Primarily Inattentive ADD

Coffee for Life, Inattentive ADD and Sluggish Cognitive Tempo

2012-05-22T21:00:00.002-04:00

Coffee for Life, Inattentive ADD and Sluggish Cognitive tEMPO

Regular readers of this blog know that I am a big coffee drinker. I drink at least two cups a day and, depending on what my day holds in store, I may drink up to four cups a day. Coffee helps my Inattentive ADHD symptoms so I was very happy to see the recent New England Journal of Medicine report showing that several cups of coffee a day promote longevity.

The New England Journal article researchers were quick to point out that they are uncertain which of the thousands of chemicals in coffee brings about these life enhancing properties. It is likely not just the caffeine but rather the result of the combination of antioxidants and other chemicals that combine to promote health and, in my case, attention.

I have written several posts about why and how caffeine helps people with Inattentive ADHD. I believe that coffee's mild stimulant is very helpful for the Inattentive type of ADHD but I also recognize that the vast majority of kids will not drink coffee and I am NOT a believer in Mountain Dew, Coca-Cola or other soda drink.

The South American and European scientific community have continued to study the ADHD benefits of caffeine and there have been two animals studies recently published that have demonstrated that caffeine improves ADHD by mainly improving memory and attention while not improving or having a lesser affect on hyperactivity. The fact that people with Inattentive ADHD sometimes react badly to strong stimulants makes coffee a good alternative that is worth trying as treatment. I do not recommend more than two cups a day as too much caffeine can cause jitters and anxiety.

Summer is coming and blending a cup of espresso with some fat free milk and ice is a pretty good treat. I recently tasted an espresso aioli which was served with Italian sausage and some really good Manchego cheese that was to die for. It would have never have occurred to me to mix mayo and espresso but it absolutely works.

Eur Neuropsychopharmacol. 2012 May 4. [Epub ahead of print]
Caffeine regulates frontocorticostriatal dopamine transporter density and improves attention and cognitive deficits in an animal model of attention deficithyperactivity disorder.
Pandolfo P, Machado NJ, Köfalvi A, Takahashi RN, Cunha RA.

Neurosci Lett. 2011 Apr 20;494(1):44-8. Epub 2011 Mar 6.
Caffeine improves attention deficit in neonatal 6-OHDA lesioned rats, an animal model of attention deficit hyperactivity disorder (ADHD).
Caballero M, Núñez F, Ahern S, Cuffí ML, Carbonell L, Sánchez S, Fernández-Dueñas V, Ciruela F.

Source

Not Much News for Defining Sluggish Cognitive Tempo

2012-05-17T01:10:00.001-04:00

Not Much News for Defining Sluggish Cognitive Tempo

If Sluggish Cognitive Tempo (SCT) is to get a "place at the table" in the DSM V (the diagnostic manual that psychiatrists use to diagnose mental health conditions) a complete and accurate definition and description of the symptoms are necessary.

A group of researchers has developed a 14 point scale of SCT symptoms that aim to distinguish SCT from ADHD and from Inattentive ADHD.

A study, just published, in the Journal of Abnormal Child Psychology has tested this scale and identified three distinct traits that correspond with SCT and/or Inattentive ADHD symptoms and a trait, that when it is present, significantly impair individuals with SCT above and beyond the impairments related to sluggishness or inattentiveness.

The three traits are Sleepy/Sluggish, Slow/Daydreamy, and Low Initiation/Persistence. The low initiaion/persistence scale contributes to significantly greater academic impairment but I would argue, as I did in the post on ADHD being a persistence deficit, that this trait can be found in everyone with a diagnosis of ADHD regardless of subtype.

I hate to be a kill joy but I honestly do not see how a study that tells us that people with Sluggish Cognitive Tempo are more sluggish or more sleepy (or that a lack of persistence contribute to greater academic impairment) adds much to our knowledge of SCT.

The abstract is below.

J Abnorm Child Psychol. 2012 May 8.
Factor Structure of a Sluggish Cognitive Tempo Scale in Clinically-Referred Children.
Jacobson LA, Murphy-Bowman SC, Pritchard AE, Tart-Zelvin A, Zabel TA, Mahone EM.

Abstract

"Sluggish cognitive tempo" (SCT) is a construct hypothesized to describe a constellation of behaviors that includes daydreaming, lethargy, drowsiness, difficulty sustaining attention, and underactivity. Although the construct has been inconsistently defined, measures of SCT have shown associations with symptoms of attention-deficit/hyperactivity disorder (ADHD), particularly inattention. Thus, better characterization of SCT symptoms may help to better predict specific areas of functional difficulty in children with ADHD. The present study examined psychometric characteristics of a recently developed 14-item scale of SCT (Penny et al., Psychological Assessment 21:380-389, 2009), completed by teachers on children referred for outpatient neuropsychological assessment. Exploratory factor analysis identified three factors in the clinical sample: Sleepy/Sluggish, Slow/Daydreamy, and Low Initiation/Persistence. Additionally, SCT symptoms, especially those loading on the Sleepy/Sluggish and Slow/Daydreamy factors, correlated more strongly with inattentive than with hyperactive/impulsive symptoms, while Low Initiation/Persistence symptoms added significant unique variance (over and above symptoms of inattention) to the predictions of impairment in academic progress.

Additude Magazine and Special Education Advisor articles

2012-05-15T14:03:00.003-04:00

Additude Article: Notes from La La Land

In January I was contacted by Additude Magazine, the magazine with a circulation of over 50,000, that serves as the main sounding board for the ADHD community, and asked to write a personal piece about living with Inattentive ADHD. I was incredibly honored, wrote the piece right away and sent it off the the editor. I few weeks later I was asked to tweak it a bit, which I did and after a few more tweaks I was informed that it would be published in the summer editions. It has now be published.

The piece is called "Daydream Believer". They asked me to write a first person narrative about growing up with ADHD. They wanted it to be poignant, witty, informative, down to earth... I had never written a piece like this for a major publication and I had my doubts that my article was what they wanted. I was hoping for it to be at least down to earth and informative as witty and poignant are a bit harder to get exactly right.

The article that was published is a bit different from what I wrote. The piece was shortened and changed a bit and in the printed edition of the magazine they misspelled Tess Messer). Overall I am thrilled. After all, Tess Messer is not my real name, it is my "web" name and because the name of this website are correct in the online and printed version, I am good.

On a completely different note, Denise Goldberg is an IEP advisor with a fantastic website called Special Education Advisor. A few weeks ago she asked me if I would write a piece on ADHD-PI for her site and I was again honored and said yes right away. She has now published the article. It is called "Spotting Inattentive ADHD". I was thrilled that Denise allowed me to contribute to her site and I believe that her site is a fantastic resource for those of us with kids in school.

One of the physicians that I work with was fired and I am filling in for his schedule which is taking up a lot of my time. Hopefully you will enjoy the Additude and Special Education Advisor articles. I promise to post something just for Primarily Inattentive ADD very soon.

Non-Drug ADHD Help for Inattentive ADHD

2012-05-10T19:40:00.003-04:00

Non-Drug ADHD Help for Inattentive ADHD

As many of you know I am trying to finish a fairly comprehensive book on non-drug treatment for ADHD. This book is non-drug help for all people with ADHD not just for people with the Inattentive Type of ADHD though I do go into what therapies work better for each of the different types.

I just received a proof of one possibility for the book cover art. I would love to know what you guys think of it. If you hate it, please let me know. If you like it I would like to know that too.

The book is is tentatively called Commanding Attention, Non-Drug Help for ADHD (I know, that is not exactly what this cover says). I am trying to reference most of what I discuss in this book so that people do not think that I am just a quack spouting out recommendations. Three hundred medical references later, I am getting close to completing it.

I started writing this book because I realized that there was no comprehensive book on the non-drug, alternative therapies for ADHD and because every day I get a question like this one:

My daughter has inattentive type. She's a junior in high school & struggling bad! We tried medications, they didn't work. What kind of treatment should I be seeking out for her? She has horrible anxiety & I'm afraid for her functioning skills in the future. We need help & I don't know what to do or how to help her. I don't believe in pumping her full of meds. We are wanting more natural. medicines, foods to treat this. Can you recommended any treatment or natural remedies? -XXXXXXXX

The book covers this topic thoroughly but I thought that I would post a very short answer to this question.

The non-drug interventions with the most promise for Inattentive ADHD include:

Classroom interventions such as instruction that motivates the individual student (see Richard Lavoie's excellent book called "The Motivation Breakthrough", as well as rewarding performance often and quickly, keeping the instruction to the point and intersting, etc
Exercise, outside not in a gym, at least 30-40 minutes 4-5 days a week.
Melatonin if cannot fall asleep within 30 minutes of turning out the lights.
A healthy diet avoid all junk food, diet.
Have her take an adult multivitamin.
Have her take an Omega-3 fatty acid that has at least 750mg of EPA. Get a product called MorEPA capules. Have her take two a day for a minimum of 8 weeks.
Try caffeine, Ginseng and/or a product called Bacopa Monieri.
If she is motivated enough to do it, try biofeedback (you can get an affordable program-send me a private email and I will send you the info on a program that can be done at home for under $300.00 but do not waste your money if she is unlikely to do it).
Try Luminosity cognitive brain training. It is $6 a month and if she will do it, it well worth it.

These are my Inattentive ADHD non-drug recommendations in a little tiny nutshell. Email me with questions or comments.

If you go to the search bar of this web page and type in any of the keywords of my recommendations (eg Bacopa, Cognitive training, diet, etc) you will pull up lots more info on these topics.

Thanks for your support and thanks, in advance, for giving me your opinion on the cover art for the book.

It's Not ADD it's Effort Persistence Deficit Disorder)

2012-05-05T18:46:00.000-04:00

It's Not ADD it's Effort Persistence Deficit Disorder

Attention Deficit Disorder has less to do with attention or hyperactivity and much more to do with the persistence of effort, staying motivated and the ability to work without a reward in site. Teachers, even those trained to work with ADHD kids fail to understand that these kids are not choosing to be unmotivated. The lack of motivation is the disorder.

This week I received the letter below from a parent and I wanted to share it with you and share my response because I think that what this parent is going through is pretty representative of what is happening in many of our schools.

Dear Tess,

I am a mother of a 14 year old boy and a 10 year old girl. Both began struggling in school when they were moved to a more rigorous school. My son was an A/B student until 6th grade. Prior to the sixth grade we had no clue, other than some trouble remembering math facts or operations. In 6th grade he:

Began failing 6th grade math and foreign language and struggled w/rest
School testing showed he slow processing speed and he was diagnosed as learning disabled

In 7th grade he:

Struggled more

Received IEP accommodations

Was diagnosed w/ADHD-PI
Was retested and found to not be learning disabled
Received OHI (Other Health Impairment) accomodations for math and classroom accomodationss

"Students are classified as having other health impairments when they have limited strength, vitality, or alertness due to chronic or acute health problems. Examples of such problems include asthma, diabetes, epilepsy, hemophilia, and leukemia. ADD or ADHD may be included in this category." (Final Regulations, IDEA, 1999).

In 8th grade he:

Was placed on Concerta
Is still struggling in school and nearly failing in 4 subjects which may cause him to repeat a grade.

I keep hassling the school to provide more help for him so he can succeed. His IQ is normal. He just has all of the inattentive symptoms and his self esteem is suffering. This week I was discussing some of his missing assignments with the "special ed teacher" as well as prodding her for some observations or insight.
The following sentences were included in her response to me: "Yesterday when given time in math to work on online math practice, he sat and drew pictures on paper part of the time. Since there were several students in the room, I didn’t see it right away because it looked like he was working on the computer. I checked on the program this morning and he had spent very little time actually working on the lesson. I know he can do the work because he has good scores when he’s actually engaged in the work. I believe it’s a choice he makes when he’s left on his own to do independent work."

It's the "I believe it’s a choice he makes when he’s left on his own to do independent work." that really irritated me (coming from someone in her position)

My question is this: Could you provide a short, to the point definition of ADHD-PI that I can reply to her that may cause her to reflect on her opinion that my son's behavior is NOT "a choice". I want it to be short enough she will read and hopefully comprehend and accept and not get defensive, as I have to rely on her to work with my child daily.

There really is a bias with this affliction. My own mother doesn't even believe it's a "real" medical problem. I grew up as a "very bright child" yet never met my potential academically. The teachers said I did not apply myself or I was viewed as "lazy". Even being this way myself, there is something about this condition that can make you second guess it because the way it is view by others that don't understand.

Thanks for your help,

XXXXX

This Special ED teacher needs to understand that if this boy could stay on task, he would. Her job, as the Special Ed teacher, is to find a way to keep him on task. The points below are summarized from a lecture given by Russell Barkley, PhD. Dr. Russell Barkley is considered by many to be the leading research Psychologist in the field of ADHD. He is the author of the Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment as well as many other ADHD books. I believe that the synopsis below is the short and sweet explanation that the Special Ed teacher needs to read.
Russell Barkley, PhD, has written at length about the fact that Attention Deficit Hyperactivity Disorder has less to do with attention or hyperactivity and more to do with motivation. He reports that ADD symptoms are the result of lost interest not the result of an inability to concentrate. Barkley states that persistence of effort is the cornerstone of ADD. As a result, telling children or adults to try harder is futile and should be stopped - rather, the interest of the curriculum (or job, etc.) should be increased to keep ADD children interested and motivated.

ADD is not an attention disorder, but a disorder of impulse control. ADD children do things other kids think of, but don't actually do. People with ADD have trouble resisting the attractiveness of things other than that immediately before them. For the person with ADD, novelty is a reward. They do well with a rich schedule of feedback. Tell them frequently how they are doing - they want immediate feedback, for they operate on the level of immediate vs. delayed consequences/rewards. Education is delayed gratification; but people with ADD want what feels good now. If you increase interest and increase rewards, you will increase the persistence of effort.

Pass it on!!

The Greatest ADHD/Diet Story Ever Told

2012-05-01T22:07:00.000-04:00

The Greatest ADHD/Diet Story Ever Told

I was recently reading the posts on an ADHD parent forum when I read a post by a mother who screamed (as best you can on a forum post), "IF ONE MORE PERSON TELLS ME THAT MY ADHD KID IS REACTING TO WHEAT I AM GOING TO TEAR ALL MY HAIR OUT". This mom was clearly on the thin edge and the ADHD diet fanatics were clearly about to put her over the edge. Diet conversations make us all cranky.

Interestingly, a similarly cranky and lively forum conversation was also going on at another Inattentive ADD Forum page over a similar discussion. People have strong opinions about elimination diets, allergies and ADHD and opposing views seem to bring out angry outburst. One seasoned poster reported on the ADD forum (without an apparent reference) that elimination diets help only 1% of people with ADHD and any discussion about elimination diets and ADHD treatment were "stupid".

Another poster on this same ADD forum said that she had personally spoken to Russell Barkley, PhD (the most respected authority on all topics ADHD) about junk food and that he reported that artificial colors seemed to cause behavioral problems in children less than 10 years of age but not in older kids or adults.

This comment was most interesting to me because the official ADHD professional community message is a very black and white one that essentially states this, "Eat a healthy diet but, overall, diet is not a significant component in the treatment of ADHD". I believe that Dr. Barkley probably has a reason to believe that diet does matter for young kids but we will never know about why he believes this because the official statements out of the ADHD expert community downplays the role of diet all together.

Diet is important in ADHD because it is an important factor in the management of all chronic illnesses. ADHD diet recommendations are an important first step in the treatment of ADHD and most pediatricians, and primary care providers recognize the importance of diet in managing illness.

The diet connection to ADHD is still a bit of a mystery. For many clinicians, it is more important to give a consistent message than it is to muddy the message with statements like, "diet may contribute to some behavioral symptoms in some people with ADHD". Clinicians do not have as much time as they would like with patients and providing certain, quick, unambiguous and implementable treatment plan message is often the key to symptom improvement.

Medical providers are more likely to write a prescription than to explore diet problems because drug treatment is quick, unambiguous, and implementable and provide certain results. Dietary habits are close to impossible to change, improvements from diet changes do not happen quickly, improved symptoms do not occur for everyone and if they do occur the patient is often unsure of how or why they improved.

Several researchers are trying to understand when, how and why diet matters in the treatment of some people with ADHD. Some scientist believe that it is related to genetic variations that cause some children with ADHD to have a non IGE histamine reaction to food additives or to certain foods Other researchers are looking at the connection between food preservatives such as Sodium Benzoate and possible amino acid and neurotransmitter abnormalities.

There are many biological processes that diet may change and which, in turn, may cause or improve ADHD behavioral symptoms but to say that ADHD behavior is related to wheat and dairy allergies is too simplistic just as saying that there is no connection between diet and ADHD behavior is too simplistic.

Until we know more, people on all sides of the diet issue will continue to argue with each other. This ADHD/Diet narrative is far from over. We are actually just at the beginning and the plot is thickening. When all the plot twists are worked out, we will know so much more and this story may turn out to be the greatest ADHD story that we have heard in a while. Stay tuned, the pace is quickening.

Clarification of Elimination Diet Help and Allergies

2012-04-26T09:56:00.000-04:00

Elimination Diet Help For ADHD May Not be Allergy Related

I recently received a comment with questions about food allergies and ADHD and the role of elimination diets in improving symptoms of inattention, hyperactivity and impulsive behavior. Many experts in the U.S. ADHD community insist that changes in your diet will not help ADHD but the results of the INCA study, completed in England last year, are causing these same experts to take a closer look at diet and ADHD symptoms.

There are now many pediatricians in the US that are taking the findings of the INCA study very seriously and considering their patient's diets when evaluating ADHD. The questions that the INCA results pose have more to do with the biological processes that occur when people eliminate certain foods from their diets than they have to do with food "allergies".

The INCA study was huge and, in fact, found improvements in the kids on the elimination diet but,and this is hugely important, the INCA study also found that these improvements did not appear to be related to allergy markers in the blood such as IGE blood levels. It is and was unclear to the researchers if the improvements in symptoms were related to calorie restrictions, food sensitivities not measured by standard blood tests such as IGG or IGE or to some other unknown factor

This study is considered, by most everyone in the ADHD scientific community, to have been performed using the most rigorous science available and the methods are not in dispute, neither are the findings of this study. There are, however, questions regarding WHY there were improvements.

The improvements may not have been related to food allergies or even food sensitivities. No one can say for sure. Though the food sensitivity" argument makes the most sense to me if you consider a "sensitivity" to be something that somehow triggers a scertain symptom or groups of symptoms.

Elimination diets are notoriously hard to do. I have tried and failed with my own family. The best that I can do is try to eliminate as much junk food from their diets as possible. In my own home I have found that when my kids eat a lot of processed foods, they seem to be more hyperactive, jittery and impulsive. The symptoms are infinitely worse for my Combined type son than for my Inattentive son.

From my observation it seems to be the artificial colors that cause the most obvious symptoms in him. I think that eventually we will find that some people have foods or food additives that trigger ADHD behaviors when they are exposed to them. This is hard to tease out in population studies but I believe that the findings of the INCA study (if you use the search bar on the website you can find the abstract of this study or just Google "INCA and ADHD) has caused many researchers in the ADHD scientific community to take a closer look at the diet/ADHD connection.

ADHD Stats and Figures

2012-04-19T13:36:00.002-04:00

Staggering ADHD Stats and Figures

In the process of compiling Commanding Attention; Effective and Affordable Non-Drug ADHD Treatments, the book that I am writing, I have come across a bunch of interesting ADHD Stats and figures. I am going to outline them here because I thought that you would find them interesting.

In the United States, Attention-Deficit/Hyperactivity Disorder (ADHD) affects an estimated 9.5%of children and 4% of Adults

From 1996 to 2008, the number of children taking stimulants such as Ritalin rose from 2.4 to 3.5 percent. Over the last decade, a half million more children and many more adults have been prescribed stimulant medication.

In 2012 the DEA (Drug Enforcement Administration) increased production quotas of Ritalin (methylphenidate) and amphetamine (Adderall) from 50,000 kg to 56,000 kg of methylphenidate and from 18,600 kg to 25,300 kg of amphetamine.

ADHD symptoms first appear between 3-6 years of age.

Two thirds or more of people with a diagnosis of ADHD will have the Combined type of this disorder meaning that they will be hyperactive, impulsive and inattentive. One third will be predominantly inattentive.

The number of people on stimulant medicine today is so large that the Federal Drug Administration (FDA) reports that increased demand for these medications have resulted in nationwide, ADHD medication, shortages.

Thirty percent of ADHD patients do not get enough symptom relief from stimulant medication to warrant continuation of the medication.

Two thirds of patients, despite debilitating ADHD symptoms, will no longer be taking their prescription medication a year after it is prescribed. Some will stop because of side effects, for some the medicine will simply not help their symptoms and others will stop for other reasons.

Fifty to seventy percent of ADHD patients will still have some ADHD symptoms as adults.

Up to one-third of patients with a diagnosis of ADHD will never complete high school.

Twenty-five to forty percent of children with ADHD have a learning disorder in addition to their ADHD.
Forty percent of patients diagnosed with ADHD also have a co-diagnosis of Major Depressive Disorder.

Twenty-five percent of patients diagnosed with ADHD have a co-diagnosis of anxiety disorder.

;As many as fifty percent of patients with a diagnosis of Combined type ADHD have an additional diagnosis of Oppositional Defiance Disorder.

Ten to twenty-five percent of patients diagnosed with ADHD will develop substance abuse problems.

Studies have found that ADHD symptoms and related problems occur in 25 to 50% of both male and female prisoners.

ADHD is thought to be 80% inheritable which means that genetic factors account for 80% of the differences in symptoms seen in people with and without ADHD.

Fifty percent of patients with Tourette's syndrome have accompanying ADHD.

No treatment for ADHD symptoms has been proven to help once the treatment is discontinued.

Two-thirds of children with ADHD will have improved symptoms after five weeks of an elimination diet that restricts processed foods, food additives and foods such as wheat, dairy, eggs. The improvement in ADHD symptoms may NOT be related to allergies.

These ADHD statistics are both impressive and staggering but stats and figures fail to tell the entire story in ADHD. When I look at the 20 facts above I refuse to sink into a major funk. Instead I focus on the fact that our future is brighter than these ADHD stats and figures indicate and that better medications and therapies are on the horizon.

Detecting ADHD Early

2012-04-16T10:39:00.001-04:00

Detecting ADHD Early

Many parents want to detect ADHD early in order that their children receive treatment as soon as possible. The pressure on children today to immediately read, add and subtract, sit still and to focus is enormous. Twenty years ago no one expected a five year old to be a good reader but today early readers have a real advantage and there is not a parent of a small child in this country who does not know this.

According to a poll taken my the website www.schoolfamily.com, 86% of parents agree with the statement, "Our children are expected to learn more sooner than before." The question of catching ADHD early or detecting ADHD early is complicated by the fact that we are expecting a lot more out of our kids at an earlier age.

According to the American Academy of Pediatrics (APA), ADHD can now be diagnosed as early as age four. Previously, because of developmental variations among children, you had to be at least 6 years of age before you were given this diagnosis. The developmental variation of children has not changed but what is expected of them at a younger age has. Focus is not something that we usually associate with four or five year olds so a 4-5 year old that is unfocused is, as far as I am concerned, pretty normal.

I recently received a long email from a mom of a five year old girl who was very worried about her child and the progress that she had made in Kindergarten. She was not reading, she was very unfocused and her teachers wanted her medicated. The women had taken her daughter to her pediatrician and the pediatrician had determined that it was too early to diagnose this particular child with ADHD.

This child had a late birthday and would not be six until August. The pediatrician explained to the mother that her child was not a slow learner but rather that her child was young. The mother wanted to detect ADHD early to "catch ADHD" and all the negative consequences associated with this learning disorder as soon as possible. She was very concerned that her daughter was already falling behind and wanted to know where her daughter could now go to get treatment.

This particular pediatrician did not feel as though this child's symptoms were abnormal enough, for her age, to even warrant a referral to a psychiatrist and he sent this family away without any advice on what to do for the school problems that the child was encountering. This is a shame and a waste of a good opportunity to begin the school behavioral interventions that we know help all students succeed (see Ebook-Ten Tips to Help Inattentive ADHD Students Succeed at School).

With regards to what is normal or not, parents know if there child falls out of the range of normal. I have a copy of the ADHD behavioral checklist on my Free ADHD stuff page but for very young kids this checklist is of limited use. I also believe that it is completely possible, in fact probable, that this child will be no better in a year. According to the mom, the child is inattentive at home as well. I trust that the mother knows her child and knows that there is truly a problem but I agree with the Pediatrician that there is no need to put a five year old on a stimulant.

There will 12 more years of potential therapy ahead. Starting Ritalin or Amphetamines at five is, in my opinion, premature unless the child is uncontrollably hyperactive, disruptive or has other severe classroom behavioral issues. The presence of Inattentive ADHD symptoms and learning problems, in a five year old, should not prompt a teacher or parent to immediately jump on a medication bandwagon. Parent and teacher may have succeeded in detecting ADHD or "catching ADHD' early but they may have also been seeing the normal trajectory of a young Kindergartner.

Cognitive Behavioral Therapy and Adult ADHD

2012-04-09T11:40:00.000-04:00

Cognitive Behavioral Therapy and ADHD

I have written before about the benefits of Cognitive Behavioral Therapy (CBT) for ADHD but a new study (the abstract is below) looking at the effects of CBT in adults with ADHD has just been published that shows that CBT helped adults with ADHD regardless of whether they were on stimulant therapy or not.

Two things are interesting about this study. The first is that it was performed by a pharmaceutical company and reported no improvement in symptoms from taking stimulant medication and the second is the finding that you can have a robust response to CBT even if you are not medicated for ADHD.

The use of stimulants for ADHD symptoms in the long term and in adults is only now being studied. Many people in the ADHD community insist that stimulant therapy is required for most patients with ADHD because non-Drug ADHD Treatments simply do not work. When a study is published indicating a positive effect from something like CBT, many ADHD authorities discount the findings by saying that the study was small, or poorly done, or that it did not have a good control group. These concerns are all valid but they apply to the research performed on drug treatment as well.

The U.S. Department for Health and Human Services Agency for Healthcare Research and Quality (AHRQ) has critically reviewed all the studies that had been performed, from 1980 to 2010, on the benefits of behavioral therapy and stimulant ADHD treatment.

AHRQ is this country's healthcare watch dog agency and they have been asked to look at diseases and their treatments to determine what interventions really work. According to the AHRQ webpage, their mission is to improve the quality, safety, efficiency, and effectiveness of health care for all American by generating the knowledge and tools required to improve the quality of life, save lives, and gain value for the health care dollars that we spend. As the amount of money spent on health care increases, questions such as, “What ADHD treatment really works?” becomes critically important.

When the AHRQ looked at 30 years worth of ADHD research, what they found was pretty amazing. The agency published their findings in an October 2011 report. Their report states that many of the studies performed over the last 30 years did not meet the criteria necessary to deem them 'good' studies, (for all the same reasons that I mention above regarding the non-drug treatment studies), but from the few good studies that were performed, there were only able to conclude that, in terms of long term benefits for ADHD symptoms:

1. Parent training worked well for diminishing the ADHD behaviors of preschoolers
2. Primary school age boys with ADHD combined type, showed improvements in behavior when they were treated with methylphenidate (Ritalin) or Atomoxetine (Strattera).

That’s it! Those were the only two conclusions that the AHRQ was able to make. The standards used by AHRQ were very stringent and most health care providers will disagree with the agency findings as they have seen great improvements in many ADHD patients treated with stimulant therapy.

There is no doubt that certain symptoms of ADHD, Impulsive behavior and hyperactivity for instance, are greatly improved with medications such as stimulants but symptoms of Inattentive ADHD, symptoms of disorganization, symptoms of skewed time management, symptoms of mood problems and other symptoms of ADHD likely respond better to other interventions.

The Cognitive Behavioral Program provided by MoodGym is free and has been found in studies to be as effective as Psychologist office based CBT. If you are an adult with ADHD, it cannot hurt to give MoodGym a try.

I have just returned from hiking in the Grand Canyon. We hiked down to the bottom and camped. The kids did phenomenally well and the adult's joints managed to hold up as well. The picture is from there.

BMC Psychiatry. 2012 Apr 5;12(1):30. [Epub ahead of print]
A Randomized Controlled Trial of CBT Therapy for Adults with ADHD with and without Medication.
Weiss M, Murray C, Wasdell M, Greenfield B, Giles L, Hechtman L.

Abstract

ABSTRACT:
BACKGROUND:

Previous studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants. The objective of this study is to examine whether use of medication improves outcome of therapy.
METHOD:

This was a secondary analysis comparing 23 participants randomized to CBT and Dectroamphetamine vs. 25 participants randomized to CBT and placebo. Both patients and investigators were blind to treatment assignment. Two co-primary outcomes were used: ADHD symptoms on the ADHD-RS-Inv completed by the investigator and improvement in functioning as reported by the patient on the Sheehan Disability Scale.
RESULTS:

Both groups showed robust improvement in both symptoms and functioning, but the use of medication did not significantly improve outcome over and above use of CBT and placebo.
CONCLUSION:

This study replicates previous work demonstrating that CBT is an effective treatment for ADHD in adults. Within the limits of this pilot, secondary analysis we were not able to demonstrate that medication significantly augments the outcome of CBT therapy for adults with ADHD. The study was funded by GlaxoSmithKline, Clinical Trials Registry #GSK707.

Manganese, Soy Milk and ADHD

2012-03-31T07:49:00.003-04:00

Manganese and ADHD

There appears to be an increased risk of Manganese toxicity in infants who are fed soy based infant formula.Manganese is a necessary nutrient but soy based infant formulas have 50 times the amount of manganese that is found in breast milk.

Increased manganese levels have been found in the hair of people incarcerated for violent crimes and is thought to cause DNA changes that can cause behavioral disorders such as ADHD. The neurological symptoms seen with manganese toxicity include irritability and aggression.

Many children and adults with ADHD have food intolerance issues that worsen their symptoms. Nutritionists often advise parents of children with ADHD to remove dairy from their diet and studies have shown that removing dairy and/or gluten from the diets of children with ADHD often improves symptoms.

Switching from milk to soy based products, however, may not be a good solution. Kelly Dorfman in her terrific book, What's Eating Your Child, has reported that 50% of kids with dairy sensitivities will also have sensitivities to soy. Add to this concern, the manganese connection and soy based products become a very poor diet substitute for adults and children with ADHD.

According to Ms. Dorfman, products such as almond milk and rice milk provide few nutrients and those children who consume these products must take supplements and multivitamins as they will not be getting the nutrients that are normally had from eating dairy products.

We learn more every day about how diet and ADHD and Inattentive ADHD symptoms are connected but finding solutions and substitutes for problematic diet habits is not easy.

Expert Rev Neurother. 2012 Apr;12(4):395-407.
Does soy-based infant formula cause ADHD? Update and public policy considerations.
Crinella FM.

Source

University of California Irvine, Department of Pediatrics, UCI Child Development Center, 19722 MacArthur Blvd, Irvine, CA 92612, USA. fmcrinel@uci.edu.

Abstract

An earlier article hypothesized a relationship between soy-based infant formulas, manganese (Mn) neurotoxicity and symptoms of ADHD. In this update, more recent literature on ADHD, Mn and Mn neurotoxicity is reviewed, as well as the risks of Mn toxicity that may accompany ingestion of soy-based infant formula. The results of several critical studies are described, including rodent and primate models that demonstrate an association between ingestion of relatively high levels of Mn and: overactivity, disinhibition and inattention; stereotypes and disturbances of social relatedness; and alterations of dopamine D1 and D2 receptors and dopamine transporter in critical brain regions. Similar deficits have been shown in children with ADHD. In addition, ADHD-like symptoms of behavioral disinhibition were found to be correlated with Mn content in tooth enamel, apparently deposited at or before the fifth gestational month. The results are discussed in terms of their weight as a risk factor in ADHD, vis-à-vis compelling evidence of genetic, epigenetic and other environmental risk factors associated with the disorder, as well as the appropriateness of additional public policy decisions regarding the safety of soy formula.

Book Review: Kids Beyond Limits by Anat Baniel

2012-03-26T11:16:00.001-04:00

Book Review: Kids Beyond Limits

Anat Baniel is clinical psychologist and a well known therapist for special needs children. She specializes in therapies that improve brain functioning and communication and is the developer of a treatment program that has helped thousands of children with genetic and neurological disorders.

She has just completed a book called Kids Beyond Limits. In her book she outlines, in nine steps, her methods for improving the communication, movement, emotional and cognitive problems seen in children with neurological disabilities.

The author's book is mostly devoted to the work she has done with children on the autism spectrum, cerebral palsy, and other genetic and developmental disorders but Ms. Baniel also treats patients with ADHD using the methods that she outlines in her book.

The autistic, cerebral palsy, and fragile X kids that she works with have many movement disabilities that parents of children with ADHD, thankfully, do not have to address. Many of the children who come to her clinic are severely mentally or physically "locked in", unable to move, communicate or emote in any way. Because some of this book is devoted to children with very severe physical disabilities, I was skeptical that I would find anything in Kids Beyond Limits that would help ADHD or Inattentive ADD. I was wrong.

The Anat Baniel Method does help kids with ADHD because much of the focus of her approach is on:

Teaching you how you meet and accept your child's development progress where it is right now and why that matters.
Teaching you to pay attention to how and why your child engages their environment in they way that they do.

This book does a fantastic job of reminding us that it can be detrimental to our mental health and to the mental health of our children to always be trying to fix them. She asks us to move away from a "Fix" mind set and more into a "Meet the child where they are" mindset as she believes that this is a much more productive way to encourage improvement and growth. Baniel claims that kids can feel when they are not
meeting your expectations and that this is stressful for them and, in the end, can lead to more, not less disability.

She does not believe in fake praise or applauding achievement that does not exist but she believes
in finding what the child can do and working with that. She has these nine essentials that she advises parents to work within and some of them I found to be very useful when you are parenting a kid (or two in my case) with ADHD.

She calls one of the essentials "slow" and describes why as parents we need to slow down. In this chapter she describes what it feels like to kids who cannot keep up. Kids who are 3-4 years behind developmentally, as are many children with ADHD, find it hard to keep up. The author explains how and why helping them at their pace is more helpful than pushing them to speed up.

There were several others of Baniel’s nine essentials that I found useful. "Awareness" is an essential where Baniel teaches us how to attend to our environment in a way that also teaches our children to attend to theirs. The "Enthusiasm" essential is a trait that could also be called joyful acceptance. This essential is not the same as praise and is explained in clear detail. The "Flexible goals" essential is also helpful and especially important as our kids are often on their own timeline.

I learned much from reading Kids Beyond Limits. Reading it has helped me understand ADHD from my children's perspective. Baniel's book is clearly written, well organized and contains practical tools for implementing every step that she recommends. This book reminds us that our children would be doing better if they could, that they are working with the brain limitations that they have, that even the most "locked in" children have keys, within them, to the communication, learning and emotional jail cells that imprison them and that we, as parents, can provide much needed support until our kids find those keys.

Waiting for an Inattentive ADHD Diagnosis in Limbo

2012-03-19T16:19:00.003-04:00

Waiting for an Inattentive ADD Diagnosis

What do you do while you are waiting for an Inattentive ADD diagnosis? When you are in what I call Inattentive ADHD Limbo.I have had a bunch of questions from folks recently that have a possibly new diagnosis of ADD and are unsure about what they should do while they are waiting.

Many of these folks are having to wait months before their doctor’s appointments or have doctors who are taking a "wait and see" approach and who will not treat them or refer them.

I have written down the steps that I would take while I was waiting for:

§ My first Inattentive ADD evaluation.

§ A Referral to a Specialist for an Inattentive ADD evaluation.

§ My doctor to decide whether I needed to be treated for ADHD.

§ Any other situation that put me in Inattentive ADHD Limbo.

Now is the time to start making all the lifestyle changes that help the symptoms of Inattentive ADHD. The most important of these are:

Start an Exercise Program: Start an exercise program where you are walking at least 15-30 minutes a day. Start gradually and work up to a brisk pace.
Manage your sleep: (search the side bar search bar for “Inattentive ADHD and sleep”. Consider taking Melatonin if exercise and sleep hygiene suggestions do not help your sleep problems.
Control your Anxiety and Depression: (There is a free online cognitive behavioral therapy program called Mood Gym- you can find the link by going to the search bar at the left hand column of my site and typing "mood gym") that has been proven is medical studies to really help with anxiety and depression.
Eat a diet that is high in protein and low in allergens and dyes: (some people find that eliminating milk and wheat helps symptoms even in people who have no IGG or IGE allergy-researchers are not sure why this is).
Take a multivitamin with at least 25% of the daily requirement of iron, zinc, magnesium, and 100% of B6, B12, Vitamin C, Vitamin E and Omega-3 fatty acids (with at least 300mg of EPA and at least 200mg of DHA- Do not be fooled by the 1500mg of fish oil label, make sure there is enough EPA and DHA). Use the search bar to read about the omega-3 fatty acids.
Try caffeine to see if it wakes up your brain and makes you more attentive. You can search “caffeine” in the search bar to learn why it may help.
Consider a low cost Neurofeedback program: There is a post on a program that shows promise for Inattentive ADD. You can find it by searching my site for 'Inexpensive Neurofeedback” (The hardware is $100 and the software should be under $150.00).
Consider buying a Posit or Luminosity Cognitive training program: Some people have had great help with symptoms using these programs.
Consider taking a product called Bacopa Monieri. It has been found to help with memory in studies performed in India.
Consider taking Ginseng, it seems to give me Energy.

You can search on the search bar for information on any topic above to find more information but feel free to ask a question at the Forum (the link is at the top navigation bar) or Email me with any other questions that you may have.

Mindfulness helps Inattentive ADHD and Academic Achievement

2012-03-12T11:35:00.001-04:00

Mindfulness helps Inattentive ADHD and Academic Achievement

In a busy inner city school, twenty, elementary age kids are socializing, squirming, running around in circles giggling, laughing, hollering or screeching. The scene can best be described as sheer pandemonium.

Soon a calm, bespectacled, fourth grade teacher walks into the classroom and tells the kids to settle into a yoga pose where they lay flat on their backs and the palms of their hands face the sky.

He begins a guided meditation asking the kids to focus on a colorful tiny light bulb that is in the center of their hearts. Soon the room is silent and for ten minutes the kids lay on their mats, calm, relaxed and quiet.

This scene is being repeated, every day, in schools all over this country. Mindfulness training in schools is not a new concept but it is one that is being use by teachers and school administrators with more and more frequency. The reason is simple. Mindfulness meditation quiets the brain in a way that makes children more prepared to learn. These findings have been known for a long time but new research is showing that these mind quieting activities have a lasting effect on our brains and on our brain's chemical balance.

The balance of neurotransmitters in our brains changes constantly and is dependent on what we are experiencing. Stress, fear and fatigue can set up a brain chemical profile that is not productive to learning or paying attention but activities such as mindful meditation, yoga, relaxation exercises, focused play or simple reflection has the opposite affect.

Now that we have brain imaging studies that can see changes occurring inside our brains, we can see that children who meditate develop permanent changes in brain areas that control their attention, hyperactivity and emotional control. Several studies have now found that when you compared meditators and non-meditators, the meditator's brains have more efficient connections, have larger volume in areas important for attention, focus and emotion control as meditating brains also have more gray matter, a finding that indicates improved mental function.

Teachers and parent are using mindfulness exercises in their classrooms because they find that these exercises can have an extraordinary effect on not only inattention and impulsive behavior but also on the holy grail of school performance, academic achievement.

We have known for a long while that meditation exercises help control stress but a new study just published in the Journal of Child and Family Studies found that meditation helps more than just stress. In this study, parents that learned mindful meditation with their children reported that their kids were more focused and the children's teachers found the kids to be less oppositional.

Because children are sponges and learn to attend from the people that surround them, it is possible that teaching both parents and kids meditation skills is better than just teaching the kids. It is also possible that as the parent becomes more attentive, the child becomes more attentive as well.

Ten minutes of mindful meditation is free, easy to do and if your child's school does not have a program, starting a program at home is easy. Mindfulness should be thought of as attention training. The steps to mindfulness are simple.

1. Bring attention to an attention anchor such as a tiny colorful light bulb in the center of your heart that rises and falls with each breath.

2. Pay attention to the distractions that pop into your mind and note them and then blow them away and refocus on the Christmas light.

3. Repeat these two steps for ten minutes.

These simple steps teach the child or adult to pay attention to paying attention and they change the brain for the better. There are many types of meditation and many online resources for the different types of Inattentive ADHD meditation that you can perform at home. I have included some free resources below to get you started.

Free Free Guided Imagery Resources

Free Free Mindful Breathing Exercises

Free Mindful Attention Exercises

Free Mindfulness for very young kids

Free Eye Concentration for Impulsive kids (not really meditation or mindfulness but attention exercise)

Free Guided Imagery (Click, at mid page, on Blue Sky - Meditation for Inner Stillness and Silence)

This last free resource is my favorite and I think you will really like it. It is what I call mindfulness music:

Mindfulness can help the adults and children with Inattentive ADHD pay attention. It can help us keep our minds from wandering and we should spend at least ten minutes every day on mindfulness activities. The cost is nothing. The side effects are nonexistent and the benefits are huge. What are you waiting for??

Psychiatry Res. 2011 Jan 30;191(1):36-43. Epub 2010 Nov 10.
Mindfulness practice leads to increases in regional brain gray matter density.
Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW.

Journal of Abnormal Child Psychology. 2010 Oct;38(7):985-94.
Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth.
Mendelson T, Greenberg MT, Dariotis JK, Gould LF, Rhoades BL, Leaf PJ.
Journal of Child and Family Studies. 2012 Feb;21(1):139-147. Epub 2011 Feb 2.
The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents.
van der Oord S, Bögels SM, Peijnenburg D.

Neuroimage. 2009 Apr 15;45(3):672-8.
The underlying anatomical correlates of long-term meditation: larger hippocampal and frontal volumes of gray matter.
Luders E, Toga AW, Lepore N, Gaser C.

Int J Yoga. 2010 Jul;3(2):67-9.
Immediate effect of two yoga-based relaxation techniques on attention in children.
Pradhan B, Nagendra H.

Is Sluggish Cognitive Tempo (SCT) Inattention with Anxiety and Depression?

2012-03-05T10:30:00.002-05:00

Is Sluggish Cognitive Tempo (SCT) Inattention with Anxiety and Depression?

Is Sluggish Cognitive Tempo (SCT) Inattention with Anxiety and Depression?

Psychiatrists have been trying to figure out what defines Sluggish Cognitive Tempo (SCT). They need to know, among other things, if SCT is just Inattentive ADHD (ADHD-PI) with a coexisting diagnosis of Anxiety and/or Depression and also if SCT is otherwise different from ADHD. They are trying to determine if people who are primarily inattentive need to be removed from the ADHD category all together and be placed in a separate category.

We are a year away from the publication date for the DSM V. You may remember that the DSM is the psychiatric manual, written by the American Psychiatric Association (APA) that defines disorders such as ADHD, depression and Sluggish Cognitive Tempo. The manual was last revised in 2000 and a lot has happened since then. One of the topics that we have been following very closely is the issue of how the American Psychiatric Association will label people with Inattentive ADHD and SCT.

It is clear that from an every day, ADHD-PI symptom management, standpoint, that people with ADHD-PI are different from people with combined type and hyperactive type ADHD. The question the APA is battling with is, are they sufficiently enough different to warrant a whole new disease category. As I write in this post on SCT, this is not the first time the APA has looked at people with Sluggish Cognitive Tempo symptoms and attempted to classify them.

Russell Barkley, a well respected ADHD expert believes that SCT is not ADHD with coexisting anxiety and/or depression and according to the study published in the February 2012, Journal of Attention Disorders, he is correct about this. Researchers looked at kids with Inattentive ADHD and found that these kids were more likely to suffer from depression but that SCT symptoms were independently correlated with Inattention. They concluded that SCT was not Inattentive ADHD with anxiety and/or depression.

Barkley has said that most, if not all, of "TRUE" Inattentive ADD patients should be reclassified as having Sluggish Cognitive Tempo because what defines people with this disorder is inattention and slower cognitive processing. He may be correct but this, as of yet, has not been proven.

I believe that people with Inattentive ADHD are more accurately defined as people with fewer impulsive and Emotional control issues and though about 50% of us do have slower cognitive processing, the other 50% of us with ADHD-PI, do not. I think that as more studies are done using functional magnetic resonance (fMRI) we may soon get to the bottom of this. Unfortunately this may not happen in time for the February 2013 publication deadline for the DSM V.

J Atten Disord. 2012 Feb 24. [Epub ahead of print]
Do Symptoms of Sluggish Cognitive Tempo in Children With ADHD Symptoms Represent Comorbid Internalizing Difficulties?
Garner AA, Mrug S, Hodgens B, Patterson C.
Symptoms of sluggish cognitive tempo (SCT) are correlated with inattention and internalizing difficulties. The purpose of the present study was to determine whether symptoms of SCT reflect comorbid internalizing disorder with ADHD or a separate syndrome. Method: Using a clinical sample of youth evaluated for behavioral and learning difficulties (N = 73), this study examined whether SCT remains associated with symptoms of ADHD after accounting for comorbid symptoms of anxiety and depression reported by children and parents. Results: SCT symptoms were correlated with inattention and parent reports of child depression, but not with parent-reported anxiety or child reports of internalizing problems. Inattention (in the absence of hyperactivity/impulsivity) remained uniquely associated with SCT even after accounting for internalizing problems. Conclusion: The findings confirm SCT as a correlate of inattention and support its construct validity as separate from comorbid internalizing problems. Further research on the clinical utility of SCT is needed.

Affordable Neurofeedback for Inattentive ADD and ADHD

2012-02-28T09:55:00.000-05:00

Affordable Neurofeedback for Inattentive ADD

Affordable Neurofeedback for Inattentive ADD and ADHD

By using EEG Biofeedback, you can train your brain to perform better and faster. Several articles including one in the Journal of Attention Disorders, have recently confirmed that EEG Biofeedback, which is sometimes called Neurofeedback or EEG Neurobiofeedback, can improve ADHD, working memory, Inattentive ADD behaviors and slow cognitive processing speed (see citations below).

The problem with EEG biofeedback has always been the cost. Practitioners and providers of Neurofeedback programs often charge $5000.00 for a 6-8 week treatment program. This is out of budget range for many patients but a new technology may soon make EEG Neurofeedback affordable for everyone.

An EEG hardware development company, NeuroSky, has just released an affordable headset ($99.00) that allows you to do Neurofeedback in your home at an affordable price. A company called Neurocog has developed an ADHD Neurofeedback software program called HokusFocus ($150.00) to use with the NeuroSky headset.

EEG Biofeedback is a treatment that allows us to harness our brainwaves so that we can learn. Different brain states produce brainwaves that have different frequencies. Some brain waves are associated with focus and others with a distracted state, some waves signal frustration and others a calm state. The NeuroSky head set is capable of detecting these different brain wave patterns and alerting us about our brain state. With the use of the NeuroSky headset and software like HokusFocus, we can get teach our brain to get into a better "state of mind".

HokusFocus is an interactive game for kids of ages. A recent study found that HocusFocus improved spatial learning, sustained attention, working memory and behavior in kids with ADHD. The findings of this study are published in the Journal Attention Deficit and Hyperactivity Disorders.

NeuroSky reports that software applications are being developed for ADHD adults as well. The headset is also being used as a safety device for monitoring truck drive alertness and as an aid for discovering what is causing reading difficulties in certain students.

Affordable Neurofeedback for ADHD and Inattentive ADD adds another therapy to our treatment arsenal. For people who tolerate stimulants poorly, or not at all, the development of an affordable Neurofeedback alternative may be a true life and brain saver.

References

J Atten Disord. 2011 Nov 16. [Epub ahead of print]

A Review of Neurofeedback Treatment for Pediatric ADHD.

Lofthouse N, Arnold LE, Hersch S, Hurt E, Debeus R.

Source

The Ohio State University, Columbus, USA.

Abstract

Objective: The aim of this paper was to review all randomized published trials and unpublished conference presentations on the neurofeedback (NF) treatment of pediatric ADHD, and their relevance, strengths, and limitations. Method: Via PsychInfo and Medline searches and contacts with NF researchers 14 studies were identified and reviewed. Results: The majority were conducted from 1994 to 2010, with 5- to 15-year-olds, usually male and White with the combined type of ADHD. Most studies used theta/beta NF with a unipolar-electrode placement at Cz and demonstrated, where reported, an overall ADHD mean effect size of d = 0.69, a medium effect. Main study strengths, within some studies, include use of randomization, treatment control conditions, Diagnostic and Statistical Manual of Mental Disorders criteria, evidence-based assessment ofADHD, standard treatment outcome measures, multidomain assessment, and, for some studies, moderate sample size, some type of blind and the identification of medication as a concomitant treatment. Main study limitations (and directions for future research) include the lack of adequate blinding of participants, raters and NF trainers, a sham-NF/blinded control treatment condition, posttreatment follow-up, generalizability, specific details about delivery of NF, identification and control of comorbidity, and the identification, measurement, and control of concomitant treatments and potential side effects. Conclusion: Based on the results and methodologies of published studies, this review concludes that NF for pediatric ADHD can be currently considered as "probably efficacious." (J. of Att. Dis. 2011; XX(X) 1-XX).

Eur Child Adolesc Psychiatry. 2010 Sep;19(9):715-24. Epub 2010 May 25.

Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial.

Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H.

Source

Nathan's Inattentive ADD Tips In Writing

2012-02-21T19:16:00.003-05:00

Nathan's Inattentive ADD Tips

I got a bunch of great feedback about the videos that Nathan had posted about Inattentive ADHD. Many of you sent me private messages about how great it was to have your kids hear from someone other than a parent, about some lifestyle suggestions that help the symptoms of inattention and disorganization.

A few of you, the non-auditory learners, could not attend to the videos and have requested that the information be in writing. I am a visual learner myself and sitting and listening to a video or oral presentation makes me want to open a vein. Being a responsible blogger, however, I have listened (as attentively as is possible for me) to Nathan and have written down his suggestions for those of us who would rather have his pearls of wisdom, in writing. I make no guarantees that every suggestion is here but this is what I heard about reducing Inattentive ADD symptoms:

Embrace the ADD problem-It is not all bad.
Find something to focus on so you know you can.
Use time management tools, planners, alarms, routines, etc.
Find a silent place to work like the library.
Get some sleep.

Have some long term goals that you are striving for.
Set deadlines for yourself so that you do not wander.
Watch a really intense movie for 15 minutes to get you blood flowing and get you engine revved.
Find an ADHD coach or a supportive and 'task oriented' advisor.
Drink caffeine

Use your computer for planning and notes.
Find an ADHD exercise routine.
Eat regularly.
Use the phone sparingly and with caution (it will waste a lot of your time).
Schedule regular diversions where you do something really fun.

Find your best time and work at that time (are you a morning person, a late night person??)
Schedule a break in your work every 15 minutes.
Use a dark room with one lit lamp in it to zone your focus.
Find a hobby that you can hyperfocus on.
Don't try to hide your ADHD symptoms

Write your notes in your own words, you will remember them better
Do less "hanging out" and more work.
Block facebook
Make good habits and continue them for a month and they will last a lifetime
Consider taking up Yoga or meditation.

Those are Nathan's words of advice in writing. I think that the kid knows how to beat this disorder. I think we would all be better off if we took his advise and implemented even 20 of his 25 suggestions. Thanks Nathan, way to go !!!

I leave you with more of Nathan (in case you did not see the other post)

Inattentive ADHD, 5 Hour Energy Drink and Focus

2012-02-16T11:04:00.002-05:00

Inattentive ADHD, 5 Hour Energy Drink and Focus

I recently read an article on 5 Hour Energy and Focus. I have always thought of those little bottles of energy drinks that you see beside the grocery cash registers as something that teenagers use to pull all nighters. I have never considered them anything more than "lots of caffeine in a little bottle" but this 5 Hour Energy Article, written by Forbes Magazine a reputable publication, claimed that it was a focus drink and I wondered if it might help ADHD and Inattentive ADHD.

This morning I decided to give it a road test. Regular readers of this blog know that I stay fairly well caffeinated as I go through my day. The coffee that I drink every 90-120 minutes keeps me pretty on task and on track but today I did not drink my daily dose of caffeine inattentive ADD treatment, I had the 5 Hour Energy and Focus drink instead. The article reported that it cost $3.00 and that it tasted like puke. I got the 'Extra' variety in berry flavor at CVS for $2.00 and it tasted like cough syrup (which, as a kid, I found extremely yummy and which today I find palatable enough).

The reason for this experiment is that recently I have been trying to finish a book. The damn thing has grown to be an epic tome. The theme of the book is interventions for ADHD that are not prescription medication. This book is so close to finished that I can almost taste it. There is a huge section on the vitamins and supplements that decently performed medical research has shown to be helpful for ADHD. A huge section on what I call therapies of the mind which includes cognitive training, executive function training, neurofeedback, etc, and a pretty good section on what I call lifestyle intervention.

Because so many critics of these interventions claim that they are all a huge waste of money, I have gone out of my way to find inexpensive alternatives (often free and never costing more than $200.00 for virtually every intervention that has proved helpful-yes even neurofeedback. I am trying to get a lot accomplished so it can be published, edited, revised, formatted, etc and that brings me to 5 Hour Energy Drink and Focus.

I have a list of many things that I need to accomplish to get this book done. I have been able to scratch a few things off my list every day but not as many as I would like. One of the things on this week's list that I meant to scratch off on Monday and I am just now getting to is this blog post. I usually post on Mondays but as you can see I am a bit behind. The good news is that it does appear that the 5 Hour Energy works better than just the caffeine to keep me focused.

The difference between the energy drink and caffeine is that the energy drink has a bunch of B vitamins and amino acids as well as 220mg of caffeine (though it comes in decaf too). The amount of vitamins in the drink are often 100s of times the daily adult requirement but they are all water soluble so you pee out what you do not need so, providing you do not drink more than one a day-and you are an adult, there are few if any safety issues.

Many Functional Medicine Experts report that some people with ADHD need many time the USDA recommended daily requirement of the B vitamins and of amino acids to turn off the genes that are making them spacy, hyperactive or impulsive. The developer of this drink is from India and he has used the functional medicine model to make a product that, in my opinion, does improve focus.

I am glad to have an Inattentive ADHD focus and energy drink to turn to when my day is in need of extra focus but I do not think it will replace my coffee. I will use the 5 Hour Energy for days like today and my delicious coffee on most other days. I do not have to go through life super focused all the time and the coffee keeps me attentive enough. If you give it a try, I would love to hear about your experiences.

Five Tips from Nathan

2012-02-06T20:11:00.003-05:00

I wanted to share these series of videos with you. This is Nathan and he is a University Student at the University of Texas. He has Inattentive ADHD and he has compiled some amazingly useful tips for people with ADHD.

Nathan covers many things in these videos including:

Embracing the condition
Ways to find Focus
Ways to best manage your time
Making goals
Lifestyle matters

He has some very unique solutions for getting himself in the mood to get work done and for avoiding distractions. If you have a teenager or pre-teenager at home, show them these videos. Nathan speaks in an engaging and compelling manner about what has worked for him. He is articulate, helpful and truly interested in getting his message across and his videos are a great achievement.

Drug or non-drug ADHD Treatment, What is Best?

2012-01-30T09:38:00.000-05:00

Drug or non-drug ADHD Treatment, What is Best?

Many people in the ADHD community insist that non-Drug ADHD Treatments simply do not work. When a study is published indicating a positive effect from taking Zinc or from computerized working memory training, most ADHD authorities insist that the study was small, or poorly done, or that it did not have a good control group. These concerns are all valid but they apply to the research performed on drug treatment as well.

The U.S. Department for Health and Human Services Agency for Healthcare Research and Quality (AHRQ) set out to critically review all the studies that had been performed, from 1980 to 2010, on the benefits of behavioral therapy and stimulant ADHD treatment.

AHRQ is this country's healthcare watch dog agency and they have been asked to look at diseases and their treatments to determine what interventions really work. As the amount of money spent on health care increases, questions such as, “What ADHD treatment really works?”, become critically important.

According to the AHRQ webpage, their mission is to improve the quality, safety, efficiency, and effectiveness of health care for all American by generating the knowledge and tools required to improve the quality of life, save lives, and gain value for the health care dollars that we spend.

When the AHRQ looked at 30 years worth of ADHD research, what they found was pretty amazing. The agency published their findings in an October of 2011 report. Their report states that many of the studies performed over the last 30 years did not meet the criteria necessary to deem them 'good' studies, (for all the same reasons that I mention above regarding the non-drug treatment studies), but from the few good studies that were performed, there were only able to conclude that, in terms of long term benefits for ADHD symptoms:

1. Parent training worked well for diminishing the ADHD behaviors of preschoolers

2. Primary school age boys with ADHD combined type, showed improvements in behavior when they were treated with methylphenidate (Ritalin) or Atomoxetine (Strattera).

That’s it! Those were the only two conclusions that they were able to make.

Studies haves shown that 50% of adults and children prescribed a stimulant for ADHD will discontinue the medication within 12 months. The reasons for discontinuation are varied and include side effects, unmet expectations or simply a discomfort with taking a controlled substance.

When stimulant medication is stopped, parents of children with ADHD and adults with ADHD symptoms may look to alternatives only to be told by their health care provider that the benefits of these therapies are questionable or short lived.

Given the findings of Agency for Healthcare Research and Quality it appears that, unless you are a preschooler or a 10 year old boy with combined type ADHD, the same can be said for drug therapy.

So the next time you question your health care provider about the merits of a non-drug therapy and they report that therapies such as working memory training, social skills training or fish oil supplements do not work, you should mention the above study and remind our learned ADHD specialist that apparently, for most people with ADHD, not much does.

Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet].
Charach A, Dashti B, Carson P, Booker L, Lim CG, Lillie E, Yeung E, Ma J, Raina P, Schachar R.
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A Western Diet Can Worsens ADHD

2012-01-22T09:23:00.000-05:00

A Western Diet Can Worsens ADHD

Some patients do not respond to ADHD Inattentive medication and in some patients ADHD medication is not indicated because of co-occurring conditions such as Tourette’s Syndrome, Anxiety or other side effects. In patients with Sluggish Cognitive Tempo and Inattentive ADHD treatment failures may be more common. Pyschiatrist and mental health specialist are coming around to believing that for a certain subgroup of patients with ADHD symptoms, dietary changes may be the answer.

According to J. Gordon Millichap, MD, and Michelle M. Yee, CPNP, of Children's Memorial Hospital in Chicago, a great alternative to traditional treatment is an ADHD diet treatment regimen. They report that diet treatment is especially helpful for:

Parents of children that do not respond to medications
Parents that want an alternative to medications
Children that may have dietary vitamin or mineral deficiencies.

Their findings, just published in the Online version of the journal Pediatrics concluded that a diet that was low in saturated fats, high in fruits, vegetables and grains was one of the very best alternatives to drug therapy. The also noted that Omega-3 and omega-6 fatty acid supplements had been shown, in well performed controlled studies, to help with ADHD symptoms.

Millichap and Yee did a literature review of 70 trials that used diet as a medical intervention for the treatment of ADHD symptoms and found the following:

Diet was an intervention that was easy for parents to implement.
The symptoms of ADHD were significantly associated with "Western" diets.
Children with allergies have improved ADHD symptoms when foods that contain colorings, preservatives, and allergens such a wheat, dairy, nuts and citrus are restricted.
Zinc and iron deficiency may cause symptoms in a small group of patients with ADHD and confirmed deficiencies should receive supplements or appropriate dietary adjustments.
The best trial performed to date on the Omega-3 and Omega-6 fatty acids confirmed that these supplements are helpful for the treatment of ADHD symptoms.

Regarding fatty acid supplementation, Yee and Millichap reported that other trials that have failed to confirm benefits may have failed to do so because the researchers of those trials used too many different methodologies to come to any firm conclusions. They also report that they, themselves, now recommend these supplements to their patients but not as a sole treatment for ADHD symptoms or Inattentive ADHD symptoms.

The researchers are quoted as saying the following: "Supplemental diet therapy is simple, relatively inexpensive, and more acceptable to patient and parent,"

Millichap and Yee concluded. "Public education regarding a healthy diet pattern and lifestyle to prevent or control ADHD may have greater long-term success."

Inattentive ADD, ADHD and the DSM V

2012-01-16T20:00:00.000-05:00

Inattentive ADD, ADHD and the DSM V

I have not posted in a long time about the proposed changes to the Psychiatric Diagnostic Manual, the DSM, which is used to diagnose all mental impairments including ADHD. The reason for this is not neglect but rather there has not been much new to say.

What is new now is the fact that there appears to be so little clarification to the question of what will happen to the ADHD subtypes even though the deadline for the proposed new edition is just 12 months away.

The manual, that last had a major revision 1994, is called the DSM IV. It is the fourth edition of the diagnostic manual but now almost 20 years latter, a new manual is necessary. Much has changed in psychiatry and psychiatrists have been working on the revised version of the manual, the DSM V for over two years.

The new manual was supposed to sort out, among other things, whether there was value in dividing ADHD into three subtypes. The subtypes were developed for the DSM-IV but they have been found to be both helpful and problematic.

The subtypes are helpful because they establish and recognize that there is a subgroup of people with attention deficits that are not inattentive because of hyperactivity and impulsive behavior. The subtypes however are confusing because calling something without hyperactivity, Attention Deficit Hyperactivity Disorder, makes no sense. It is also confusing because the grouping has had the affect, in my opinion, of having psychiatrist treat ADHD, regardless of subtype, much the same.

The two conditions both have Executive Function problems but the problems that they have are not the same. People with Inattentive ADHD do not have the debilitating emotional control and impulse problems of the Combined type though they do have in common much of the organization, time management, motivation and perseverance problems.

There are many conditions in the DSM-IV that also have executive function issues and they are not all lumped into one diagnostic pile. People with Post Traumatic Stress Disorder, Depression and schizophrenia all have executive function problems but they are not all lumped into the same DSM category.

The American Psychiatric Association (APA) was hoping to have some empirical data (research findings, scholarly analysis, etc) to inform them of how to best sort out the entire subtype dilemma by February of 2013 and they still may make their deadline.

Functional MRI studies are shedding light on the ways that the brains of the Inattentive and the Sluggish are different from the brains of the impulsive and the hyperactive and there are some extremely brilliant people working this out. Hopefully they will come to a conclusion that improves recognition, diagnosis and treatment of all the subtypes of ADHD as that, after all, is the goal.

Two other proposed ideas for the new DSM had to do with the age of diagnosis and the number of symptoms that had to be present to determine if there was a 'true' ADHD diagnosis. Currently the DSM-IV states that for you to be diagnosed with ADHD, you have to have had symptoms before the age of seven and that you have to have 'X' number of these symptoms or 'X' number of that symptom.

The symptom number is an issue because as people age, their hyperactivity symptoms can improve or they may control their impulses better than they did when they were six, but they are still impaired despite not having the exact number of symptoms needed for a diagnosis. The age of onset stipulation is also problematic and especially detrimental to those with Inattentive ADHD because Inattentive ADHD kids can sit in a classroom until middle school without anyone noticing that they are not focused on school.

These latter two issues will likely be clarified in the new DSM-V but only time will tell if the APA is able to sort out the subtype issues before the February 2013 deadline for the publication of the new edition.

Inattentive ADHD, Baby Boomers and the Aging Brain's Default Mode

2012-01-09T11:33:00.000-05:00

The world works in mysterious ways. People with Inattentive ADHD and Sluggish Cognitive Tempo (SCT) may finally get more scientific insight into what is causing their symptoms thanks to Baby Boomers and a new discovery called the Brain's Default Mode.

As the cohort of Baby Boomers age, this huge demographic is driving research into what happens to our aging brains that make us forgetful, mentally slower, unfocused and unable to tune out irrelevant distractions.

I have just finished a book called The Secret Life of the Grown Up Brain by Barbara Strauch and I was struck by how the aging brain resembles the brain of people with Inattentive ADHD. Researchers are now, with Pet Scans and other diagnostic tools, able to see a decrease in brain cell communication in the aging brain, they are able to actually see the brain daydreaming and they have just discovered a brand new brain state which they have called the Brain's Default Mode.

This default mode is described by researchers as a brain mode where the brain is distracted by silent but continuous chatter. This is the part of the brain that when you are doing nothing starts thinking thoughts like, 'Boy, that cobweb on the wall has an interesting pattern and maybe I will make a design on my notebook with that pattern..."

Apparently, as the brain ages, it's ability to switch off the default mode starts to become less efficient and scientist are now seeing that older individuals have poorer memories, slower processing speeds and are less focused because, during problem solving, they use their prefrontal cortex less and the default mode of their brain more.

Using scanners, neuroscientist at the University of California at Berkeley have been able to see the aging brain struggle to maintain focus. The researchers did a study where they showed older adults faces and scenes and told them to concentrate on the faces. The older adults were able to focus but it took them longer, their processing speeds were slower, because they were less able to filter out the distractions of the scenes that accompanied the faces.

Does this not sound familiar? Inattentive ADHD (ADHD-PI)could be the results of our brains being stuck in default mode. It not only explains our problems with working memory and focus, it also explains why some of us have Sluggish Cognitive Tempo. The great news is that Baby Boomers are also driving research into the interventions that will keep us from getting stuck in the brain's default mode.

The aging brain does not look as much like the Combined type or the Hyperactive type of ADHD but it does look an awful lot like Inattentive ADHD and Sluggish Cognitive Tempo. Hopefully all this new research on the aging brain will, inadvertently, turn out to bring more insight into what is going on in the brains of people with ADHD-PI and SCT.

Inattentive ADHD Scholarships

2012-01-04T11:26:00.001-05:00

Happy New Year!! I am finally getting back in gear after a wonderful family vacation in Florida and I wanted to let you know about a scholarship opportunity. Shire the pharmaceutical company behind Vyvanse, Intuniv, Adderal XR and the Daytrana Patch has a program for college bound kids with ADHD and ADHD Inattentive type. The award not only includes $2000 in cash but also offers youngsters a year's worth of ADHD Inattentive counselling.

Last year Shire had a few hundred applications for 50 spots. I think that it is well worth applying because given that Inattentive type ADHD is generally under represented in any ADHD group, your chances of having your child selected may be even better than if you have a kid applying that had a diagnosis of Combined type or hyperactive type ADHD.

This is only the second year that Shire will award the fifty scholarships to college bound folks with ADHD and the deadline for application for these scholarships is 3/30/2012 for the 2012-2013 school year. Scholarships will be awarded by June of 2012. The press release with the web link to the Edge Foundation, the organization managing the awards, and to the Shire scholarship site is below.

Philadelphia, PA, US – October 20, 2011 – Shire, a global specialty biopharmaceutical company, has expanded its ADHD Scholarship Program. The program is for individuals in the United States diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) who are pursuing higher education at a college, vocational school or technical school. Fifty winners will be selected in 2012, twice as many as in the first year.

The Shire ADHD Scholarship includes a $2,000 monetary award and offers a prepaid year of ADHD coaching services provided by the Edge Foundation to assist with the transition to higher education. Fifty one-time scholarships will be awarded on June 12, 2012. The deadline to apply is March 30, 2012. For information, including eligibility requirements and scholarship application, visit www.ShireADHDScholarship.com.

“The response to the Shire ADHD Scholarship Program in 2011 was tremendous, with hundreds of applications from inspiring students across the nation,” said Michael Yasick, Senior Vice President of Shire’s ADHD business. “There are thousands of high school seniors, college students, and adults going on to higher education who suffer from ADHD. We want to recognize the brave individuals who work hard to overcome the challenges of this life-altering condition, and help them continue their educational pursuits.”

Award recipients will be offered ADHD coaching from the Edge Foundation, which includes weekly sessions with specially trained ADHD coaches. The students set weekly goals and action plans to meet those goals and have e-mail and phone support from their coaches to help keep them on track. This support may be important for students transitioning to the higher education environment because they have more free time and less adult supervision.

The Edge Foundation is a Seattle-based nonprofit organization that offers support for students with ADHD. The Edge Foundation’s primary mission is to provide access to qualified, professional coaches for students with ADHD as part of their multi-modal treatment program. For more information on the Edge Foundation, please visit the company’s website: Hwww.edgefoundation.orgH.

Shire’s ADHD Scholarship Program is part of Shire’s patient centric approach that offers support to patients, parents, advocates and others while providing care for people diagnosed with ADHD.

Comprehensive Evaluation and Treatment for ADD and ADHD is Required

2011-12-19T20:50:00.000-05:00

Why Not Comprehensive Treatment for ADD

“The doctor came in the room pulled out a questionnaire and asked me to fill it in. I answered the questions as best I could and less than five minutes later I had a prescription for Adderall, a diagnois of ADHD and the doctor had left the room.”

Musings of a bewildered ADHD Patient

The above scenario sounds preposterous, right? It may be a bit of an exaggeration but the experience of this bemused ADHD patient happens every days and is not all that dissimilar to the experience that many families and patients have when they first go to see a physician with ADHD like symptoms.

Though ADHD is a chronic condition that affects billions of adults and children worldwide; most parents and patients are barely evaluated when they are given a diagnosis of ADHD. A teacher or educator has probably been the driver of the doctor's referral and the diagnosis is often a given before the patient has even entered the clinician's office.

Under many circumstances, the health care provider performs a short and inadequate examination, does not explain in any detail the course or scope of ADHD symptoms to the parent or patient, he/she does not discuss medication alternatives, side effects or contraindication and most patients are rarely made aware of anything but the pharmaceutical treatments available for this problem. This is simply not right!

I have said many times on this blog that I am not anti-medication, I believe that treating ADHD, like treating any medical problem involves a comprehensive approach that includes appropriate diagnosis, education, a review of all available interventions and continuing evaluation regarding the success or failure of any treatment plan.

The Herman Miller Healthcare plan has reported the following regarding chronic illness. “In order to effectively and efficiently treat chronic diseases, there needs to be a continuum of cooperation, from doctor to home, from specialist to patient and from intervention to prevention." but this philosophy appears to be non-existent and a non-starter in the ADHD healthcare community. Comprehensive evaluation, education and intervention rarely, if ever, happens.

ADHD has reached epidemic proportions in this country. Estimates have reported that almost 10% of children and over 4% of adults have a current diagnosis of ADHD. We need to consider ADHD as a chronic condition that requires both a comprehensive approach to diagnosis, and a treatment plan that is also comprehensive and includes other interventions in addition to and besides medication. The treatment of ADHD must include education regarding diagnosis, prevention, lifestyle interventions, behavioral therapy and other potential treatment options.

I hope to in future post address where we stand today with regards to new, old and controversial treatments for ADHD. I believe that treating ADHD with a full court press, no holds barred, “pull out all the stops”, diagnosis and treatment plan will make a difference in the lives of millions of people diagnosed with this condition.

Parents, educators, physicians and individuals with a diagnosis of ADHD must know what is involved in a ‘kitchen sink’ approach to ADHD Treatment. Only with this type of information can parents and the medical community move ADHD diagnosis and treatment to a more thorough, complete, safer and more effective level.