Previous studies on the co-occurrence of ASD and ADHD are based on patients seeking care from clinics, making them biased towards having more multi-faceted or severe impairments. By recruiting patients as infants or toddlers, the likelihood of bias in the current study is significantly reduced.
“We are increasingly seeing that these two disorders co-occur and a greater understanding of how they relate to each other could ultimately improve outcomes and quality of life for this subset of children,” says Dr. Rebecca Landa, senior study author and director of the Center for Autism and Related Disorders at Kennedy Krieger. “The recent change to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to remove the prohibition of a dual diagnosis of autism and ADHD is an important step forward.”
Participants in this prospective, longitudinal child development study included 162 children. Researchers divided the children into ASD and Non-ASD groups. The groups were further categorized by ADHD classification according to parent-reported symptoms of ADHD on the Hyperactivity and Attention Problems subscales of the Behavioral Assessment System for Children-Second Edition, a standard assessment specifically designed to identify the core symptoms of ADHD.
Results revealed that, out of 63 children with ASD in the study, 18 (29%) were rated by their parents as having clinically significant symptoms of ADHD. Importantly, the age range for children in the study (four to eight) represented a younger and narrower sample than has been previously reported in published literature. “We focused on young school-aged children because the earlier we can identify this subset of children, the earlier we can design specialized interventions,” says Dr. Landa. “Tailored interventions may improve their outcomes, which tend to be significantly worse than those of peers with autism only.”
Researchers also found that early school-age children with co-occurrence of ASD and ADHD were significantly more impaired than children with only ASD on measures of cognitive and social functioning, as well as in the ability to function in everyday situations. They were also more likely to have significant cognitive delays (61 versus 25 percent) and display more severe autism mannerisms, like stereotypic and repetitive behaviors. The study findings suggest that children with the combined presence of ADHD and ASD may need different treatment methods or intensities than those with ASD only in order to achieve better outcomes.
Dr. Landa and her team recognize that this research supports the need for future prospective, longitudinal studies of attention, social, communication and cognitive functioning from the time that the first red flags of ASD are identified. Such research will lead to important insights about the relative timing of onset and stability of disruption to attention mechanisms and barriers to successful functioning in children with co-occurring ASD and ADHD.
So I was diagnosed with aspergers at the age of 7 and I had only a few of the symtoms. As I got older, the symtoms got milder and almsot all of them have dissapeered completly. Anywhay, heres why I think I don;t have aspergers
People with aspergers often lack social skills, wich often causes them to become shy, I was pretty shy as a child, but as I became a teenager, I came out of my shell more and more andnow, I’m still somewhat shy, but not notcabaly,[I will be turning 18 this year] Looking back on it, I thnik I was just natually shy, because I had somewhat average social skills, I was just to nervous to use them. About a year after my diagnosis, I started seeing a therapist, and I do not exzaggerage when I say this lady had NO CLUE what she was doing When I was in 5th grade, she put me in a social skills group to “help me read social cues”. I had NO PROBLEM reading social cues, wich also laeds me to bellieve I don;t have aspergers. I also have NO PROBLEM whith maintaining eye contact [something aspies struggle tremendously with] I do not take things literally[ another signs of aspergers] infact my friends say I understand jokes better than they do and they are NOT autistic.
Peopel with aspergers often exel in logical thinking, math, and science, but struggle with exepressing themselves emotionaly. I am the opposoite, I am AWFUL in math, I am more emiotional then logical and Im only average at science, but I am EXELLINT at expressing my emotions
When I was 12 I got a new therapist who was MUCH better than the old one. And seeing her lead me to be diagnosed with ADD which, I have to say, the diagnoses fits me like a glove, I would daydream in class, and I am very forgetful and disorganized. I am fairly inteligent for my age, but I am TERRIBLE at spelling, and reading is not my best subject eiter.
I have asked severeal peope lI know if they think I have aspergers and ADD. Pretty much everyone said I had ADD but I didn’t have aspergers. My friends were actually supprized I was ever diagonosed with aspergers. Alot of people in my class ask me If I have “dislexya” which I have NEVER heard of. So, do you think I have aspergers? Does dislexia cause similar symptoms to aspegrers? Am I only borderline aspergers? What do you think?
By Traci Pedersen Associate News Editor
No Link Found Between ADHD Drugs and Future Substance AbuseChildren with attention-deficit hyperactivity disorder (ADHD) are far more likely than their peers to engage in serious substance abuse as teens and adults.
But do ADHD meds contribute to the risk?
In the most comprehensive research ever on this topic, UCLA psychologists found that children with ADHD who take medications such as Ritalin and Adderall are at no greater risk of using alcohol, marijuana, nicotine or cocaine later in life than kids with ADHD who don’t take these medications.
The researchers looked at 15 long-term studies, including data from three studies not yet published. The studies followed more than 2,500 children with ADHD from childhood into their teen and young adult years.
“We found the children were neither more likely nor less likely to develop alcohol and substance-use disorders as a result of being treated with stimulant medication,” said Kathryn Humphreys, a doctoral candidate in UCLA’s Department of Psychology and lead author of the study. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana and cocaine.”
The children had a mean age of 8 years old when the research began and 20 at the most recent follow-up assessments. They came from a broad geographical range, including California, New York, Michigan, Pennsylvania, Massachusetts, Germany and Canada.
“For parents whose major concern about Ritalin and Adderall is about the future risk for substance abuse, this study may be helpful to them,” Humphreys said.
“We found that on average, their child is at no more or less at risk for later substance dependence. This does not apply to every child but does apply on average. However, later substance use is usually not the only factor parents think about when they are choosing treatment for their child’s ADHD.”
The researchers report that children with ADHD are two to three times more likely than children without the disorder to develop serious substance-abuse problems in adolescence and adulthood, including the use of nicotine, alcohol, marijuana, cocaine and other drugs.
This new study does not oppose those results but finds that, on average, children who take stimulant medication for ADHD are not at additional risk for future substance abuse.
Ritalin is associated with certain side effects, such as suppressing appetite, disrupting sleep and changes in weight, said Steve S. Lee, a UCLA associate professor of psychology and senior author of the study.
“The majority of children with ADHD—at least two-thirds—show significant problems academically, in social relationships, and with anxiety and depression when you follow them into adolescence,” Lee said.
“For any particular child, parents should consult with the prescribing physician about potential side effects and long-term risks,” said Lee.
“Saying that all parents need not be concerned about the use of stimulant medication for their children is an overstatement; parents should have the conversation with the physician. As with other medications, there are potential side effects, and the patient should be carefully evaluated to, for example, determine the proper dosage.”
As the study participants get older, researchers will be able to study the rate at which they graduate from college, get married, have children and/or get divorced and to assess how well they function, Humphreys said.
As children with ADHD enter adolescence and adulthood, they typically fall into one of three groups of similar size, Lee said: one-third will have significant problems in school and socially; one-third will have moderate impairment; and one-third will exhibit only mild impairment.
The research is published in the journal JAMA Psychiatry, a psychiatry research journal published by the American Medical Association.
Source: JAMA Psychiatry
Seventy to 80 percent of children with ADHD respond to treatment with stimulants, so this is often the first line of defense. Doctors sometimes prescribe nonstimulants for the approximately 20 to 30 percent of children with ADHD who don’t respond to stimulant treatment.
There are over a dozen stimulant medications on the market, but here are the most common.
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin, Focalin): The most widely-used drug therapy for ADHD and still the most common.
Lisdexamfetamine dimesylate (Vyvanse)
It seems strange that giving stimulants to an already hyper child could help, but researchers believe they may help adjust the levels of neurotransmitters in the brains of ADHD children. Stimulants can be prescribed in short-acting and long-acting forms, so your child may take medication as often as three times a day or perhaps only once a day. Medications come in pill, liquid, capsule and patch forms.
Most children experience some side effects, the most common being insomnia, decreased appetite, or weight loss. Occasionally, kids will experience irritability or a “rebound” effect when the medication wears off. Very rare side effects can include facial tics, which most often disappear with a lower dose or change in medication, and a reduced growth rate. Kids should be screened for any pre-existing heart conditions before starting stimulants.
There are two nonstimulants specifically for ADHD treatment in children.
Atomoxetine (Strattera): Strattera increases the levels of the neurotransmitter/hormone norepinephrine to the brain. Researchers think this chemical plays a key role in focus and attention. This drug may also reduce anxiety. Strattera can cause some rare but very serious side effects, including jaundice and other liver problems, and suicidal thinking.
Guanfacine (Intuniv): This newer form of Tenex, a drug for high blood pressure, was approved for ADHD treatment in fall 2009. Again, doctors are not really certain why it works, but it may help control behavior by affecting the prefrontal cortex, the area of the brain that serves as a check on our impulses. The most common side effects of Intuniv are tiredness and sleepiness. Other side effects may include low blood pressure and low heart rate, dizziness, fainting episodes and nausea.
There is no legitimate way to diagnose an infant with ADHD, but the American Academy of Child and Adolescent Psychiatry says that all of the following can be signs of a tendency to develop ADHD later.
Poor sucking/frequent feedings
Difficult to comfort/dislikes being held
Of course many babies exhibit these behaviors and do not go on to develop ADHD. They’re of more concern if the baby has other risk factors, such as a family history of ADHD or prenatal exposure to drugs, alcohol or cigarettes.
Diagnosing toddlers with ADHD is extremely controversial since developmentally, most lack impulse control and have short attention spans. However, children that will later be diagnosed with ADHD can exhibit these traits to the point where they are actually dangerous – hitting, taking toys, even dashing into the street – on an ongoing basis. Children with ADHD may have frequent and violent temper tantrums, and be poor sleepers and picky eaters as toddlers. (But please remember, none of these signs guarantees your child will have ADHD!)
Some parents do seek diagnosis and treatment for very young children with severe behavioral issues. But because the brain is still rapidly developing at this point and few psychiatric medications are approved for very young children since side effects can be severe and troubling, doctors are most likely to recommend only parental training and behavior modification.
In 2011, the AAP expanded its guidelines to diagnose children as young as age 4 in an attempt to provide evidence-based, specific recommendations for what some pediatricians were already doing unofficially: using Ritalin and other stimulants off-label to treat small kids with problems severe enough to get them expelled from preschool and wreak havoc on their families. Behavior modification therapy should be the first line of defense for preschoolers diagnosed with ADHD, with prescription medications like Ritalin to be tried at a low dose only if therapy is not effective on its own.
The vast majority of children are diagnosed with ADHD during the first few years of school when their inability to focus and lack of control make learning and social functioning difficult.
Children with ADHD may be rude, aggressive or inattentive in class. They are likely to forget assignments and lose materials. Many will fall behind because of ADHD behaviors or learning disabilities, which are common in children with ADHD. However, ADHD children can be extremely bright and may compensate, working feverishly to get good grades. Children with ADHD may have difficulty behaving appropriately on sports teams, at parties and on family outings. ADHD behaviors can cause family stress and strain parental relationships and marriages.
Once diagnosed with ADHD, children are most often treated with a combination of medication and therapy, however, some will only need one or the other. These therapies are effective in most children, but they’re not magic – many ADHD children will struggle more than their peers to succeed in school and social environments.
Early diagnosis and intervention is key to later success for ADHD children. Thanks to federal civil rights laws, public schools are required to provide accommodations or strategies and aids to enable children with ADHD to learn and compete with their non-ADHD classmates.
The Middle School Years
Many kids who have the inattentive type may be diagnosed for the first time around this age. Whether your middle schooler’s been recently diagnosed or not, an increasingly difficult curriculum and adolescent hormones can wreak havoc in the lives of ADHD kids (not to mention their parents!) Parents, teachers and doctors need to be ready to readjust treatment strategies, including changing medications and doses, and developing new methods for organizing more complex schedules.
Middle schoolers should also begin to take more responsibility for their decisions and therapy. Some experts recommend that kids take a “holiday” from medication if they want and see how it affects their lives and their school performance. Otherwise it can become an area of conflict with parents.
Behavioral therapy should also focus on strategies that kids, rather than parents, can employ to remember homework and materials. Color coded charts will give way to notebook or computer organizers.
Beyond Middle School
All teens are impulsive, but since ADHD kids can be even more so, the dangers that lurk for all teens — car accidents, drinking, drug abuse and irresponsible sex — are magnified for them. Experts used to think children outgrew ADHD in their teen years, but now research indicates that about 60% of children with ADHD will have the condition as adults, although symptoms become less severe over time. That’s why it is important for children to continue treatment and for parents to continue to advocate for their education. ADHD students may qualify for accommodations like extra time on standardized tests in high school and college.
Experts say teens who have learned how to schedule themselves and how to make appropriate decisions through therapy earlier in life will be less likely to struggle in school and with social relationships during the critical teen years. This will boost their self-esteem and lead to happier, healthier kids.
NEW YORK, May 20 (UPI) U.S. men who had attention-deficit/hyperactivity disorder as children weighed 19 pounds more at age 41 than those with no ADHD, researchers say.
Study co-author F. Xavier Castellanos, a psychiatrist at the Child Study Center at New York University Langone Medical Center in New York, and colleagues at Verona University in Italy; the Institute for Psychiatric Research in Orangeburg, N.Y.; and the Neuroingenia Clinical and Research Center in Mexico said ADHD might affect up to 11 percent of U.S. children, the majority boys.
The study involved 207 white boys with childhood ADHD — mean age of 8.3 — interviewed at ages 18-25 and age 41. At age 18, 178 boys without ADHD were recruited.
At 41, 111 men with childhood ADHD and 111 men without childhood ADHD self-reported their weight and height.
The study, published in the journal Pediatrics, found at age 41, the men who had ADHD weighed an average of 213 pounds, and 41 percent of them were obese, while the men who hadn’t had ADHD weighed 194 pounds on average, and 22 percent were obese.
The study didn’t figure out why boyhood ADHD might be causing weight problems in adulthood — the weight gain could be caused by psychological factors or neurobiology, Castellanos told NPR.
Differences in the pathways for dopamine, a neurotransmitter in the brain, have been found in both people who are obese and people with ADHD, Castellanos said.
“It makes sense, because they’re self-medicating with carbohydrates,” Dr. Edward Hallowell, a psychiatrist in Sudbury, Mass., who has ADHD and treats adults with ADHD but wasn’t involved with the study, told NPR. “Carbs do the same thing that stimulant medications do — promote dopamine.”
Read more: http://www.upi.com/Health_News/2013/05/20/ADHD-in-childhood-may-be-linked-to-obesity-in-adults/UPI-34151369093137/#ixzz2TwJL5KU5
By Heather Hatfield
WebMD FeatureReviewed by Hansa D. Bhargava, MDTalking with your child about his ADHD isn’t always easy. But it’s important to do, and it goes better if you keep it productive and positive.
“I have two children with ADHD, so I can speak from experience here,” says Terry Dickson, MD, director of the Behavioral Medicine Clinic of NW Michigan, and an ADHD coach. “The reason why you need to talk about your child’s ADHD with him directly is because you want them to be involved, to understand, and to be on board.”
These eight tips will help you talk about it.
ADHD in Children
When you find out your child has ADHD, that’s the time to start communicating with them about it.
“It’s never too early to start talking with your child about his ADHD,” says Patricia Collins, PhD, director of the Psychoeducational Clinic at North Carolina State University.
You’ll talk about it many times as your child grows and develops. Start having those talks as early as possible.
A good approach is to help your child understand what ADHD means, what it doesn’t mean, and how to be successful at school and in life. What you say should be appropriate for their age.
“You need to help your child feel special, and like he is part of the plan,” Dickinson says. “He should feel like he is involved.”
1. DO make sure your child feels loved and accepted.
Help him understand that ADHD has nothing to do with his intelligence or his ability, and it’s not a flaw, Dickson says.
2. DO pick the discussion time wisely.
“It should be a time when you are unlikely to be interrupted,” Collins says.
Try to pick a time when your child isn’t eager to do something else, like playing outside or before dinner or bed.
Leave some time for follow-up, so you’re available to the child after the conversation is over if he has extra questions.
3. DO let them know they’re not alone.
Many other people have ADHD, too, and everyone with ADHD can be successful.
Give your child examples of people who have or had ADHD that they might know, like Walt Disney, Michael Phelps, and designer Tommy Hilfiger.
Let your child know they are special and they can succeed as well as anyone else.
4. DO learn more about ADHD.
Talk to your doctor, reach out to advocacy groups, and find support groups in your area.
“One of the best things you can do is talk to other parents who already have experience with ADHD about what they’ve learned,” Collins says.
5. DON’T focus on the negative.
“Focus on their strengths, what they do well, and praise their accomplishments,” Dickinson says.
“Whether its sports, arts, or dance, they can pursue their interests and do well with your support.”
6. DON’T let your kids use their ADHD as an excuse.
“Kids can’t take the easy way out by blaming their setbacks on their ADHD,” Collins says.
“Parents need to help their child understand that ADHD is not a reason to not turn in homework, to not try their hardest, or to give up.”
7. DON’T expect instant interest.
Don’t be surprised if your child doesn’t respond immediately or seems uninterested, Collins says.
It takes some children, particularly younger ones, some time for new information to make sense, or for them to know what questions to ask.
8. DO maintain open communication.
“One conversation is just the beginning,” Dickinson says.
“Keep the dialogue going, talk about school, their friends, homework, extracurricular activities, and keep a positive attitude.”
In case you missed it, Rock Center with Brian Williams did a fantastic story on Adult ADHD this past Friday. The piece focused on what it’s like for an adult with undiagnosed ADHD, and also touched on how things can change for the better with treatment.
It’s rare to see a story in the media (especially one on a popular network program) take such a personal approach to ADHD and the adults who have been diagnosed with it. I was pleasantly surprised to see that no one was villianized in this story; not the adults with ADHD, not the doctors who diagnose it, and not the pharmaceutical companies who make the medicines that treat it. Instead, we got a glimpse into the lives of real people, and that is refreshing.
I highly recommend taking the time to view this video, and taking the time to pass it along, too!
So, should ADHD kids be made to sit still?
I would say probably not; however, that doesn’t mean just letting them bounce off the walls. I encourage parents to find strategies that fit these two categories. It definitely requires more creativity, but there are so many ways available now to help kids learn and focus better, without requiring them to sit still during boring tasks. Here are three of my favorite products. (Note: I am not affiliated with any of these companies, nor have I received any sort of compensation whatsoever for mentioning these products. I just think they are really cool!)
The Safco AlphaBetter® Desk is standing desk with a swinging foot bar. This combines several great ideas. First, standing helps many people focus better on their work. The foot bar incorporates a movement strategy, that is much less annoying that foot tapping. Third, there is a chair as well so kids can sit and stand alternatively. It’s not cheap ($300-450), compared to regular school desks ($100-150), but I think many parents and teachers can see the advantages of a standing desk like this one.
The Time Tracker from Learning Resources is a visual timer that helps kids see how much time is left. The visual aspect can help them remain on task better, and fidget less, especially if they know that the end of a boring task is coming soon. I’ve seen this priced around $35 usually. Learning Resources also makes a Time Tracker “mini” version that is only $14.
The Sunrise System Alarm Clock is probably one of the best things I’ve ever bought myself. This clock hooks up to a bedside lamp and mimics the sunrise in the morning over 45 minutes or so, and comes with a back up buzzer alarm as well. Adding more light in the morning, gradually, will help the ADHDer who struggles to wake up in the morning. It’s a little pricey ($99), but provides much more light via a lamp than other sunrise clocks that have a built in light.
- See more at: http://www.spectrumpsychological.net/1/post/2013/04/adhd-tips-for-parents-should-they-sit-still.html#sthash.p0QkPfBk.dpuf
Disorder often goes undiagnosed in adults, but it’s quite common and can cause big lifestyle problems
By Linda Lewis Griffith — Special to The Tribune
A recent study published in the journal Pediatrics reports that two-thirds of children diagnosed with ADHD continue to have symptoms into adulthood. A problem that was once thought to disappear with maturity not only interferes with adult sufferers’ functioning but is often accompanied by other serious psychiatric illnesses.
This information may be startling to the general public. But it’s old news to the estimated 8 million men and women already grappling with the disorder.
Adult ADHD often flies under the diagnostic radar because it presents itself differently at different stages of life. For instance, children diagnosed with ADHD may be easily distracted or have difficulty following directions. They may have trouble sitting still, find it hard to wait their turn or blurt out answers in the classroom. On the other hand, adults with ADHD might put things off until the last minute or fail to follow through on work or family commitments. They report feeling restless and impatient, always needing to be on the go, even when they’re on vacation. They frequently interrupt others’ sentences and have problems maintaining relationships.
Other symptoms of adult ADHD include poor listening skills, difficulty starting a task, chronic lateness, angry outbursts and an inability to establish priorities. Adults with ADHD are also apt to have problems managing money, be involved in frequent traffic violations and impulsively change jobs.
Research conducted by Dr. William Barbaresi, director of the Developmental Medicine Center at Boston Children’s Hospital, found that adults with ADHD were five times more likely to commit suicide. More than 25 percent of those who had ADHD and another mental disorder abused alcohol; 16 percent abused other substances. Personality disorders and mood disorders, such as anxiety and depression, were also common.
Treatment for adult ADHD involves a multifaceted approach. Stimulant medications, such Ritalin, Adderal and Vyvanse, are commonly prescribed. Anti-depressants such as Wellbutrin and Effexor are also used. Equally important are behavioral and environmental changes as well as counseling and marital therapy.
Linda Lewis Griffith is a local marriage and family therapist. For information or to contact her, visit http://indalewisgriffith.com.
TRY THESE STEPS TO HELP MANAGE YOUR ADULT ADHD
• Follow a routine. Your life is inherently chaotic. You need to impose structure and control from the outside. Eat meals at regular times. Develop a regular sleep routine. Exercise at set times throughout the week.
• Purchase a date book. Write down every activity you perform during your week. Carry it with you wherever you go so you can add and refer to it often.
• Make lists. Write down everything you need to accomplish each day. Put the most important items at the top. Check tasks off as they’re completed.
• Keep a notepad handy. Details are apt to slip your mind. So it’s helpful to jot notes to jog your memory. For instance, write down where you parked your car or that you drive the carpool at 2:45.
• Avoid clutter. Prevent clutter by throwing away items you’re not using and tidying your desk at the end of each day. If clutter is already a problem, designate time to tackle one specific area. Or ask help from a friend or loved one to help you stay on track.
• Put things in the same place. Avoid the stress of looking for lost items by creating a home in which everything lives. Put your keys in a bowl on your dresser. Hang your purse on the back of the chair.
• Break tasks down to a manageable size. It’s easy to feel overwhelmed and then avoid those chores that feel daunting. Instead, decide on a first step that you can accomplish. When that’s completed, move on to step two.
• Use an alarm clock, watch or timer. Punctuality is not your strong suit. Timers ensure you’re always on time or don’t get distracted. Set your alarm clock to get up in the morning. Program your cellphone to alert you of impending meetings. Set a timer to ring when you’ve spent 20 minutes on the Internet.
• Avoid credit card debt. Credit cards can entice you to spend money that you don’t have. If you do use credit cards, pay your full balance every month. If you’re frequently in financial trouble because of your cards, pay off your debt as quickly as possible, then cut up the cards and pay cash.
• Exercise. Exercise decreases stress and anxiety and enhances your mood. It improves impulse control and reduces compulsive behavior.
• Get counseling. Knowledgeable therapists can help you create personal structure and devise strategies for decreasing your symptoms. They’ll also hold you accountable for the changes you’ve committed to making.
Read more here: http://www.sanluisobispo.com/2013/04/09/2462328/when-adhd-grows-up.html#storylink=cpy
By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 9, 2013
Autistic Kids Tend to Imitate ‘Efficiently,’ Not ‘Socially’ Normally, kids copying adult behavior will go out of their way to repeat each and every element of the behavior even if they realize parts of it don’t make any sense.
But a new study shows that when a child with autism copies the actions of an adult, he or she is likely to omit anything “silly” about what they’ve just seen.
Researcher say the findings, reported in the journal Current Biology, are the first to show that the social nature of imitation is very important — and challenging for children with autism. They also emphasize just how important it is for most children to be like other people.
“The data suggest that children with autism do things efficiently rather than socially, whereas typical children do things socially rather than efficiently,” said Antonia Hamilton, Ph.D., of the University of Nottingham.
“We find that typical children copy everything an adult does, whereas autistic children only do the actions they really need to do.”
The researchers made the discovery after testing 31 children with autism spectrum conditions and 30 typically developing children who were matched for verbal mental age.
On each of five trials, each child was asked to watch carefully as a demonstrator showed how to retrieve a toy from a box or build a simple object. Importantly, each demonstration included two necessary actions (e.g. unclipping and removing the box lid) and one unnecessary action (e.g. tapping the top of the box twice).
The box was then reset behind a screen and handed to the child, who was instructed to “get or make the toy as fast as you can.” They were not specifically told to copy the behavior they’d just seen.
Investigators discovered almost all of the children successfully reached the goal of getting or making the toy, but typically developing children were much more likely to include the unnecessary step as they did so, a behavior known as overimitation.
Those children copied 43 to 57 percent of the unnecessary actions, compared to 22 percent in the children with autism. That’s despite the fact that the children correctly identified the tapping action as “silly,” not “sensible.”
Researchers now plan to investigate precisely what kind of actions children copy, and how that tendency to copy everything might contribute to human cultural transmission of knowledge.
Hamilton said parents and teachers should be aware of the social value in going beyond the successful completion of such tasks.
Individuals with ADD and ADHD have a tendency towards addictive behavior. As I wrote in an earlier piece on gambling, addictive and impulsive behaviors are common place for people with ADD/ADHD. Last October, scientists from McGill University in Canada released a study suggesting that there’s a genetic link between childhood ADHD and heavy tobacco consumption as an adult (McGill University Study). The study also goes on to explain how it is important for people with ADD/ADHD to identify programs that are catered to the individual if he or she is looking to quit.
So does this mean that a child with ADD/ADHD is going to run to his or her local store and buy cigarettes the rest of his or her life? Obviously not, but what it does tell us and helps us to understand is that there’s a little more to this than just being addicted to nicotine. We need to look at this from a bigger-picture standpoint. If individuals with ADD/ADHD are more-likely to smoke when he or she gets older (from a genetic and scientific perspective), than the problem goes much deeper than just saying no. But at the same time, just because one’s genetically more likely to take on an activity doesn’t mean he or she is going to do it.
With my clients that have expressed an interest in quitting tobacco use, I always suggest he or she starts slow. Instead of stopping, cut down. Set short-term and achievable goals aimed at eventually stopping the activity. For example, if an individual smokes a pack-a-day, start by smoking three less cigarettes a day for one week. If that is successful, make it six less for the next week. And so on and so forth. If a goal is set to quit smoking with no real plan, it is almost-always going to fail. Approach quitting smoking gradually and with achievable goals. There will be slip-ups, but try to hold to your goal as well as you can.
For more information on my ADD, ADHD and Executive Functioning coaching, please visit www.adhdcoachchicago.com. To learn more information about some of the other services I provide, please visit www.carrolleducationalgroup.com and www.iepexperts.com. I can be found on Twitter at ADHDEFCoach. You can also find me on Facebook, Google Plus and Tumblr. My good friend and fellow ADD/ADHD Coach Tara McGillicuddy invites me as a regular guest on ADD/ADHD Support Talk Radio. Tara does many wonderful things and you should check out her website here. Feel free to email me at firstname.lastname@example.org or call 773.888.ADHD (2343) with any additional questions.
Posted on Wednesday, April 11, 2012 9:58 AM
Earlier this week I blogged about a practical alternative which I regularly offer to individuals and families who have questions about ADHD and related disorders, but aren’t sure they’re ready to spring for a full neuropsychological evaluation. The next post here at this blog was a consideration of how to determine when such evaluation is in fact right for you or your family member.
So what happens after a neuropsychological evaluation? After all the testing and scoring and writing up the results…what next?
The Feedback Session
As much as I enjoy (I really do!) administering the various tests which make up the neuropsychological battery, and as interesting as it is to score these tests and look at the pattern of strengths and weaknesses, the real heart of the neuropsychological evaluation is the Feedback Session.
Usually scheduled a week or two after the evaluation is complete (you’ll need a chance to breathe!), the feedback session offers the client and his spouse or parents a chance to review the test scores with the neuropsychologist and “make sense of the scores” together.
In the Feedback Session, I’ll explain how a neuropsychologist thinks about these tests and scores and how I pull this data together to answer referral questions. In the Feedback Session we’ll connect the dots – I’ll relate your chief concerns to my own mental status exam observations and to the test scores. We’ll identify patterns of strengths and weaknesses among test scores and relate those patterns to know patterns of brain-behavior relationships in the scientific literature. (There are identifiable patterns among neuropsychological test data which suggest, for example, ADHD or dementia or brain injury or depression-related concentration problems.)
Feedback Session data typically fall into three categories:
1.It confirms what the client already knew or suspected about him/herself;
2.It challenges the client to see him/herself in a new way, but seems reasonable or acceptable or “true”;
3.It just doesn’t seem to fit – the client says “nope, I don’t think that fits the picture for me, doesn’t seem consistent with my experience of myself.”
When my clients reject feedback data, I assume that maybe they’re right or maybe they’re not ready to hear that feedback about themselves just yet. Either way, we don’t focus on feedback data that falls into category #3. We focus on that second category – feedback which the client can accept, but which “pushes” him/her a bit, and offers a new way of seeing himself or moving towards treatment or rehabilitation or supports.We typically consider two or three next steps. As a result of this feedback, what are you going to do next? What are you going to do differently? What will help? We set specific behavioral goals and agree to meet again for the Followup Feedback Session.
The Followup Feedback Session
A unique feature (as far as I know) of my own evaluations is the Followup Feedback Session scheduled for 6-8 weeks after the first feedback meeting. This second feedback session allows the client, his family, and I to “check in” and see what they might have missed from the first feedback hour, and what they need to review.
The Followup Feedback Session builds in a bit of accountability. Did the client do what he said he/she was going to do as a result of the first feedback visit? If so – how is it working out? And if not – why not, what obstacles have prevented that follow-through? At the Followup Feedback Session the client and her spouse or parents have had a chance to review my report and offer any comments or feedback to me, or to clarify any remaining questions.
What recommendations might follow a neuropsychological evaluation for attentional or learning problems?
Speaking with a mom who was considering neuropsychological evaluation for her son, I indicated that I try to write jargon-free reports which are user-friendly for parents, doctors, teachers, and therapists. I also let her know that I don’t presume to tell pediatricians how to do medicine, or to suggest to occupational therapists how to plan OT interventions. And I don’t tell educators how to do curriculum planning or how to teach. At this point, mom asked, “Hmmm, what do you recommend then, David, after your evaluation?” It was a good question, and the answer depends on the type and severity of neurocognitive deficit identified in the evaluation. But some interventions which might follow my evaluation include:
•preferential seating for the distracted student
•frequent checks for understanding (by the teacher) for a student with auditory processing problems
•use of multi-sensory teaching styles for students with auditory processing problems or easy distractibility
•reduced homework assignments (as permitted by classroom objectives) for a student with speed of information processing challenges
•”buddy system” with either younger students (to give the child the experience of teaching) or older students (to give a child the experience of learning from a slightly more mature student who has mastered navigating lockers and hallways and other “executive” challenges outside the classroom)
•considering special education services (for students with adhd, learning disability, or general developmental delay)
•considering Section 504 services (for the same students noted above)
•considering state agency support (for students with documented head injury or students with developmental delay)
•involvement of occupational therapy (for students with sensory overload, or students who need more sensory input throughout the day)
•involvement of speech/language services (for students with developmental articulation problems or with “language pragmatics” problems associated with autistic spectrum disorder)
•allowing alternate ways of turning in homework (google docs, memory sticks, faxing at start of day, etc).
•use of FM system (lapel microphone) for students with central or peripheral hearing/auditory impairment
•regular teacher-family communication re: homework details (for students who “lie” or “forget” about homework assignements as a way of avoiding hard work)
None of these recommendations is appropriate for every student with a particular diagnosis, and some of them might even be a bad idea for a particular student. That’s why any recommendation should flow logically from the findings of neuropsychological evaluation. For each recommendation, I ought to be able to answer a question like “why do you think this strategy would work for this student?”
By Jessica B. Konopa
ADHD isn’t just a kid’s problem. An estimated 2 to 4 percent of adults live with the disorder. Half of those who have ADHD as children continue to have it when they grow up. In fact, it often goes undiagnosed. Many adults who have ADHD had it when they were kids, but were never diagnosed.
Like kids with ADHD, adults who suffer from the disorder often:
•Have a hard time completing tasks they consider boring or difficult
•Are distracted easily
•Are prone to losing things
In addition, they may fidget and easily lose their tempers. They often feel hyperactive and can’t relax.
These behaviors often interfere with an adult’s ability to work or have relationships. ADHD can interfere with an adult’s ability to:
•Complete tasks that require concentration
Adults with ADHD may have a problem with jobs that use these skills. As a result, they may change jobs a lot or experience conflict at the office.
ADHD can make personal relationships difficult, too. It can be hard for people with ADHD to share their feelings with others. They may also find it hard to pay attention when other people are speaking. This can create strained conversations. An estimated 75 percent of adults with ADHD have emotional problems. All of these things can make it difficult for adults to maintain long-term relationships and friendships. Adults with ADHD often have marital problems, battle depression, or may abuse alcohol or drugs. At first glance, ADHD may seem daunting for adults. However, they can often overcome it by making small changes to the way they do things. This includes:
•Breaking large tasks into smaller ones
•Making lists to keep track of things that need to be done
•Communicating when they need help
In reality, research indicates that only 10 percent of adults with ADHD experience problems in their daily lives. About 50 percent report that their ADHD sometimes interferes with their daily lives. Finally, about 33 percent of adults say they have learned to manage their symptoms or no longer suffer from ADHD symptoms.
Not sure if you have ADHD? Your health care provider will be able to evaluate you and diagnose ADHD, if appropriate. Your provider will also help you develop a plan to manage it.
1.National Resource Center on AD/HD. (2008, February). The Disorder Named ADHD – What We Know – Info Sheets on AD/HD. Retrieved August 24, 2010, from http://www.help4adhd.org/about/what/WWK1.
2.WebMD. (2005, October 1). Attention-deficit hyperactivity disorder: ADHD in adults. Retrieved August 24, 2010, from http://www.webmd.com/add-adhd/guide/adhd-adults
3.Preidt, R. (2003, June 25). National ADHD education campaign launched. HealthDayNews. Retrieved August 24, 2010, from http://www.healthscout.com/template.asp?page=newsdetail&ap=1&id=513770
4.WebMD. (2006, May 31). ADHD guide: Treatment overview. Retrieved August 24, 2010, from http://www.webmd.com/add-adhd/tc/attention-deficit-hyperactivity-disorder-adhd-treatment-overview
February 25, 2013 by Sucheta Kamath
Unmotivated, unaware, scattered and disorganized children are often thought to be lazy (and unintelligent). In fact, they typically struggle with symptoms of Executive Dysfunction.
It’s hard to like people who are unreliable or unaccountable. It’s even harder when those same people don’t change their ways in response to suggestions, guidance or advice. That’s the plight of a person with Executive Dysfunction.
I want to offer parents a framework to clearly understand Executive Dysfunction (also known as poor Executive Functions or Executive Function disorder). With an understanding of the challenges faced by an ADHD underachiever, you can approach the ‘appearance’ of laziness differently, improving your child’s ability to manage his/herself, and strengthening relationships within the family.
Get to Know the Beast
The main symptoms of ADHD include inattention, impulsivity and hyperactivity. They reflect dysfunctions in a wide range of “executive” abilities – cognitive, communicative, social, behavioral and emotional.
To simplify Executive Dysfunction, it helps to understand what well-developed executive abilities look like. Among other things, Executive Functions allow individuals to:
Constantly adapt or change
Shift focus or behavior, as necessary, when there is a slight interruption
Tweak familiar ways to handle unfamiliar situations
Make changes without being prompted by outside forces
Sustain focus on personal or group intentions
Pay attention, and maintain attention
Handle tempting distractions without wavering from task
Put effort into actions that move towards a final goal
Help others by helping yourself stay on joined goals
DO what needs to be done
Understand personal challenges and how they interfere with success
Use critical thinking to understand why goal-directedness matters
Solve problems to promote SELF goals
Executive Functions were once known as street smarts or common sense. When a child lacks these skills, it may appear lazy, rude, obnoxious, annoying or lacking in personal responsibility. Historically, discipline for children with Executive Dysfunction treats a child with ADHD like s/he has “character flaws”:
- Rule with iron fist: be tough on the child.
- Punish the child. Create a “fear of god” so s/he will stop.
- Ignore it because getting the child to cooperate is tedious.
- Just give up because nothing seems to help.
Parents can inadvertently blame the child with ADHD as intentionally difficult or purposefully oppositional. However, deeper understanding can lead to greater respect for the suffering of the children with ADHD and subsequent Executive Dysfunction.
4 Tricks To Shift your Thinking
1. Make Family Values Transparent: Trouble with concrete thinking, working memory and self-awareness makes it harder for kids with ADHD to accept a parent’s advice. Family values can foster loving relationships:
Listen more respectfully
Keep an open mind to ideas that may not make sense at first
Work hard on a suggestion before giving it up
Thank those who are patiently helping
2. Show More and Lecture Less: Trouble with self-awareness and self-judgment leads to a tendency for kids with ADHD to stall, procrastinate, or lose interest in their work. S/he may argue, annoy or show insensitivity towards those who are trying to help, leading to parenting “lectures” that often make the parent feel better, but does not necessarily reach the child. Think differently about the guidance you offer:
Show the first step. “Walk” your child through how to get started.
Email your concerns so your child can slowly process and not miss any details.
Emphasize your “feelings” using “I” language, and keep them brief.
Keep it simple — do not bombard with suggestions.
Avoid spilling out your fears of “impending doom” if your child doesn’t do what s/he is expected to do.
Keep words to a minimum when you are upset. Bring your child’s attention to the nuances of the emotional state of others.
3. Tools Are needed AND They Require Practice: Children with ADHD who present themselves as disorganized, inefficient and inconsistent are often offered help and support. However, if a parent comes up with the solutions, the child’s Executive Functions are not trained. Children must be educated about the WHY and the HOW of the Tools offered (such as planners, timers, Apps, recorders, organized binders, color-coded drawers).
Take time to explain why it is important to use a tool
Do not invent new tool each time the previous tool fails
Don’t be bedazzled by technology. A tool is valuable if it works and is easy to use, not because of its bells and whistles.
4. Bring Mindfulness Practice to the forefront: While children with ADHD have many needs, they tend to resist addressing them. The symptoms of Executive Dysfunction can create enormous amounts of stress on the family, especially when a child’s day is so full of glitches and faux pas that s/he doubts his/her ability to succeed. Managing these challenges takes resilience and optimism! This mysterious balance can be achieved through the practice of Mindfulness!
Involve the whole family in learning mindfulness tools.
Bring intentionality in healthy eating habits and exercise.
Learn deep breathing techniques through Yoga, Tai Chi etc.
Create bed-time routines that include no electronics, fresh set of clean clothes, calm lighting, and inspirational reading material.
Learn meditative practice that emphasize using visual imagery and body relaxation.
Use CDs for guided relaxation.
Bring some type of spiritual elements to your daily life.
Parenting has never been easy. Modeling good citizenship is even harder. People who suffer from ADHD and Executive Dysfunction have an added burden of compensating for impulsivity, lack of awareness and inability to take different perspectives. Shifting the mindset from “how to handle this problem” to “how to lead a meaningful life in spite of it” will bring a sense of calm, certainty and hope. ADHD and Executive Dysfunction CAN be managed!
by Cindy Goldrich, Ed.M., ACAC
Oppositional Defiant Disorder (ODD) is characterized by excessive anger, frustration, arguing, stubbornness and defiance. The correlation rate for being diagnosed with ADHD and ODD is staggering, ranging between 60% and 80%. It is the most common co-existing condition associated with ADHD and people with ADHD are 11 times more likely to be diagnosed with ODD than the general population. Anyone familiar with ADHD knows that its core components are Inattentiveness, Hyperactivity and Impulsivity. Yet, very often I receive calls from parents who are confused and concerned that the behavior of their child with ADHD is becoming combative and rebellious. Is there a connection between ADHD traits and the development of oppositional behavior?
According to Dr. Russell Barkley, world-renowned Clinical Scientist and Researcher in the field of ADHD, there absolutely is a link between having ADHD and developing ODD. In fact, Dr. Barkley believes that if you have ADHD you have a propensity for developing Oppositional Defiant Disorder from the start. Why? Because, he believes that ADHD involves one more vital component that has been left out of the Clinical diagnosis for ADHD – Emotional Dysregulation: deficits in inhibiting and regulating emotions.
During his Keynote Address at the recent National CHADD (Children and Adults with Attention Deficit Disorder) Conference, Dr. Barkley provided compelling evidence to suggest that, overwhelmingly, the difficulties people with ADHD have in both suppressing and regulating their emotions are not co-existing conditions of ADHD such as ODD or Bipolar Disorder … they are characteristics of ADHD itself. Simply stated, Emotional Dysregulation is as much a part of ADHD as are hyperactivity, impulsivity, and inattentiveness.
With the work being done now to rewrite the DSM-V, the manual physicians and clinicians use to diagnosis Mental Health Disorders and Insurers use to determine coverage, this vital and exciting new insight by Dr. Barkley could change the way ADHD is defined and treated. More importantly for most of us, it may change the way we understand and parent our children.
The Connection Between ADHD and Emotional Self-Regulation
Emotional Self-Regulation is the ability to manage your behavior in relation to the events that happen in your life. This can involve suppressing or inhibiting your response, self-soothing to calm or comfort yourself, prolonging your pleasurable experience, or refocusing your attention to a more positive goal directed activity. By providing compelling evidence where he analyzed neuro-anatomy, psychological evidence, and clinical research, Dr. Barkley found that children diagnosed with ADHD also exhibited difficulties in Emotional Self-Regulation.* He found that every rating scale that is given to children who have been diagnosed with ADHD that measures symptoms of emotions is elevated dramatically for hostility, anger, frustration and impatience. These children exhibited much stronger emotional reactions and had much greater difficulty in controlling their reactions once elicited.
What does this mean for Parenting the Child with ADHD?
So, if part of the experience of having ADHD for a child is having difficulty suppressing and regulating their emotions, how does this impact the way we parent these children? First and foremost, as I always say, you must Parent the Child You Have. If your child is having difficulty managing their emotions, you must understand, without judgment, that this is an inherent part of their disability. The tremendous social roll that the Emotional Dysregulation part of their ADHD plays cannot be understated. Dr. Barkley states: “The single biggest predictor of social rejection among children and adults with ADHD is not distractibility, inattentiveness, not completing their goals, [nor] their hyperactivity – it is their inability to regulate their frustration, impatience, hostility and anger.”
Dr. Barkley explains that the capacity to Self-Regulate is limited like a fuel. Teaching children what depletes their ability to Self-Regulate and the steps they can take to refuel their willpower can go a long way in helping them cope with the stressors they face in life. It is also important for parents to recognize and intervene when their children’s fuel may be tapped out, perhaps after a long and stressful day at school, rather than being surprised or agitated with them. Just as with hyperactivity, impulsivity and inattentiveness, you will need to learn the specific ADHD parenting skills needed to help your child develop the tools needed to manage their emotions.
In addition to helping children learn to regulate their emotions, there is a second implication in Dr. Barkley’s findings related to the strong link between ADHD and the development of Oppositional Defiant Disorder. He states, “The single best predictor of who will develop diagnosable ODD is parenting.” What does this mean for parents? We must recognize the tremendous stakes involved in how we parent our ADHD children. ODD has two main components: Emotional Regulation and Social Conflict. The Social Conflict component has to do with being argumentative, defiant, and stubborn. It seems that the Social Conflict component of oppositional behavior is a learned behavior. Dr. Barkley states: “The way parents manage the emotional gambits of the child may make the emotions of the child better or worse and may teach the child that emotions are a tool to use on others. This is known as coercion theory.” By being inconsistent, both emotionally and actionably, in how we react to a child’s emotions and actions, we leave the door open for children to use negative emotions to coerce others into doing conforming to the child’s desires.
It is not easy parenting a challenging child. More than with other children, you must gain clarity on your rules and expectations, strengthen your resolve when you are secure in your decisions, and be consistent in your parenting. This must at all times be adjusted as your child matures and seeks greater need for independence and inclusion in decision-making.
* For more information on Dr. Barkley’s research and evidence discussed in this article, please refer to: Deficient Emotional Self-Regulation: A Core Component of Attention-Deficit/ Hyperactivity Disorder, Journal of ADHD & Related Disorders, Vol. 1, No. 2
Written by Cindy Goldrich, Ed.M., ACAC ADHD Parent Coach
Children with ADHD may have reading problems because of:
slower information processing
problems with working memory and executive function
Inattention and reading problems
Children who are inattentive in kindergarten often read poorly later on. This is true even when allowing for:
other behaviour problems
early reading skills
Behaviour problems make it less likely that a child with early reading problems will improve in the first few grades. These children should be monitored so any problems can be addressed early.
ADHD and orthographic processing
Some children with ADHD have poor orthographic processing, which is the ability to code written words into short-term memory. This means that they may have trouble with:
deciding whether words are correctly spelled, for example, blame/blaim or streat/street
Text recall and comprehension in children with ADHD
Children with ADHD may have trouble remembering and understanding what they read.
Studies have found that children with ADHD may:
read single words and non-words (nonsense words that are used to test a child’s ability to connect letters to sounds) more slowly
have trouble remembering and repeating information from stories
have trouble retelling stories in a well-organized way
have trouble identifying cause and effect in stories
have trouble following spoken information
read more slowly and less accurately
ADHD and reading disability
Between 15% and 40% of children with ADHD also have a reading disability such as dyslexia. This means that they have reading weaknesses from both ADHD and the reading disability. Children who have both ADHD and a reading disability generally get lower grades, have weaker academic skills, and are more likely to need special education services than children with only ADHD or only a reading disability. These children may also have more social challenges than children with ADHD alone.
Helping children with ADHD and reading problems
In the classroom, the following may help children with ADHD and reading problems:
direct instruction on reading-related skills. Direct instruction is a type of instruction that is given individually or to a small group of children. It involves breaking down tasks into smaller steps, using diagrams, having the teacher model skills for the children, allowing independent practice, and providing frequent feedback.
helping the child focus on the letters and combinations of letters that represent sounds and words in written text
teaching strategies the child can use to become an independent reader
giving the child many chances to participate and be involved with lessons, such as small group learning or peer tutoring
frequent, clear feedback on their performance
These are discussed in detail on the TeachADHD web site.
Jasper/Goldberg Adult ADD/ADHD Screening Quiz
By Larry Jasper & Ivan Goldberg
By Rick Nauert PhD
A new study published in the journal JAMA Pediatrics finds that new cases of children diagnosed with attention deficit hyperactivity disorder by physicians jumped 24 percent between 2001 and 2010.
Investigators examined the electronic health records of nearly 850,000 ethnically diverse children, aged 5 to 11 years, who received care at Kaiser Permanente Southern California between 2001 and 2010. The research findings are in line wih a number of recent nationwide studies documenting more diagnoses of ADHD.
It found that among these children, 4.9 percent, or 39,200, had a diagnosis of ADHD, with white and black children more likely to be diagnosed with the neurobehavioral disorder than Hispanics and Asian/Pacific Islander children.
Researchers discovered non-Hispanic white children presented the highest diagnostic rates. The study also showed there was a 90 percent increase in the diagnosis of ADHD among non-Hispanic black girls during the same nine-year period.
For instance, in 2010, 5.6 percent of white children in the study had an ADHD diagnosis; 4.1 percent of blacks; 2.5 percent of Hispanics; and 1.2 percent of Asian/Pacific Islanders.
The study also examined increases in the rates of first-time ADHD diagnosis. Researchers found that the incidence of newly diagnosed ADHD cases rose from 2.5 percent in 2001 to 3.1 percent in 2010 — a relative increase of 24 percent.
Black children showed the greatest increase in ADHD incidence, from 2.6 percent of all black children 5 to 11 years of age in 2001 to 4.1 percent in 2010, a 70 percent relative increase.
Rates among Hispanic children showed a 60 percent relative increase, from 1.7 percent in 2001 to 2.5 percent in 2010. White children showed a 30 percent relative increase, from 4.7 percent in 2001 to 5.6 percent in 2010, while rates for Asian/Pacific Islander children and other racial groups remained unchanged over time.
“Our study findings suggest that there may be a large number of factors that affect ADHD diagnosis rates, including cultural factors that may influence the treatment-seeking behavior of some groups,” said study lead author Darios Getahun, M.D., Ph.D., from Kaiser Permanente Southern California’s Department of Research & Evaluation.
“These findings are particularly solid given that our study relied on clinical diagnoses of ADHD based on the criteria specified within the Diagnostic and Statistical Manual of Mental Disorders and that it represents a large and ethnically diverse population that can be generalized to other populations,” he said.
In addition, the study found that boys were three times more likely to be diagnosed with ADHD than girls.
Higher family incomes also were associated with the likelihood of ADHD diagnosis; children from families with a household income of more than $30,000 a year were nearly 20 percent more likely to be diagnosed with ADHD than children from families making less $30,000.
According to the Centers for Disease Control and Prevention, ADHD is one of the most common neurobehavioral disorders of childhood. The CDC estimates that between 4 percent and 12 percent of school-aged children have the disorder, which generates health care costs of between $36 billion and $52 billion per year.
Children with ADHD are more likely to experience learning problems, miss school, become injured and experience troublesome relationships with family members and peers, according to the researchers.
“While the reasons for increasing ADHD rates are not well understood, contributing factors may include heightened awareness of ADHD among parents and physicians, which could have led to increased screening and treatment,” said Getahun.
“This variability may indicate the need for different allocation of resources for ADHD prevention programs, and may point to new risk factors or inequalities in care.”
Attention Deficit Disorder (ADHD/ADD) also known as attention deficit hyperactivity disorder is a chronic disease occurs in certain age and years of a children, defined as a condition with characteristics of co-existence of attentional problems and hyperactivity. It effects about 5% of the all children in the world with boys have 3-4 times higher risk than girl. Over one third of children with ADHD will have continued symptoms existed into their adult life.
ADHD/ADD in conventional medicine perspective
Diagnosis depending to the observation of the symptoms of the children with ADHD and answering to questions about past and present problems, and a medical exam is also important to rule out other causes for symptoms. The diagnosis of children with development A is always a stressful and time consuming road for both parent and children, because each doctor in conventional medicine mostly specializes in one field and can not make any suggestion outside of his or her professional judgement. You may be recommended to see other specialists if one found to be necessary. Since ADHD is complex disease, it requires a team of doctor before it can be diagnosed correctly and many wrong diagnosis have been done, leading to overwhelming pressure and time wasting to the parent and their children. Fortunately, many cases of ADHD have been correctly diagnosed and are treated accordingly.
To avoid wasting your time, here is the basic list of doctors and specialists who have been required for all children with development disorder to be diagnosed correctly.
1. Development and behaviour pediatrician
2. Paediatric neurologist
3. Children psychiatrist
4. Children psychologist
5. Developmental/Behavioral Pediatricians
6. Occupational therapist
8. Behavioral therapy
9. Social worker
Some children may require more or less specialists than the list above in their road to find a cure, but we believe the list is a basic team for fast and corrected diagnosis.
Cognitive behavioral therapy and medication may be at least partially helpful in the treatment of children with ADHD or with ASD, if it is not accompanied with diet and nutrition as in Children with Autism, researchers said, according to the study “Effectiveness of nutritional interventions on the functioning of children with ADHD and/or ASD. An updated review of research evidence” by Martí LF., posted in PubMed(a)
2.1. Cognitive behavioral therapy
The aims of behaviour theory is to help the ADHD children to overcome the emotional, behavioural and cognitive dysfunction through a goal-oriented, systematic procedure. It is said that this types of treatment have proven to be successful in treating mood, anxiety, personality, eating, substance abuse, and psychotic disorders in some degrees.
Research is demonstrating that acute exercise facilitated performance in the Stroop Test, particularly in the Stroop Color-Word condition. Additionally, children in the exercise group demonstrated improvement in specific WCST performances in Non-perseverative Errors and Categories Completed (10)
2.3. Parental Training
Parental Training in early alliance and change in alliance over time predicted improvements in several parenting behaviors and child outcomes, including peer sociometrics in a lab-based playgroup. These preliminary findings lend support to the importance of examining the parent-therapist alliance in parent-training groups for youth social and behavioral problems (11). Even though it is always difficult for parent to try them in the beginning, but be consistent. follow through on punishments and rewards. Keep rewards frequent and short-term, etc.
2.4. Occupational therapy
Occupational therapy is a type of program, helping to compromise physically, intellectually or emotionally to integrate coping skills into their lives in order to perform necessary tasks. but for children with ADHD, the main goal of occupational therapy is to integrate sensory perception through recognition and interpretation of sensory stimuli based chiefly on memory, therefore it helps the child to gain a more peaceful frame of mind and concentrate on certain tasks.
2.5. Social skill training
Social skill training plays an important role for many children with ADHD to learn social skills for improving relationships with peers for the child and formed part of the ADHD treatment.
2.6. Make Environment ADHD Friendly
Some researchers suggested that making environment friendly may be essential for children with ADHD such as reduce distractions and strategies for keeping attention for the ADHD children
Stimulants are used to treat and manage ADHD. All stimulants involved the increasing levels of dopamine, a neurotransmitter in the brain associated with pleasure, movement, and attention.
a. Methylphenidate , including Biphentin®, Concerta® or Ritalin®)
a. 1. Methylphenidate is a piperidine compounds used to treat ADHD by increasing the levels of dopamine and norepinephrine in the brain byreleasing medication in the body over a period of time to prvide a paradoxically calming and attention effect on individuals with ADHD. Some researchers have found the beneficial effects of methylphenidate for both boys and girls. Methylphenidate therefore would appear to be as useful a treatment for ADD girls as for ADD boys.(22)
a.2. Side Effects are not limit to
a.2.1. It can be addictive
a.2.2. the medication of can cause nervousness including dizziness, agitation, anxiety and irritability
a.2.3. It may also cause gastrointestinal disorders including stomach ache, nausea, decreased appetite, vomiting, etc.
a.2.4. Do not use the medication if you have high blood pressure or any form of heart disease
a.2.5. The medicine is easy to abuse and toxicity
As therapeutic use increases, the risk increases of unintentional overdoses, medication errors, and intentional overdoses caused by abuse, misuse, or suicide gestures and attempts. Side effects during therapy, which include nervousness, headache, insomnia, anorexia, and tachycardia, increase linearly with dose. Clinical manifestations of overdoses include agitation, hallucinations, psychosis, lethargy, seizures, tachycardia, dysrhythmias, hypertension, and hyperthermia(23)
b. Dextroamphetamine (Dexedrine®, amphetamine mixed salts (Adderall XR®)
b.1. Dextroamphetamine used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD, is a central nervous system stimulants used by changing the amounts of certain natural substances in the brain in which involved the effect in wakefulness and focus as well as decreased fatigue and decreased appetite.
b.2. Side Effects are not limit to
b.2.1. Prolonged period of use may decrease the effectiveness of the medicine
b.2.2. Over doses or using can cause cause serious heart problems or sudden death.
b.2.3. The medicine can cause nervous tension, including restlessness, difficulty falling asleep or staying asleep, headache, uncontrollable shaking of a part of your body , etc.
b.2.4. Dextroamphetamine can also cause digestive
disorder, including diarrhea, constipation loss of appetite, etc.
b.2.5. abuse, misuse, and diversion
Although, evidence on abuse, misuse, and diversion was limited, if compare to the use of Methylphenidate. But misuse and diversion rates varied by age and were highest among college students, and rates of diversion were highest with amphetamine-based products but similar among methylphenidate products. Evidence of effects in important subgroups of patients with ADHD (e.g. comorbid anxiety) was not comparative.(24)
c. Lisdexamfetamine (Vyvanse®)
c.1. Lisdexamfetamine dimesylate (LDX) is the medicine used in children with and without previous exposure to stimulant medication in the treatment of attention-deficit/hyperactivity disorder (ADHD) as a significantly less active form to dextroamphetamine. As LDX reduced the core symptoms of ADHD with more severe adverse events in stimulant-naïve than previous-exposure subjects. Future controlled studies with larger samples should address the impact of previous stimulant exposure on other ADHD treatments(25)
c.2. Side effects are not limit to
c.2.1. The medication can cause nervous tension, including mild irritability, nervousness, restlessness, dizziness, trouble sleeping, etc.
c.2.2. Lisdexamfetamine dimesylate can also cause digestive disorders, including, constipation, decreased appetite, diarrhea, dry mouth, nausea, stomach pain; vomiting, etc.
c.2.3. It may be subject to abuse cause as increased risk for impairment in driving behaviors.(26)
Recommended E books
Dr. Joseph Mercola’s Complete Guide
To Weight Loss, Preventing Diseases, Premature Aging,
And Living Healthy And Longer
For other children health articles, please visit http://medicaladvisorjournals.blogspot.ca/p/children-health.html
other health articles, please visit
On the surface, obsessive compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD) appear very similar, with impaired attention, memory, or behavioral control. But Prof. Reuven Dar of Tel Aviv University’s School of Psychological Sciences argues that these two neuropsychological disorders have very different roots – and there are enormous consequences if they are mistaken for each other.
Prof. Dar and fellow researcher Dr. Amitai Abramovitch, who completed his PhD under Prof. Dar’s supervision, have determined that despite appearances, OCD and ACHD are far more different than alike. While groups of both OCD and ADHD patients were found to have difficulty controlling their abnormal impulses in a laboratory setting, only the ADHD group had significant problems with these impulses in the real world.
According to Prof. Dar, this shows that while OCD and ADHD may appear similar on a behavioral level, the mechanism behind the two disorders differs greatly. People with ADHD are impulsive risk-takers, rarely reflecting on the consequences of their actions. In contrast, people with OCD are all too concerned with consequences, causing hesitancy, difficulty in decision-making, and the tendency to over-control and over-plan.
Their findings, published in the Journal of Neuropsychology, draw a clear distinction between OCD and ADHD and provide more accurate guidelines for correct diagnosis. Confusing the two threatens successful patient care, warns Prof. Dar, noting that treatment plans for the two disorders can differ dramatically. Ritalin, a psychostimulant commonly prescribed to ADHD patients, can actually exacerbate OCD behaviors, for example. Prescribed to an OCD patient, it will only worsen symptoms.
Separating cause from effect
To determine the relationship between OCD and ADHD, the researchers studied three groups of subjects: 30 diagnosed with OCD, 30 diagnosed with ADHD, and 30 with no psychiatric diagnosis. All subjects were male with a mean age of 30. Comprehensive neuropsychological tests and questionnaires were used to study cognitive functions that control memory, attention, and problem-solving, as well as those that inhibit the arbitrary impulses that OCD and ADHD patients seem to have difficulty controlling.
As Prof. Dar and Dr. Abramovitch predicted, both the OCD and ADHD groups performed less than a comparison group in terms of memory, reaction time, attention and other cognitive tests. Both groups were also found to have abnormalities in their ability to inhibit or control impulses, but in very different ways. In real-world situations, the ADHD group had far more difficulty controlling their impulses, while the OCD group was better able to control these impulses than even the control group.
When people with OCD describe themselves as being impulsive, this is a subjective description and can mean that they haven’t planned to the usual high degree, explains Prof. Dar.
Offering the right treatment
It’s understandable why OCD symptoms can be mistaken for ADHD, Prof. Dar says. For example, a student in a classroom could be inattentive and restless, and assumed to have ADHD. In reality, the student could be distracted by obsessive thoughts or acting out compulsive behaviors that look like fidgeting.
“It’s more likely that a young student will be diagnosed with ADHD instead of OCD because teachers see so many people with attention problems and not many with OCD. If you don’t look carefully enough, you could make a mistake,” cautions Prof. Dar. Currently, 5.2 million children in the US between the ages of 3 and 17 are diagnosed with ADHD, according to the Centers for Disease Control and Prevention, making it one of the most commonly diagnosed neuro-developmental disorders in children.
The correct diagnosis is crucial for the well-being and future trajectory of the patient, not just for the choice of medication, but also for psychological and behavioral treatment, and awareness and education for families and teachers.
By Kaitlin Bell Barnett
I’ve argued before that declaring American kids and teens to be “overmedicated” is something of a cop-out.
How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?
Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.
A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.
Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.
Among Kids With Diagnosable Disorders, Low Rates of Recent Medication Use
The study, which was published online in the Archives of Pediatrics and Adolescent Medicine, surveyed a large, nationally representative sample of more than 10,000 teens ages 13 to 18.
It found that about 14 percent of kids with DSM-IV psychiatric diagnoses had been treated with medication in the past year.
The percentage ranged widely, however, depending on the condition. Thirty-one percent of teens with diagnosable ADHD reported having taken medication for that condition in the past 12 months, compared to just 11 percent of those with anxiety disorders.
Researchers Find ‘No Compelling Evidence’ For Overmedication
The research team – which includes several major figures in this field – considered these percentages to be reasonable, especially considering the amount of distress and dysfunction involved in the kids they surveyed. “There was no compelling evidence for either misuse or overuse of psychotropic medications,” they wrote.
“The majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings,” they added, “had a mental disorder with severe consequences… functional impairment, suicidality, or associated behavioral and developmental difficulties.”
The study also found that most kids were taking a medication commonly prescribed for their diagnosis, such as antidepressants for depression, or stimulants for ADHD.
Antipsychotic use, which has been growing dramatically in recent years and is the subject of much debate about alleged overprescribing, was very low overall, ranging from 0.1 percent of those with anxiety as their primary diagnosis to 2 percent of those with developmental disorders as their primary problem.
Moreover, just 2.5 percent of kids who didn’t qualify for a psychiatric diagnosis reported having taken meds in the past year.
But even this small percentage of kids who didn’t meet the formal criteria sufficient for a diagnosis at the time they were surveyed weren’t necessarily inappropriately mediated: 78 percent reported having a prior mental or developmental disorder (like autism) that caused distress or impairment.
What’s Missing From The Study
It’s important to note that this study collected data between 2001 and 2004, so it’s possible medication use in teens – or at least the use of certain medications, like antipsychotics – has expanded since then.
And an important measurement was missing from the article that would provide key context about under- or over-treatment. Although researchers queried teens and families about where they received mental health services (in school, from a general practitioner, a mental health specialist, etc.), the text of the article didn’t indicate what percentage of the medicated kids were also receiving other services, such as psychotherapy. It also didn’t indicate what percentage of the unmedicated kids were receiving other services.
That’s crucial, because medication isn’t the only treatment out there. Other therapies have been shown to be effective, and a number of studies have found combined therapy and medication to be superior to either treatment alone.
Therefore, the issue isn’t so much what percentage of kids are taking medications – or even what percentage of kids with a bona fide diagnosis are taking them, the focus of this study.
Rather, the more salient questions are whether kids with troubling emotional and behavioral problems have appropriate and sufficient access to treatment, and whether they and their families consider that treatment – and those who administer it – adequate and effective.
An editorial accompanying the article made that point convincingly.
The editorial also pointed out that this study included a relatively high percentage of well-off kids with private insurance, which might account for the low rates of medication use. Previous studies have shown that kids with public insurance, especially foster children, are far more likely to be medicated at higher rates.
So What Do We Still Need To Know?
Although this study provides valuable information showing that relatively few teens take medication for their psychiatric disorders, we need a study that examines how common psychiatric diagnoses, medication use and other treatment modalities are in youngsters from diverse backgrounds.
And that same study should also measure kids and families’ opinions about access to and effectiveness of different kinds of treatment, as well as their level of satisfaction with the medical and with mental health professionals who administer it.
By Laura Rolands, ADHD Coach
Why Active Listening?
Listening is a core competency of coach training programs and coaching organizations, so, you would expect me to find it valuable. Active listening provides many benefits beyond coaching in our relationships and in daily conversations. ADHD can make active listening more difficult for individuals which is why, as an ADHD Coach, I often work with my clients to improve their listening skills. By actively listening, you will better understand what is being discussed and be better equipped to provide valuable input at the appropriate time. Sometimes when someone else is speaking, you might spend time figuring out what you will say next and that can interfere with your understanding of the situation. Or you might simply struggle to pay attention to what is being said. You will gain more insight into discussions and have more meaningful input if you actively listen while the other person is speaking.
If you have ADHD, listening can be a challenge since ADHD can naturally interfere with your listening skills. Impulsiveness may drive you to unintentionally interrupt someone while speaking. Inattentiveness might cause your mind to wander during conversations, meetings or presentations. Both of these situations can be frustrating for you if they apply. You may personally have other listening challenges that come into play. There are steps you can take, however, to improve your listening skills. Review the ideas below and give one of them a try to help improve your listening skills.
Talk to a friend or co-worker whom you know and trust. Perhaps they have concerns about listening as well. Take turns telling each other something about a recent event that happened in the past week. Make it brief, but long enough to stretch your listening skills. Two to four minutes is a good time length to start. When your friend is done talking, reflect the story back to him or her and ask for feedback. Discuss with your friend what got in the way of your listening and brainstorm ways you can listen more actively in the future. Then reverse roles and tell your friend something of interest. Practice this a few times each week and keep track of your listening skills to see if you notice any improvements.
If your ADHD is largely inattentive you might drift off and lose focus while struggling to listen while someone is talking during a conversation or meeting. Another activity to try is to fidget. One of my coaching colleagues, Sarah Wright and her co-author, Roland Rotz, wrote a book called Fidget to Focus. Outwit Your Boredom: Sensory Strategies for Living With ADD (2005). Their website is http://FidgetToFocus.com and explains that fidgeting means “any simultaneous sensory-motor stimulation strategy”. The authors encourage using the active of fidgeting to keep your brain activated which will help you pay attention to what you need to pay attention to. Examples of fidgeting include squeezing a stress ball, chewing gum, playing with pipe cleaners and even listening to music. My favorite fidget is to tear paper into small pieces and roll them up – sounds strange to many people, but it kept me focused during many long corporate meetings! For more ideas, I encourage you to check out the Fidget to Focus website or book.
Notice When You Listen (or don’t)
Sometimes the first step to improving your listening skills is to notice when you listen well and actively. By noticing when you listen, you can focus on recreating the positives of those situations in the future. What is the environment? How is the speaker speaking? What did you eat for breakfast? How much sleep did you get last night? By noticing the positive listening experiences that you have, you can be more mindful of creating those experiences again in the future. After you notice the positive of when you listen well, you might also want to take notice of when you do not listen so well. How can you use the strengths you identified above to make the situations where you don’t listen well better?
Children with ADHD often have more social and emotional problems than other children. This is true for all subtypes of ADHD and for both boys and girls. Children with ADHD often have trouble making and keeping friends, for a variety of reasons:
They may have difficulty reading social cues; for example, they may interrupt or have trouble taking turns.
They may have problems learning social skills, such as conversation skills and problem-solving. They may have trouble controlling their behaviour and emotions. Other children may find their hyperactive or impulsive behaviour irritating.
They may be very physical or aggressive.
They may react angrily or inappropriately when they are upset.
They may have trouble cooperating with friends.
Signs of social problems
Children with ADHD may:
be rejected by peers
have poor conversational skills
have trouble using conversational skills in social situations
become frustrated or angry more easily than other children
be anxious or depressed
seem quiet and withdrawn
be shunned or bullied by peers
These “problem” behaviours are not intentional; they are part and parcel of the disorder. Children with ADHD often have trouble regulating their emotions, or controlling emotional reactions. Many children with ADHD also have a psychiatric disorder such as anxiety disorder, oppositional defiant disorder, or conduct disorder. These too can affect children’s social and emotional skills.
Helping children with ADHD and social and emotional problems
There are many programs available to help children develop social skills. Research shows that the most effective programs take place in the environment where the child is having trouble.
It is important for parents and teachers to:
Teach, model, and support appropriate behaviour.
Provide lots of positive feedback to reinforce appropriate behaviour.
Teachers can make a difference in the classroom:
Children who feel connected to their school and classroom are more likely to engage in pro-social behaviour. They are also more likely to achieve academically. Teachers can make children feel connected by creating a positive learning environment.
Teachers need to become aware of which students are at risk, and then recognize and support their skills.
Parents can help their children with ADHD by:
Playing games with them that require following rules, concentration, and cooperation.
Talking about difficult situations your child encounters with other children. Encouraging him or her to be empathetic by thinking how the other person might have felt.
Noticing when they handle a situation successfully and pointing out what they did and why it worked.
Talking about and imagining the consequences of actions or behaviour, such as “What do you think might happen if you did that?” or “What might the other person feel like if you said that?”
Helping them to understand the importance of personal space and boundaries. For example, not interrupting when someone else is talking and not speaking too loudly.
Social skills training is usually provided by a trained counsellor. It can help children with:
problem-solving and conflict resolution
improving interpersonal skills
making and keeping friends
Not everything that looks like ADHD is ADHD!
For example, children may be worried or stressed about events at home, at school, or in the world in general. Stressful events could include divorce or separation, moving, the death of a family member or pet, or the child’s performance in school. These children may:
have difficulty concentrating
have difficulty listening to and following instructions
find it hard to sit still
be easily distracted
make careless mistakes
Behaviour symptoms like those of ADHD can also be caused by:
side effects of medication for other health problems such as asthma
brain injury following an accident
Fetal Alcohol Spectrum Disorder (FASD)
developmental delay or mental retardation
The doctor will want to rule out these and other possible causes before making a diagnosis of ADHD.
Peter Chaban, MA, MEd
Earlier studies suggest people with ADHD are more likely to commit offences than the general population.
Providing better access to medication may reduce crime and save money, experts and support groups say. Researchers say the benefits of the drugs must be weighed against harms.
In the UK 3% of children have a diagnosis of ADHD, with half of them continuing to have the condition in adult life. People with the disorder have to deal with problems with concentration, hyperactivity and impulsiveness.
Estimates suggest between 7-40% of people in the criminal justice system may have ADHD and other similar disorders, though in many cases the condition is not formally recognised. Researchers from the Karolinska Institute looked at data from over 25,000 people with ADHD in Sweden.
They found people with ADHD were more likely to commit crime (37% of men and 15% of women) than adults without the condition (9% of men and 2% women).
The study published in the New England Journal of Medicine found when people took their medication they were 32-41% less likely to be convicted of a crime than when they were off medication for a period of six months or more.
Dr Seena Fazel, an author of the study and from Oxford University, says medication may reduce impulsive choices and may enable people to better organise their lives – allowing them to stay in employment and maintain relationships.
Co-author Prof Paul Lichtenstein says: “It is said that roughly 30 to 40% of long-serving criminals have ADHD. If their chances of recidivism can be reduced by 30%, it would clearly effect the total crime numbers in many societies.”
Prof Philip Asherson, a psychiatrist and president of the UK Adult ADHD network, who was not involved in the study says: “We want people to have personal choice and personal responsibility – no-one is trying to force people to take drugs.”
He points out it costs £100-£300 a month to provide medication for someone with ADHD, and taking into account the costs of unemployment and the criminal justice system, these would “vastly outweigh” the costs of medication, he says.
But he cautions that the side effects of the drugs used, such as Ritalin, must be taken into account.
“There are of course a lot of people with ADHD in the population who are not involved in crime.
“But for some people with the condition – if you don’t treat them, they will try to treat themselves with street drugs,” says Andrea Bilbow, founder of the National Attention Deficit Disorder Information and Support Service, Addis.
“A referral to specialist adult services can cost £1,500 – compare this with the amount of money you can save if you keep people out of prison – it’s a no brainer.”
ADHD Trick Of The Day from: Adam Dachis
The best way I remember something is if I actually do something a little out of the ordinary. By myself, I’m pretty quiet, so when I have something like remembering if I locked my door before leaving my place, I’ll say “I’ve locked this door, Scotty.” That way if I have to remember, I can just think to myself “I told Scotty I locked the door. He shouldn’t be complaining.”
It sounds crazy, but it works. Do something strange, and note doing that strange thing. That way you can remember mundane things. You provide a mental hook to hang something on.
ScienceDaily (Oct. 15, 2012) Men who were diagnosed as children with attention-deficit/hyperactivity disorder (ADHD) appeared to have significantly worse educational, occupational, economic and social outcomes in a 33-year, follow-up study that compared them with men without childhood ADHD, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.
ADHD has an estimated worldwide prevalence of 5 percent, so the long-term outcome of children with ADHD is a major concern, according to the study background.
Rachel G. Klein, Ph.D., of the Child Study Center at NYU Langone Medical Center in New York, and colleagues report the adult outcome (follow-up at average age of 41 years) of boys who were diagnosed as having ADHD at an average age of 8 years. The study included 135 white men with ADHD in childhood, free of conduct disorder (probands), and a comparison group of 136 men without childhood ADHD.
“On average, probands had 2½ fewer years of schooling than comparison participants … 31.1 percent did not complete high school (vs. 4.4 percent of comparison participants) and hardly any (3.7 percent) had higher degrees (whereas 29.4 percent of comparison participants did). Similarly, probands had significantly lower occupational attainment levels,” the authors note. “Given the probands’ worse educational and occupational attainment, their relatively poorer socioeconomic status at [follow-up at average age of 41 years] is to be expected. Although significantly fewer probands than comparison participants were employed, most were holding jobs (83.7 percent). However, the disparity of $40,000 between the median annual salary of employed probands and comparisons is striking.”
In further comparisons of the two groups, the men who were diagnosed with ADHD in childhood also had more divorces (currently divorced, 9.6 percent vs. 2.9 percent, and ever been divorced 31.1 percent vs. 11.8 percent); and higher rates of ongoing ADHD (22.2 percent vs. 5.1 percent, the authors suspect the comparison participants’ ADHD symptoms might have emerged during adulthood), antisocial personality disorder (ASPD, 16.3 percent vs. 0 percent) and substance use disorders (SUDs, 14.1 percent vs. 5.1 percent), according to the results.
During their lifetime, the men who were diagnosed with ADHD in childhood (the so-called probands) also had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. And relative to the comparison group, psychiatric disorders with onsets at 21 years of age or older were not significantly elevated in the probands, the study results indicate.
The authors note the design of their study precludes generalizing the results to women and all ethnic and social groups because the probands were white men of average intelligence who were referred to a clinic because of combined-type ADHD.
“The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD,” the study concludes.
By Marie Suszynski Medically reviewed by Pat F. Bass III, MD, MPH
Adults with attention deficit hyperactivity disorder, or adult ADHD, tend to be restless and impulsive, and have a hard time paying attention. That makes time management a real challenge. ADHD symptoms may mean you aren’t adept at being aware of time passing, predicting how long tasks will take, monitoring how you’re doing, and making adjustments accordingly, says Ari Tuckman, PsyD, a clinical psychologist in West Chester, Pa., vice-president of the Attention Deficit Disorder Association, and author of “More Attention, Less Deficit.” Here are some techniques that can help turn a chronic procrastinator into an efficient time manager.
Create a Daily To-Do List
When you have adult ADHD, creating a to-do list can be a great way to set goals for the day, but the key is to not overdo it and keep the list small. “If you have too much on a to-do list, the more important items get lost in the clutter,” Tuckman says. He recommends keeping a master to-do list and pulling items from it for your daily to-do list.
Color-Code Your Priorities
“Prioritizing is actually a fairly complicated process, and it’s one that people with adult ADHD struggle with,” Tuckman says. How do you do it? Consider your deadlines and think about what needs to happen first, second, third, and so on, Tuckman says. Then color-code your to-do list according to priority. You might use a yellow highlighter to color-code the things that are most important to get done in the morning and a blue highlighter to code the tasks that need to get done in the afternoon.
Schedule Enough Time
A fundamental piece to getting past adult ADHD symptoms is having the ability to get yourself moving on a task before a deadline is upon you, Tuckman says. As you plan your day, be realistic about how much time it will take you to complete a goal. When you start to procrastinate, remind yourself of the reward for reaching your goal early: You avoid the anxiety of rushing to finish and you have the time to do your best work. That’s the essence of time-management skills.
Break Tasks Into Manageable Chunks
For people with adult ADHD, the first challenge of taking on a big project is stopping long enough to think about how to break it down into smaller tasks, Tuckman says. Too often, they tend to jump into a project without planning it well. Having better time-management means you start by thinking through what needs to be done each step along the way to finish a project on time.
Invest in Planning Software
If you have trouble doing it on your own, project planning software can enable you to sit down, think about a project, and break it down into pieces, Tuckman says. It can help you make interim deadlines, consider what resources you need to get the job done, and provide reminders of deadlines. But it can be a hindrance to your time-management skills if playing with the program becomes a distraction to getting your work done, Tuckman adds.
Rely on Visual and Audio Reminders of Time
Because someone coping with adult ADHD doesn’t have a reliable internal clock, one strategy is to rely on external markers of time. Tuckman recommends putting up plenty of clocks in your workspace so that you can always see the time. And a more active solution, he says, is to set an alarm to go off or vibrate every 15 minutes. This will be a reminder that time is passing and will give you a chance to evaluate where you are and what still needs to get done.
Use Technology to Your Advantage
The biggest challenge to using a paper calendar is that you have to keep looking at it to know what’s coming up. For adults living with ADHD it can be easy to miss appointments or fall behind. But when an automatic reminder on an electronic calendar, Blackberry, or cell phone pops up on your computer screen or beeps in your pocket or purse, it’s hard to ignore. Consider one of these high-tech options as a time-management tool.
Carry a Notebook
It may help to keep track of different projects with notebooks. Chana Klein, a Teaneck, N.J.-based certified professional coach who works with people with adult ADHD and has struggled with ADHD herself, says that she uses a different notebook for every business relationship she has. That way, the information is organized and easy to find and it’s better than writing something down on a random piece of paper and then losing it, she says. Klein also keeps a notebook on her desk and another in her bag, so she always has a place to write down notes to help her remember later.
Take Time to Recharge
Everyone needs a break from work, and some people who have adult ADHD stay on track when they schedule breaks ahead of time, Klein says. “You need to know when you’ll have a day off and when you’ll have an hour off,” she explains. But don’t let a break derail your time-management skills. Tuckman recommends setting an inexpensive kitchen timer to alert you when it’s time to go back to work. “It comes back to time awareness,” he says.
By Rick Nauert PhD Senior News Editor
Attention deficit hyperactivity disorders (ADHD) is now a common diagnosis with the U.S. Center for Disease Control and Prevention estimating that almost one in ten (9.5 percent) children aged 4-17, has at some time, received a diagnosis of ADHD.
Common treatment strategies for ADHD include cognitive-behavioral therapy and pharmaceuticals. The Food and Drug Administration has now approved Quillivant XR (methylphenidate hydrochloride), the first once-daily, extended-release liquid methylphenidate available for patients with ADHD.
The new medication is a welcome addition to traditional medication regimens as authorities say that in 2011, there were more than 52 million prescriptions filled for ADHD medications, representing a 10 percent increase over 2010.
“The approval of Quillivant XR fills a void that has long existed in the treatment of ADHD,” said Ann Childress, M.D., president of the Center for Psychiatry and Behavioral Medicine, Las Vegas, who was an investigator in the Quillivant XR laboratory classroom study.
“We routinely see the struggles of patients who have difficulty swallowing pills or capsules. Having the option of a once-daily liquid will help alleviate some of these issues while still providing the proven efficacy of methylphenidate for 12 hours after dosing.”
Researchers determined the efficacy of Quillivant XR by performing a randomized, double-blind, placebo-controlled study of 45 children with ADHD.
For the study children received an initial 20mg dose of Quillivant XR once daily in the morning. The dosage was then titrated weekly until an optimal dose or maximum dose of 60mg per day was reached.
After this, a two-week double-blind study was performed on the study using a crossover design (meaning that kids would alternate between receiving the medication or a placebo.
At the end of each week, trained observers evaluated the attention and behavior of the patients in a laboratory classroom using an established behavioral rating scale.
Quillivant XR significantly improved ADHD symptoms compared to placebo at the primary endpoint of four hours post-dose, and in a secondary analysis, showed significant improvement at every time point measured, from 45 minutes to 12 hours after dosing.
“We are pleased with the FDA’s approval of Quillivant XR and believe it will address an important need for many patients with ADHD and their caregivers,” said Jay Shepard, President and CEO of NextWave Pharmaceuticals.
“We are eager to enter into the ADHD market and believe the unique liquid formulation of Quillivant XR—which was developed in conjunction with NextWave’s technology and manufacturing partner Tris Pharma—will provide another treatment option for patients with ADHD.”
Quillivant XR is expected to become available in pharmacies in January 2013. Quillivant XR was developed using Tris Pharma’s patent protected drug delivery platform.