ADHD Article July 1998

Hope this edition of ADDed Attractions finds everyone Having a safe and "sane" summer! I'm very excited about Our new contributors to this newsletter so on to the news!

**California Bay Area Readers**

San Francisco/North Peninsula CH.A.D.D. There is a new information line The new number is (415) 442-1944

Sandy Gordon is available for IEP consults and limited "warmline crisis" Consults. You can reach Sandy at 650-994-2438, be sure Your message is left in the CHADD mailbox.

REQUEST FOR VOLUNTEERS: There is much to be done To get the word out to ADDers in the Bay area community. If you have a skill or can provide a service that you think can Benefit the CHADD community please contact us.

CALL TO FORM WOMEN'S ADD SUPPORT GROUP. CHADD member Lynn Heidleberg is collecting names for a sign up list while Arrangements are made and finalized for this group. If you are Interested in attending or assisting to organize the group, please Call Lynn at 621-1078.

12 STEP GROUP FOR ADDers FORMING: Many of us are familiar with the famous and successful 12-step programs originated by Bill Wilson for Alcoholics Anonymous. The 12- step format offers a safe structure to bring healing to old wounds. Meetings would follow the 12-steps for ADDers book format. If you would like to put your name on a list to be notified when Meetings begin or can help to locate a room please call Josephine Cilluffo at 415-563-9359.

RESOURCE LIST: CHADD has a resource list of Bay area Professionals for sale. It costs only $5 and is loaded with Names of psychiatrists, psychologists, MFCC'S, LCSW'S Pediatricians, coaches, IEP advocates and others. All names On this list have been submitted by members over the years. Professionals do not pay to be on this list but are recommended By members. To order your copy of the resource list, mail your Check for $5.00 to Eileen Barry, 35 Kammerer Court, Hillsborough, CA 94010. Allow several weeks for delivery.

If any other groups have announcements they would like to See published in this newsletter or on the website, Please send your information to either <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a> Or to Brandi Valentine, P.O.Box 473, Browns Valley, Calif, 95918.

Do YOU know your health care rights? Serving readers In the counties of Sacramento, El Dorado, Placer and Yolo In the state of Ca, call the Health Rights Hotline, toll free At 1-888-354-4474. The Health Rights Hotline provides Free assistance and information to health care consumers.

I'm often asked by parents how to deal with their teenage son or daughter who may still need to receive medication but who refuses to take it. This can be a very frustrating and difficult problem for parents to deal with, and I thought I'd share with you an approach that I have often found to be helpful.

Before addressing this issue, I'd like to invite you to request samples of ADHD RESEARCH UPDATE, the electronic newsletter I publish that help parents stay informed about new research on ADHD/ADD. Just addhelp@mindspring.com and type "sample issues" in the subject line.

In my experience, one reason why many adolescents start to protest taking medication to help with their ADHD symptoms, is that many children are never receive a good explanation about what it means to have ADHD and why they are taking medication in the first place. I have seen many children who have been taking medication regularly for years without really understanding why. In these instances, it is not surprising that a child would start refusing to take medication in adolescence.

One way to try and prevent this problem is to make sure that when your child begins medication, he or she understands why. Ask your child's physician to explain this to your child and get their advice/suggestions about how you can talk with your child about this. There are also many good books that have been written for children that explains what ADHD is and how medicine can help.

A very good book for older children and adolescents is called "Distant Drums and Different Drummers - A Guide for Young People with ADHD" by Dr. Barbara Ingersoll. Another good choice is "I Would if I Could - A Teenagers Guide to ADHD/Hyperactivity" by Dr. Michael Gordon For younger children, a very good book is "Otto Learns About his medicine. All these books are available at www.addwarehouse.com/indexbv.htm in the Kids section.

If a teenager refuses to take medication, here is the approach that I take. First, I would really listen to what concerns the teen has about the medication. Trying to engage your son or daughter in a dialogue about their concerns so that you can more fully understand them is the first step. Inevitably, acquiring this understanding will be essential in helping decide how to best address this issue. If engaging your child in this dialogue is difficult, your child's physician may be able to help. If your child has been seeing a counselor, this person should also be able to help with this.

Something that can almost always be helpful to do is to try and interest your child in an "experiment" to see if he or she continues to need and benefit from the medication. There are two ways to do this. One way is to actually discontinue medication for a period of time - say several weeks or more. Before doing this, discuss with your child how you and he/she will judge the outcome of this "experiment". Be clear about what changes in your child's grades and behavior at school would indicate that the medication is still needed. If your child is able to maintain his or her performance at the expected level for this period without medication, then perhaps it is no longer required. If their grades and/or behavior decline, it would suggest that the medication needs to be resumed.

The problem with this approach is that an entire grading period can go down the drain as the results are being gathered. For this reason, I often try to arrange a shorter "trial" to see how helpful the medication continues to be. This trial covers a 3 week period during which I try to get the best feedback I can about the child's behavior and academic productivity at school . During the first week, the child is on medication as usual. During the second week , the medication is discontinued, and during the final week the medication is resumed. At the end of each week, the child's teachers are asked to complete ratings of the child's behavior and school work for the week. Similar ratings can be completed by the teen him or herself. Once again, the ADHD Monitoring Forms are a good choice to use for this.

Make sure your child understands that the value of the trial is to see whether the medicine is still helpful. I would present it like this: "Why don't we do a careful experiment to see whether the medicine is still being helpful to you? At the end of the "experiment" we can go over the results with your doctor. This will help all of us to decide whether it still makes sense for you to take medication or whether you may no longer need it." The important thing is to secure your child's cooperation with the proposed study. If this is not possible, than having your child talk with his/her physician or counselor about this is probably necessary.

Two important points. First, for this to be helpful, the teachers need to understand the importance of what they are being asked to do. Try to pick a couple of teachers who know your child well and whose cooperation you can count on. Because middle school and high school students typically only spend 50 minutes per day with each teacher, you really need a teacher who will observe your child carefully and fill out the forms conscientiously.

It is also best to do this kind of trial in such a way that your child does not know when he or she is not getting medication. If they simply stop taking their meds for one week, they may act differently at school simply because they know they are not on meds - certainly, their self ratings for this week could be biased.

The way around this problem is to have your pharmacist prepare identical capsules to be used during the trial. They do this by grinding up the medication and placing it in an opaque gel cap. For the non-medication week, your child receives identical capsules that are filled with an inert substance such as lactose. This way, your child does not know when they are getting medication and when they are not. (Note: You may need your physicians help in arranging this with the pharmacy.)

I know this seems like a lot of trouble but at the end of the trial you should have is some pretty objective data about the impact of medication for your child. In cases where medication is still needed, what you see is that the child received much better ratings for behavior and/or work during the medication weeks than during the placebo week. What if this is not the case and your child did as well during the placebo week as during the medication weeks? If so, then your child may be right - perhaps medication is not necessary.

The thing to do is to sit down and review the findings with your child. I'd suggest getting the physician involved here. If it looks like the medication was helpful, this may convince your child that they should continue to take it. Of course, this still may not happen, but then talking with your child about why they want to deny themselves something that really helps would need to be done, often with the assistance of a physician or psychologist. Trying to force medication on a teenager who simply does not want it is likely to create more problems than it solves. This is why the kind of experimentation described above in which your child is involved as a willing participant is preferred.

I hope the above discussion can be helpful to you. Remember, if you would like to receive sample issues of ADHD RESEARCH UPDATE to review just e-mail your request addhelp@mindspring.com and I'll send them out to you.

David Rabiner, PhD
Licensed Psychologist

Parenting asks us to fill many roles in our children's lives. Provider, nurturer, advisor, friend, observer, authority figure, confidante, tutor, the list goes on and on. Often times these roles conflict with one another. No doubt every parent has experienced the sense of being pulled in opposite directions, unsure of which role to step into at any given moment.

The struggle over which parenting role to fill is complicated further by the fast-paced, permissive world our children confront every day. A daily barrage of social and emotional forces await kids at school, among friends and peers, on the sports field, and without exception, at home as well. Disappointments, competition, provocation's, inequities, temptations, distractions, and many other pressures, can easily jeopardize a school aged child's efforts to keep their lives in balance.

Many kids do not possess the necessary "coping with life" skills to contend with these pressures. This results in all-too-familiar negative outcomes: academic underachievement, social problems, damaged self-esteem, missed opportunities, and conflict-torn family relationships, among others. The probability of these consequences is increased if a child struggles with Attention Deficit Hyperactivity Disorder (ADHD). ADHD hampers a child's efforts at emotional self-management, pursuit of long term goals, learning from mistakes, and other critical developmental tasks of maturity. Of course, plenty of children without ADHD confront similar hurdles on the road to social and emotional maturity.

In my professional role as a child psychologist, and family role as a father of two sons, I've often witnessed the painful effects of children meeting up with situations they are unprepared for. Children's lives are filled with many decision points challenging their social judgment, self-control, and problem solving abilities. It's easy for them to err in any of these skill areas, setting the stage for trouble. Whereas the child might pin the blame on the situation I attempt to broaden their view. After expressing understanding of their feelings, my aim is for them to recognize how coping skills will help them deal better with demanding circumstances, and ultimately, offer preparation for the many challenges ahead.

My belief in planting the skills for social and emotional growth in children has become a central thread in my roles as parent and psychologist. Rather than wait for problems to occur I have opted for a more proactive and preventive approach to helping children mature. In my work, I guide parents toward discussing with their child the skills that are necessary to successfully cope with problem situations. And to strengthen the child's sense of trust and security, I stress that children must feel that parents are on their side and will help them figure out why things go wrong, not just punish them for misbehaviors. My convictions about children's need for vital social and emotional skills building in today's challenging world led me to develop a parenting approach called Parent Coaching.

Parent Coaching places the parent in a new role when their child fails to cope with a difficult situation. This role is much different than the multitude mentioned earlier. It takes into account present priorities, such as putting a stop to an emotional episode or getting a child to complete homework, but it doesn't stop there. Emphasis is also placed upon using the present circumstance as a window into the child's inventory of emotional and social skills. Much like an athletic coach keeps an eye on each player's performance to signal the need for practice drills, the Parent Coach holds a similar perspective. From this vantage point, the child's efforts to cope with the usual and expectable demands of life signal where "coaching" is needed.

The Parent Coach role emphasizes the importance of a safe and nonjudgmental dialogue between parent and child. In order for coaching to proceed, the child must feel accepted and understood, not criticized and lectured. This requires that parents resist stepping into the shoes of the disciplinarian, or what I refer to as the "parent cop," since this role either silences children or invites them into a defensive posture. Especially in today's culture, children need our guidance but they are less accepting of it if parents impose it through intimidation tactics. When problems are discussed the Parent Coach affirms through words and body language that parent and child are "on the same side" in their efforts to identify why the difficulty arose. In other words, the old standard, "I'm going to teach my child a lesson" is replaced by, "What is the lesson that both of us can be taught?"

Although there are many social and emotional lessons for children to learn, the Parent Coach accepts the fact that they have much to learn as well. Children will be far more receptive to a parent's attempts to coach life skills if they don't feel talked down to, but sense that they and their parent are "in this coaching thing together." Parents contribute to this safe dialogue when they admit to their own errors, accept helpful and constructive feedback from others (including their child), and pledge to work harder at self-correction. In fact, when children observe their parents demonstrating these vital qualities, they tend to be much more willing to accept parent coaching.

Once the parent is prepared to step into the "coach's shoes" it's time to consider the overall plan. The objective is to develop and refine children's coping skills. Broadly speaking, these skills can be placed under two headings: social and emotional. Under the heading of social skills includes cooperation, sharing, judgment, perspective-taking, and so on. Under the heading of emotional skills include resilience, frustration tolerance, self-control, perseverance, and many others. The Parent Coach keeps these various skills in mind when talking with their child about tough times. Many situations require several of these skills, and children will typically succeed in some areas while falling short in others. Parents are advised to pinpoint where successful coping was practiced, as well as note where their child had difficulty handling a challenge.

One of the difficulties that arises for parents is holding their child's attention during these coaching sessions. Similarly, it can be problematic to discuss these skills in a language that children can quickly understand, i.e., most kids will be confused if parents use the term, "social judgment." Because of these obvious limitations I have developed a series of Parent Coaching Cards that allow coaching to proceed in a kid-friendly fashion. By taking the typical and trying circumstances in children's lives, and transferring the coaching messages into terms that kids easily understand, parents have a "play book" to refer to in their coaching role. Colorful illustrations on one side, and "talk-to-yourself" coping messages on the other, provide simple self-help solutions to children.

The appeal of Parent Coaching Cards has inspired many parents and children to develop their own. These "home grown" projects have helped further strengthen the coaching bond between parent and child. Readers are invited to refer to my website www.parentcoachcards.com for examples of how the cards are structured. Those of you who proceed with this parent/child project are invited to submit your stories and/or examples of what developed.

Next month I will be providing specific anecdotes of how the coaching role has helped families with ADHD children. Please e-mail me with your ideas, concerns, and questions. I applaud your commitment to advancing your children's social and emotional skills.

"Dr. Steve"
Dr. Steven Richfield
July, 1998

For more information on Dr. Steven Richfield and his program, Parent Coaching Cards Please visit www.parentcoachcards.com and to read recent articles about Steve and his program, visit www.parentcoachcards.com/press.html

How Does Management of Adult ADD Differ From That of ADD in Children?

In last month's column, we talked about how many parents of ADD/ADHD kids are themselves undiagnosed ADDers. That entire issue of discovery, be it of ADD in yourself or in your spouse, covers a lot of territory - from self image, coping skills and finally some decisions about what you are going to do with this new found knowledge.

Realizing that you are ADD at age 37 is a lot different than being told you are ADD at age 6. At age 6, most decisions, such as which medication and how often you will attend therapy (if at all), are made for you. As an adult, hopefully you are in the position where you are making most of those decisions on your own.

Stop right here -

This brings up a very important point which needs to be addressed. Often we will see a situation where the husband will be suspected of having ADD but is undiagnosed, and therefore untreated. The wife will write saying something to the effect of "What can I do".

The answer - nothing.

No one can force their spouse in for medical or psychological treatment. To do so changes the relationship from "husband-wife" to more of a "Parent-child" dynamic. No adult likes to be treated like a child, and the resulting resentment will only make matters worse. Encourage your spouse to check into it, or whatever, but be very careful that you do not make matters worse by "parenting" your mate.

Once an adult is diagnosed, there are a lot of decisions that must be made. In some cases, the adult with ADD has learned enough coping skills over the years so that all that he or she really needs is just some help in a particular area. There is no need for a total rebuilding or anything like that. If the ADDult is happy with his or her marriage but has trouble holding down a job, then perhaps work in that area is more appropriate. Obviously more severe problems, such as substance abuse, will require more work.

So The First Decision is "What needs to be fixed?"
That makes The Second Decision "How do I want to fix this?"

Traditional ADD treatment for children involves a triad of behavior modification, therapy and medications. That triad also holds true for adults. The problem comes in reinforcement. Behavior Modification in children is usually accomplished by the adults in the child's life, usually the parents, setting up a system of rewards and consequences. In the life of an ADDult, this becomes more complicated - just ask anyone who has ever tried dieting. Most ADDults will need some sort of support system for behavior modification to work. This support may be a group, a coach, a therapist, or any other adult who is willing to help. When you want to take the kid to the therapist, you strap him in the seat and go. You can even get away with not telling him where you are going, if you really dont want to deal with that. Strapping your 210 pound hyperactive husband to a car seat might not be quite as simple.

Unless, you know, he's kind of into that sort of thing....

Spouses are strongly cautioned here. If you attempt to enforce a system of rewards and punishment on your mate, you are once again changing the marriage dynamic to more of a Parent-child nature. Resentment will be the inevitable result in most cases.

Medications also bring a unique set of problems to the ADDult. For a child, we decide what is the most appropriate medication based strictly on what works best for the patient. However, for an adult, there are certain lifestyle considerations that must be made as well. Is this particular medication going to affect job performance in a negative way? What about drinking? What about sex?

Most 7 year olds I know aren't really that into drinking. However, for adults, this may be a very real part of their life. Not only is drinking alcohol a medical problem, it is also a social situation that must be faced. If the ADDult should stop drinking, what will happen to his circle of friends? Is that necessarily a bad thing? Is the adult prepared to deal with these issues?

Check with your doctor about the side effects of combining alcohol with any of the medications you may be considering. Better yet, just stop drinking altogether, if that is a possibility for you. 'Nuff said.

Also, most 7 year olds that I know aren't really that into sex either. But, for adults, this is a very real issue.

Some medications, particularly the antidepressants, can affect sexual function in both men and women. These side effects can include everything from delayed orgasmic response - again, in both sexes - to a total inability to function. Libido may also be affected. That may be important to know if you are about to get married.

But, its not all bad news. Some of the meds can actually increase libido and improve function. Again, ask your doctor about these important personal issues.

Finally, The Third Decision - "How much time and energy do I want to invest in this?"

Being ADD is a lifelong thing. You will never "cure" your Attention Deficit Disorder.

However, you cannot allow yourself to become so obsessed with controlling your ADD that you lose control of your life. Change what you can change; change what you WISH to change, and learn to accept the rest. So what if your house never looks like it came from "Good Housekeeping". Is that really that important?

Or is it more important that you are happy in your relationships, your career and in your overall life?

Sounds like a no-brainer to me
. Take care,
Bob

Recently, In "Worst Pills Best Pills News" produced by the Public Citizen, a story about a child seven years ofld died due to misleading and omitted prescription drug information, adverse drug interaction, and improper dosages, and a lack of knowledge of other options available.

We are addressing in this article the subject of "misleading information and the consequences thereafter."

This has a personal interest for me and you'll soon read why that is. My son was diagnosed with Attention Deficit Hyper Disorder, Oppositional Defiant Disorder, Conduct Disorder, Compulsive Behavior Disorder, Post Traumatic Stress Disorder, and we believe there were some signs of Tourette's early on. These disorders led me to the only option I had knowledge of being prescription drugs. Initially, the suprresssion of symptoms was a blessing until he began to develop a tolerance level fast and had to increasingly be adjusted. The options then began with a variety of toehr prescription drugs of which had ever increasing side effects. My son was placed on ritilin and then clonidine was added. After this, another physician stated that he felt Jon should be raised up to 70 mg of ritilin. Son's body weight was at that time(ona good day) 50 pounds. Fortunately, I knew of an adult that was easily over 230 pounds and that was his dosage in a treatment facility.

What we need now to remember is that not all doctors or prescription drugs are bad. The prescription drugs bought me time to seek other options and the ability to wean off by lowering the dosages with the addition of natural alternatives. There are also those that can add natural alternatives with the prescription drugs and utilize other options when presented. Many doctors will work with you or direct you to another doctor who is more willing or knowledgeable in the area you with to pursue.

The FDA believes that inadequate access to appropriate patient information is a major cause of inappropriate use of prescription drugs resulting in serious personal injury and related costs to the health care system.

Recommendations:

• 1. Make a list of symptoms- don't settle for just one answer and if possible seek natural alternatives to correct symptoms - what you've been told may not be absolutely correct.
• 2. Seek more than one physician, counselor, therapist, or test until you feel comfortable with the answers. When you keep getting the same answer, see if it adds up.

• 1. Get list of pro's and con's (adverse reactions, drug interaction, and dosage amounts)
• 2. Get FDA approved "professional labeling or package insert" for the prescription drug and "not" a generic version form the pharmacist. This is not against the law to request a copy.
• 3. Get a Physician's Desk Reference which is a compendium of information available to doctors and pharmacists. Most public libraries have this or request one to be sent to your library.

Please remember that whatever you may decide to do, it is best to seek out the supervision of a physician knowledgeable in the area in which you decide to pursue and that each situation is different. It has to be treated uniquely it's own.

It is my dearest prayer that this has helped many of you to seek out answers that may change your life.

I have a fax and address to send your personal stories to for those who may want to see what options are available to them. I do not hold all the answers but it is my hope to be able to lift your spirits and give you a list of options. My book is also available at the below address.

Michelle Davis
P.O. Box 10757
Prescott, AZ 86304-0757
1-520-771-2691 Fax

Please send a self addressed stamped envelope and a donation is always helpful to cover costs of material sent but not required.

That it's for this addition of ADDed Attractions. I want to thank ALL my sponsors and contributors Who make my site and this newsletter possible. Please take the time to check them out.

ADDWAREHOUSE: www.addwarehouse.com/indexbv.htm
FOCUS: http://www.cdipage.com/focus.htm
DR. DAVE RABINER: www.helpforadd.com
BOB SEAY: add.miningco.com
DR. STEVEN RICHFIELD: http://www.parentcoachcards.com
MICHELLE DAVIS: www.freeyellow.com/members4/michelledavis/index.html

Copyright 1998 Brandi Valentine. All rights reserved. This Newsletter is copyrighted by the authors and/or publisher. ADDed Attractions may be used for non-commercial purposes only and may not be redistributed for commercial purposes without the express written consent of Brandi Valentine.

Appropriate credit should be given to this resource and it's authors if It is reproduced in any form. Brandi Valentine