ADD Resource Center » Training

Caring for Children with ADHD: A Resource Toolkit for Clinicians

Harold Meyer — Thu, 22 Dec 2011 12:11:04 +0000

ADHD – NICHQ Toolkit

National Initiative for Children’s Healthcare Quality

To download the entire toolkit as a zip file, click here.

To download individual documents from the Toolkit, use the links below.

The Proper Purpose of Assessments in the IEP process: It’s a Lot More Than Reporting a Score.

kerch — Thu, 22 Sep 2011 21:40:51 +0000

The Proper Purpose of Assessments in the IEP process: It’s a lot more than reporting a score.

NYSBA Elder and Special Needs Law Journal, Vol. 22, No. 1, 2012 (in press).

This is a prepublication copy.
By Anthony Rifkin

We’ve all experienced not quite being able to remember something. It’s on the tip of our tongue, but … . Yet at the same time, you are sure you know it: the name, the word, the fact, etc.

We are lucky. Because there is a very good chance we’ll be able to retrieve that piece of information. (Technique: do something else, and it will probably pop out.) But what about those that can’t remember, and are challenged by a bottle-neck in that very same channel?! We are able to ‘stay on top of’ things because we can remember. But what happens to those that face such a challenge? Should it be assumed that ‘they don’t know’? Or, that they are less intelligent?

I use this as a simple example to show how and why testing must be so much more that scoring ‘yay’ or ‘nay’ on a set of test items. For as can be seen in the above case, what is the meaning of such a score, if it reflects only that ‘the right answer’ came out? Is it an honest ‘assessment’ of the individual? If it is us, then we can show what we are able to retrieve, and how we are able to perform. But with those that face challenges, the same score may only indicate that that retrieval or performance is not forthcoming. But that score tells us nothing about why. And if an individual requires a customized educational program that focuses on their needs, then an answer to why is needed.

For starters, it is also important to note how many such challenges may exist. There are broad categories, of course: problem solving, memory, attention, perception, language. But within each of these there are a multitude of possibilities. Secondly, it is important to remember what those scores actually reflect (e.g., the scores on intelligence or educational tests): they primarily reflect the norms for individuals the same age. In other words, just as we can perform well in relation to our peers (and can score well on these tests), those with challenges don’t. But again, that is all that the scores are indicating – these individuals don’t perform well in comparison to others, in general.

Yet we may have the responsibility to design a program for these individuals, which must not only address their reality, but also help them to deal with it, i.e., a program that addresses their challenges and can help them to learn and develop, as well as compensate for their challenges and participate in the world as fully as possible. As such, it is the challenges themselves that must be assessed.

This is a tricky business, but also not beyond our purview, as it can be done with those very same tests. We can even use those very same scores in doing this! But those scores become part of an interpretive and exploratory process. They become means to map out a terrain, showing the client’s high and low spots, strengths and weakness. But that is just a first step, as one must then try to discern why the terrain is shaped like that. And the terrain of an individual’s mental, emotional and social makeup is a very subtle thing. Plus one must account for their experiences up to that time as well.

As such, the task is, at the very least, daunting. And it can be easily understood why educational systems fall back upon normed scores to place and position individuals. But thankfully we can examine our client’s performances on those tests, item by item. And in that we can start to see what may underlie their performance, test further, and then eventually find what underlies that terrain. And this is an ongoing process. For the individual’s subsequent program can be structured to test that terrain too. But the initial key is to first perform a decent assessment. With that, we can start to open the door for them.

Luckily, the modes for doing this have been explored, and have been shared for some time now, with those very same tests that standardized scores are reported from. One of the primary approaches to this mode of testing is called the Process Approach[1].Via the Process Approach, one examines how the individual arrived at their answers on a test. In fact, on some of those same tests, alternative means are provided. For example, if one cannot retrieve a name, one may be able to recognize it, thus testing for the very blockage I mentioned earlier. Regrettably though, an individual’s issues are often not that simple. In fact, the combination of two or three challenges can provide quite a knot to be untied.

But that is why testing across the whole terrain becomes so important. This is the cornerstone of Neuropsychological testing, of which the Process Approach is a part. Obviously, on one hand, schooling in terms of brain functions can play an important part in the interpretive process. With head injuries and conditions leading to insults of the brain, one can see specific impairments in function and in the performances that result from localized damage. However, the parts of the brain are not organized in isolation of each other. Instead, the brain normally performs its functions via connections made between multiple areas of the brain, so that multiple processes can occur simultaneously. As such, when you hear something, there is an order and partitioning to processing what you hear. Multiple systems (e.g., cognitive, mnemonic, linguistic and perceptual) may be brought to bear on the processing of a single piece of information, and an additional full set of processes may in turn be brought to bear on one’s reaction to it, which can include a response (e.g., motoric or linguistic) and/or seeking further information (thus involving perceptual, attentional or linguistic processes).

If a brain insult occurs to one of the areas responsible for a part of one of these processes, then an isolated impairment may be seen, which will be seen when testing these individuals. In fact, they can be very similar to our ‘tip of the tongue’ example, with all else functioning normally (e.g., the rest of their language and thinking being in place) but with their just not seeming to be able to perform that one piece. It’s like it just ‘dropped out’. Or, depending on the injury, there may be multiple such pieces. Or worse, qualitatively different complexes. But still, there can be an identifiable, ‘localized’ sense to these.

However, with the neurological challenges that children face, the situation is different. The subtle contributions of development are so strong that isolatable functions and performances are less likely, especially in terms of how we know those functions in our fully-developed, ‘adult’ terms. Kids are still putting the pieces together. So even the role that a function may have (e.g., naming or remembering things) may be very different than it is for us. And that is so in their daily lives and the development which is the core focus of their lives. For example, it is not just that piece that is lost (e.g., when retrieving a piece of information), but the entire structure of their knowledge and ways of knowing, which they are actively building, that they need those ‘pieces of information’ for! By comparison, we have already ‘built’ our knowledge bases, so only need the information in the moment. And in the most general terms for the child, each of the sub-systems, (e.g., attentional, perceptual, linguistic, and motoric) play a part in development coordinated with the others. If one of them does not play its part, a broader set of issues may arise. These are like the complexes I mentioned for adults above, but their ramifications go even further. For they effect that ground that is being built for and by the child, through their development. As such, with kids, one is assessing a dynamic terrain, and having to judge occurrences yet to come.

But before we start feeling too phenomenally intimidated by all this, let’s drop back and look at a single test item, to see how we may tackle it. Part of what is so interesting about the standardized tests is how many systems may come into play within one test item. This is obviously the case, given the description I gave a few paragraphs back of how multiple systems must be coordinated for processing a single piece of information, much less our having to respond to it as well. As such, there is seldom an item that is a solely “verbal’ or solely “perceptual”. Like anything else, an item will be made of parts. A test with a set of such items may be similar. But caution must be taken here too, for new processes may be added on with later items, so that they are ‘harder’. For example, with an arithmetic problem, there’s a qualitative difference between addition of single digits versus addition of double digits, the addition of two numbers and the addition of 3 or more numbers, etc.. As such, our basic unit must be the single test item, with our noting exactly what the task demands are in each item.

But within a single such item one can see the whole of how an assessment can account for the above too. A single item, in this respect, is a microcosm of the larger whole, with the larger whole operating by the same principles. A single item is made of parts, so examine how those parts are dealt with, and you will be able to see how the whole operates.

Take a standard arithmetic word problem. If Mary has 6 tomatoes and sells 3 … . You’ve already solved it, without my even having completed the statement. Interesting, eh? You did it ‘in your head’, mentally. And you did it ‘automatically’ – I didn’t need to ‘tell you’ to do it. Six minus 3 equals … . And you used memorized ‘math facts’. Still a child counting on their fingers could solve it. But there is a strong linguistic component too. How did you (and the child) arrive at subtraction? A linguistic ‘convention’ indicated by ‘sells’ tells us this, plus the concepts behind ‘Mary has’, so that we’re looking for some alteration in that amount.

That is an example just a small piece of the mental terrain that is your life, that you don’t even think about. Yet the child must build a terrain like that which you now stand on. But our judgments of a child and their performance are not always so lenient. Even if transferred to paper, written down and solved, these are clearly mental manipulations. But what if a child can’t do it without writing it down? Are they unable to perform the ‘mental manipulation’? Hardly, especially if they did all the steps of translating and transferring the problem, performing the calculation, and arriving at the solution. No, rather, that child may be burdened by some other aspect of short term retention, of not being able to hold on to the information and perform the mental manipulation at the same time. Now we are starting to get at something.

However, whereas this ‘single item’ is probably not making you feel comfortable with this world of assessment yet, let me expand to show you where it fits. What if that single item, just the mental arithmetic problem alone, with its answer scored as ‘right’ or ‘wrong’, is all the information gotten from the testing?! Then all that underlies there is missed. For we that can ‘pop out’ with our answer, this is not a problem. But for a child that is struggling with some aspect of this, it is a problem. Luckily, in this case, it is likely that our child will be given a sheet of written problems to solve too. But if they do well with those, then it may be said “good with calculations, but not good with mental manipulations”. And even worse, that mental arithmetic score may be entered into an over all “verbal score” for the child (as they are ‘word’ problems), thus lowering that score too. Of course, any test worth its salt, and the testers who administer them, will note the significant difference of this test from others within that ‘verbal’ domain. But in the process of getting those scores reported, and meeting the demands for the classification and placement decisions for all students, are these differences really noted?

So we stop for a moment, and start with our single item again. If we at least have it as a snap shot of the student, that may give us an honest starting point, before all else is swept under the rug. While our single item is still no less intimidating, it at least gives us something – something real.

The trick for using it though, is in using it in combination with other test items – across tests – but doing so in terms of those ‘parts’ I illustrated. If two test items on different tests, share two parts, but differ on a third part, and the child’s performance is different on these two items, then … .This is why so many tests are administered during neuropsychological testing. Only in this way can you get a true picture of this child’s terrain, for their particular strengths and weaknesses. For example, that very subtle difficulty in ‘retaining and comparing information when problem solving mentally’ may show up elsewhere. Of course, with experience, you know what tests those may be, so you use them! As now you are looking at the terrain itself, testing it. The scores are secondary. Though you calculate them too, so that when writing about your findings, you can say, “the child fell below the norms on … “, but then with your comparison of items you can say, “… but here appears to be the reason why”. It is the combination of elements within particular tasks that you are now looking at … or more precisely, that you are looking at to see how the child responds. A similar task with just perceptual combinations may not give the child a problem. But that may be because the perceptual problem is ‘seen’, and can be solved by using mental manipulations of visually-present materials (such as puzzles). Or, because they got to perform the task motorically. So you look at tests that require the manipulation (juxtaposition and selection) of visually-presented materials without motor manipulation – quite a mouthful, but you know the tests, and what is done with them. Or maybe it’s the retention of linguistic information, which must then be manipulated, that is giving the child a hard time. So you look to see if they can handle other types of verbal materials that require inferences and prediction. Or is there something in the word/arithmetic problems themselves? Or is the problem in the character of number, and how the child relates to that?

In this way, all the single items are like atoms, bouncing off of each other. And the sets they come from, that may have similarities and differences within them as well, are like molecules. So you can see whether the atoms do or don’t bond. One watches their behaviors, and performs tests to see how they behave. And in this way one can come to know a child’s terrain – by closely examining it with these special tools, tools that one becomes familiar with, and with which one is able to see the nuances of an individual.

But finally, with a view of the child, one must then approach the dynamic of their development. As noted, a child’s purpose and place with all of this is very different from ours. They are testing and trying things. They are learning and coming to be. But as it is ‘us’ that is viewing ‘them’, so there is another point we should remember – we have values that we are bringing to this picture, much like the judgments I mentioned above. But is it the child we see, or our judgments? For we see a low score in mental arithmetic, or his need to use paper to solve the problem, but is that the end of the world? Our view says, ‘something is wrong’. But have we looked at its meaning for the child … and most importantly, for their development? For, what is the effect the pronouncement of ‘wrong’ itself? With that (and our normative scoring systems), we become as much of an ‘effect’ upon development as anything else!

I put this like this to suggest what our role is at this point, as we head toward setting out a program for the child – one that hopefully relates to their educational needs! So let’s say we find that there’s a mix, right there at the point where the linguistic aspect of the problems meets the arithmetic itself. And, that to overcome this impasse, the child has to write down the problem. We find that this enables them to make the transition. But (hypothetically), what if the other children aren’t allowed to do that, and there is a very stringent rule at the child’s school about this? Should our child be allowed to? Will he/she be given an unfair advantage thereby? Or do we look at our child as a developmental whole, who could well use that aid, to open and ease their way in the world.

Now obviously, I’m being a bit simplistic with this example. But it’s to make a point. To bring that point home, we are only talking about a single, easily imagined aid and solution, for a problem that does not appear that severe. And a solution that few would object to. But what if the linguistic gap is much larger? For example, our child has been found to have a real difficulty dealing with ‘abstractions’, exactly of the type found in word problems. I.e., our testing led us down a path that showed those aspects to be malfunctioning. Now what are our responsibilities, and how can they be met? What ‘compensations’ will be ‘allowed’? Will the child be allowed to use a calculator, even though he/she can perform the operations sufficiently without one. But what if this aids their linguistic challenge in this case, which can be tested and shown? Here we are starting to cross over a line, out of the land of our familiar, conventional knowledge and judgments. Here we are moving into that land above, the terrain of the brain systems themselves. And this is the child’s brain, the one they need to build their mental world with!

And this is still only scratching the surface. We may be helping to get the child by, but greater educational questions may need to be addressed as well. I.e., what ‘compensations’ may be needed if a part is not fully functioning, or potentially even “missing”. And, in terms of the IEP process, can the child receive an appropriate education if these challenges are not adequately identified and the necessary compensatory strategies not provided? Again, with the brain injured adult, that piece might be taken out, and a function lost. It is noted, and it is seen. Of course, such an occurrence, in and of itself, may be seemingly devastating, and means for compensating for the loss may be sought. But with the child, a distinct ‘piece’ is not as visible, because it has not as yet contributed its part to the child’s whole. And the child may present as being ‘of this character or that’, and may even seem fine. And, for example, in our world where ‘I’m not good at math’ is heard all the time, it may be easy to pass the problem by.

But we have identified a problem. We have looked further than the initial ‘word problem’ and the situation with arithmetic. And we are not satisfied with the global test score that may simply suggests that the child is a bit ‘slow’, if that is where this is leading. There is a reason why they are not performing well, and on a SET of very specific types of problems! So before the labels can be made to stick, what can be done?! If they have talents and strengths, those should be accentuated. How can they be given a better balance? As that is what we would feel, and hopefully seek for the brain injured above. So why not for our child too? Even if those stronger parts are not of an accelerated type, they must be supported and enabled to flourish, rather than the ‘whole’ simply receiving a label. This is where the ‘parts’ that have been identified by our initial test items can come into play. And work with those ‘parts’ should always continue. Even if it is never ‘complete’, ways may be found for the child to compensate, just as we would think about our brain-injured person who as ‘lost’ something. Yes, in the case of our child, it requires looking into the future, which is harder than noting something that was there and is suddenly gone. But we are looking at how they may grow, not weighed down by that part that they didn’t have, and by finding a way to live and work with it! And again, it is those ‘parts’ that we can ‘see’ in our tests!

In this way, an IEP should be sculpted to meet a child’s needs. And that should be an ongoing process over the years, tracking progress in the identified areas, and noting changes as they are needed. Of course, the challenges that may need to be faced, for and by any specific child, may be far more than portrayed above as well. The above picture was drawn to show a single thread. In actuality, a combination of linguistic, attentional, perceptual and motoric problems, can result in a rather complex terrain. But the challenge for us, as well as the child, is the same. Identify the problem, and deal with it. Scores and classifications mean nothing if they simply ‘place’ a child. That placement must be for the child’s identified needs. And their educational program, including placement and support services, must be for the same purpose. So the proper use of an assessment will be to tell us what those needs are. And it is only from that point that the work then begins. I.e., that which needs to be done to best facilitate and assure appropriate, measurable educational growth, leading to the achievement of the student’s independent functioning[2].

Endnotes

[1] Kaplan, Edith. A process approach to neuropsychological assessment. In Boll, Thomas (Ed); Bryant, Brenda K. (Ed), (1988). Clinical neuropsychology and brain function: Research, measurement, and practice, The Master lecture series, Vol. 7 (pp. 127-167). Washington, DC, US: American Psychological Association, 202 pp.

[2] Blau, A.F. Advocating for “Appropriate” Special Education Services: Focusing on the IEP. NYSBA Elder and Special Needs Law Journal Vol 21, No. 3, 20-24, 2011.

About the Author

Anthony Rifkin is a neuropsychologist and clinical consultant working with Dr. Blau & Associates, PLLC, with offices based in New York City. Dr. Blau & Associates focus on communication, education, and vocational program customization for individuals with complex physical and neurological challenges. The people served range from infants to the elderly, based on a philosophy that supports customized intervention for functional self sufficiency throughout the life span. Anthony earned his Ph.D. in Developmental Psychology at CUNY in 1986 and completed a Re-specialization in Neuropsychology at Teachers College, Columbia University in 1990.

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2011/2012 CHADD Meeting Schedule

kerch — Thu, 14 Jul 2011 00:26:55 +0000

Meetings take place at 5:55 PM at 65 East 89th Street

Oct 3, 2011
Nov 7
Dec 5
Jan 9, 2012
Feb 8 (Wednesday)
Mar 5
Apr 2
May 7
Jun 4

For the latest information bookmark this page , and check back often!

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ADHD And the Role of The Educational Therapist

Harold Meyer — Wed, 08 Jun 2011 17:34:41 +0000

CHADD NYC Audio Presentation – June 2011

Susan Micari, MS, Ed. Board Certified Educational Therapist
365 West End Avenue, suite 101 New York, NY 10024
susan.micari@gmail.com www.susanmicari.com
Board of Directors The Association of Educational Therapists

The Most Efficient Way to Respond to Your Emails

kerch — Wed, 02 Feb 2011 12:12:53 +0000

Responding to Emails: (By Harold R. Meyer and Susan K. Lasky)

Read the email carefully.
Decide how much time you will need to reply, then set a timer to keep track of the amount of time you spent responding to this email.
Highlight questions that require an answer (hit ‘Reply’ then you can highlight, underline or list them separately).
Reply as a ROUGH DRAFT - This draft IS NOT TO BE SENT!

o Answer only the questions you highlighted

o Do not worry about grammar, spelling or redundancy in this ‘sloppy copy’

o Do not edit anything you write until you have completed your entire rough draft

Pause for a few seconds. Look away.
Read the draft – out load, if possible.
Look at each highlighted question and check that it was answered.
Now you should edit your response: (pretending that the other person has no patience/time to read your email)

o Is it succinct and to the point? Eliminate as much as possible.

o Cover only the topic of the incoming email. Do not add anything outside of the single topic. New topics should be in a new email with a new Subject line.

o Remove any extraneous words, thoughts or sentences. Edit ruthlessly but quickly.

o Check for spelling/grammatical errors and punctuation.

o Did you answer the questions in the best possible way, within time limitations?

o Add any *required* niceties.

What is the next step? Is action required from the recipient or from you? If so, clarify who needs to do what, and by when.
If you have any questions, make sure they are written clearly and concisely.
Hit ‘Send’
Turn off the timer. Measure how long this took.

by Harold R. Meyer and Susan K. Lasky

The Multimodal Treatment of ADHD Study (MTA):Questions and Answers

kerch — Tue, 11 Jan 2011 15:04:26 +0000

The Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA):Questions and Answers

NIMH

Revised November 2009

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in childhood. Several interventions are effective in treating children with ADHD, including medications and behavior therapy. To examine how intensive treatment with medications compares with intensive behavior therapy, or with the combination of the two, NIMH sponsored the Multimodal Treatment of ADHD (MTA) study. The main findings from this study were published in December 1999, and are discussed below.

Q. What is the MTA?

A. The MTA was a multisite study designed to evaluate the leading treatments for ADHD, including behavior therapy, medications, and the combination of the two. The study included nearly 600 children, ages 7-9, who were randomly assigned to one of four treatment modes:

intensive medication management alone;
intensive behavioral treatment alone;
a combination of both; or
routine community care (the control group).

Q. Why is the MTA important?

A. While previous studies have examined the safety and compared the effectiveness of medication and behavior therapy for ADHD, they generally were short-term—no more than four months. The MTA study examined for the first time the safety and relative effectiveness of these two treatments—alone and in combination for a time period of up to 14 months, and compared these treatments to routine community care.

Q. What are the major findings of the MTA?

A. The MTA primary results were published in December 1999 in the Archives of General Psychiatry. Combination treatment and medication management alone were both significantly superior to intensive behavioral treatment alone and to routine community care in reducing ADHD symptoms. The study also showed that these benefits last for as long as 14 months.

In other areas of functioning (e.g., anxiety symptoms, academic performance, parent-child relations, and social skills), combination treatment was consistently superior to routine community care, whereas medication alone or behavioral treatment alone were not. The children in the combination treatment also ended up taking lower doses of medication than the children in the medication-alone group. These findings were consistent across all six research sites, despite substantial differences among sites in the children’s sociodemographic characteristics. Therefore, the study’s overall results can apply to a wide range of children and families in need of treatment services for ADHD.

Q. What did the MTA tell us about the safety of stimulant medication?

A. Of the 289 children randomized to medication, 4 percent had adverse effects severe enough to prompt them to discontinue the medication. Adverse effects included loss of appetite, sleep problems, crying spells, and repetitive movements. Medication also slowed the physical growth of children during the 14 months of treatment. The children who received intensive medication treatment (seven days a week) grew 4.25 cm on average and gained 1.64 kg on average, while the children who received behavior therapy only (no medication) grew 6.19 cm on average and gained 4.53 kg on average.¹ Over time, these growth effects may persist if medication is continued.² However, 88 percent of the children were successfully treated for the full duration of the study.

Q. What is the role of behavioral therapy in treating ADHD?

A. Research has shown that behavioral therapies are very effective in treating children with ADHD. However, the MTA study demonstrated that, on average, carefully monitored medication with monthly follow-up is more effective than intensive behavioral treatment alone, for up to 14 months.

All children improved over the course of the study, but they differed in the relative amount of improvement. The children receiving medication management, either alone or in combination with behavior therapy, generally showed the greatest improvement. However, children’s responses varied enormously, and some children did very well in each of the treatment groups.

For some types of functioning, such as academic performance and family relations, the combination of behavioral therapy and medication was superior to the other treatment groups. Therefore, medication alone is not necessarily the best treatment for every child, and families often need to pursue other treatments, either alone or in combination with medication.

Q. Which treatment is right for my child?

A. Parents must consult with their child’s doctor to determine the best course of treatment for their child. No single treatment is best for all children with ADHD. Families should consider side effects of medications, or other circumstances that might render certain treatments inappropriate for their child.

Children with coexisting conditions such as anxiety or external stressors such as high levels of family conflict may do best with a combination of treatments. When determining a suitable treatment, a child’s needs, personal and medical history, and other relevant factors need to be carefully considered.

Q. Why do many social skills improve with medication?

A. Previously, it was thought that children with ADHD could only learn new social skills if they were explicitly taught. However, the MTA study findings suggest that many children can acquire these skills on their own when given the opportunity. Children treated with medication management (either alone or in combination with intensive behavioral therapy) showed more improved social skills and peer relations than children in the community comparison group after 14 months. This finding suggests that symptoms of ADHD may interfere with a child’s ability to learn specific social skills. Medication may help them learn these skills by diminishing symptoms that had previously inhibited the child’s social development.

Q. Why were the MTA medication treatments more effective than community treatments that also usually included medication?

A. There were substantial differences in quality and intensity between the study-provided medication treatments and those provided in the community care group. During the first month of treatment, the MTA doctors worked hard to find the best dose of medication for each child receiving the MTA medication treatment. After this period, the children saw their MTA doctor monthly.

During the treatment visits, the doctor spoke with the parent, met with the child, and worked to determine any concerns that the family might have regarding the medication or the child’s ADHD. If the child was experiencing any difficulties, the MTA doctor could adjust the child’s medication, In contrast, the community treatment doctors generally saw the children face-to-face only one or two times per year.

Careful monitoring also allowed for early detection and response to any side effects from the medication, which probably helped the children stay on the medication. In addition, the MTA doctors consulted with each child’s teacher on a monthly basis, and used this information to make any necessary adjustments in the child’s treatment. In contrast, the community treatment doctors did not interact regularly with the children’s teachers.

Finally, the MTA doctors delivering the medication treatments generally prescribed higher doses of stimulant medications per day than the community treatment doctors.

Q. How were children selected for this study?

A. Parents heard about the study through their pediatricians and other health care providers, their children’s teachers, or through radio/newspaper announcements. They then contacted the investigators. Study investigators interviewed the children and parents to learn more about the nature of the child’s symptoms and medical history, and rule out other conditions or factors that may be causing the child’s difficulties. The children needed to meet strict criteria to be eligible for the study.

Q. What are the main limitations of the MTA, and what happened after it concluded?

A. The MTA was designed and conducted in the early 1990s, before the extended release formulations of stimulant medications became widely available. The MTA used immediate release methylphenidate (Ritalin), which was administered three times a day. Currently, most children receiving stimulant treatment for ADHD are given a once-a-day dose of medication in the morning. However, this difference in medication administration does not change the study’s main conclusions.

In addition, the MTA treatment lasted for 14 months only, after which the children were referred back to their community providers. Some of them continued treatment. Others discontinued their treatment or changed it, based on their individual situation. All participants, regardless of the treatment they received, were invited to return to the MTA clinics every one to two years for an assessment of their ADHD symptoms and level of functioning.

Because their treatment after the end of the study was not controlled, it is not possible to draw accurate conclusions about the effectiveness of interventions beyond 14 months, or determine if treatment improves long-term functioning. However, the observations collected from these uncontrolled follow-up assessments can provide information about the long-term course of ADHD itself. These data are being analyzed and reported as they become available.³

Q. Where did this study take place?

A. The study was conducted at the following clinical research sites:

New York State Psychiatric Institute at Columbia University, New York, NY.
Mount Sinai Medical Center, New York, NY
Duke University Medical Center, Durham, NC
University of Pittsburgh, Pittsburgh, PA
Long Island Jewish Medical Center, New Hyde Park, NY
Montreal Children’s Hospital, Montreal, Canada
University of California at Berkeley, CA
University of California at Irvine, CA

Q. Where can I find more information about the MTA study?

A. In addition to the information available on the NIMH Web site on MTA the following is a selection of MTA references:

The MTA Cooperative Group: A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder (ADHD). Arch Gen Psychiatry 1999;56:1073-1086.
The MTA Cooperative Group: Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder (ADHD). Arch Gen Psychiatry 1999;56:1088-1096.
Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB, Clevenger W, Davies M, Elliott GR, Greenhill LL, Hechtman L, Hoza, B, Jensen PS, March JS, Newcorn JH, Owens EB, Pelham WE, Schiller E, Severe JB, Simpson S, Vitiello B, Wells K, Wigal T, Wu M: Clinical relevance of the primary findings of the MTA: success rate based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry 2001; 40:168-179.
Greenhill LL, Swanson JM, Vitiello B, Davies M, Clevenger W, Wu M, Arnold LE, Abikoff HB, Bukstein OG, Conners CK, Elliott GR, Hechtman L, Hinshaw SP, Hoza B, Jensen PS, Kraemer HC, March JS, Newcorn JH, Severe JB, Wells K, WigalT: Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial. J Am Acad Child Adolesc Psychiatry 2001; 40:180-187.
Vitiello B, Severe JB, Greenhill LL, Arnold LE, Abikoff HB, Bukstein O, Elliott GR, Hechtman L, Jensen PS, Hinshaw SP, March JS, Newcorn JH, Swanson JM, Cantwell DP: Methylphenidate Dosage for Children with ADHD over Time under Controlled Conditions: Lessons from the MTA. J Am Acad Child Adolesc Psychiatry 2001; 40:188-196.
Owens EB, Hinshaw SP, Kraemer HC, Arnold LE, Abikoff HB, Cantwell DP, Conners CK, Elliot G, Greenhill LL, Hechtman L, Hoza B, Jensen PS, March JS, Newcorn JH, Pelham WE, Richters JE, Schiller EP, Severe JB, Swanson JM, Vereen D, Vitiello B, Wells KC, Wigal T: What treatment for whom for ADHD: Moderators of treatment response in the MTA. J Consult Clin Psychol2003;71:540-552.
MTA Cooperative Group: National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics 2004;113:754-761.
MTA Cooperative Group: National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 2004;113:762-769.
Swanson JM, Elliott GR, Greenhill LL, Wigal T, Arnold LE, Vitiello B, Hechtman L, Epstein J, Pelham W, Abikoff HB, Newcorn J, Molina B, Hinshaw S, Wells K, Hoza B, Severe JB, Jensen PS, Gibbons R, Hur K, Stehli A, Davies M, March J, Caron M, Volkow ND, Posner MI, for the MTA Cooperative Group: Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry 2007;46:1014-1026.
Molina BSG, Hinshaw S.P., Swanson J.M., Arnold, L.E., Vitiello B, Jensen PS, Epstein JN, Hoza B, Hechtman L., Abikoff, H.B., Elliott GR, Greenhill LL, Newcorn, JH, Wells KC, Wigal TL, Severe JB, Gibbons RD, Hur K, Houck PR, and the MTA Cooperative Group: The MTA at 8 years: prospective follow-up of children treated for combined type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 2009;48:484-500.

Citations

¹MTA Cooperative Group: National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: changes in effectiveness and growth after the end of treatment. Pediatrics 2004;113:762-769.

²Swanson JM, Elliott GR, Greenhill LL, Wigal T, Arnold LE, Vitiello B, Hechtman L, Epstein J, Pelham W, Abikoff HB, Newcorn J, Molina B, Hinshaw S, Wells K, Hoza B, Severe JB, Jensen PS, Gibbons R, Hur K, Stehli A, Davies M, March J, Caron M, Volkow ND, Posner MI, for the MTA Cooperative Group: Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry 2007;46:1014-1026.

³Molina BSG, Hinshaw S.P., Swanson J.M., Arnold, L.E., Vitiello B, Jensen PS, Epstein JN, Hoza B, Hechtman L., Abikoff, H.B., Elliott GR, Greenhill LL, Newcorn, JH, Wells KC, Wigal TL, Severe JB, Gibbons RD, Hur K, Houck PR, and the MTA Cooperative Group: The MTA at 8 years: prospective follow-up of children treated for combined type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 2009;48:484-500.

The Overlap Between ADHD and Bipolar Disorder

kerch — Tue, 11 Jan 2011 11:43:35 +0000

Cathryn A. Galanter, M.D. discusses the overlap between attention deficit hyperactivity disorder (ADHD) and bipolar disorder as well as how to differentiate between the two.

Why ADHD Is on the Rise

kerch — Wed, 01 Dec 2010 17:05:55 +0000

This article (and others) is available at everydayhealth.com

Why ADHD Is on the Rise?

Statistics show that more children are being diagnosed with ADHD each year. Why? Read about possible explanations in Everyday Health’s exclusive expert roundtable discussion.

Everyday Health: Why are so many more children being diagnosed with ADHD now than in the past?

Steven Richfield, PsyD (parentcoachcards.com)

Child psychologist, Plymouth Meeting, Pa.; author of The Parent Coach: A New Approach to Parenting in Today’s Society

There is far greater awareness now of the signs and symptoms of ADHD because of in-service training for teachers and more enlightened parents. The emotional, educational, and social costs of undiagnosed ADHD are perhaps the biggest reasons that so many more kids are referred for evaluation. The lack of identification [of an ADHD diagnosis], proper educational planning, and treatment can be devastating for a child’s future.

Jacquelyn F. Gamino, PhD (brainhealth.utdallas.edu)
Research scientist, Center for BrainHealth, University of Texas, Dallas

The measures we currently have to diagnose ADHD are more sensitive than they used to be. Think about common ailments such as heart disease. Current medical practices make it much easier to detect and treat; the same is true of ADHD. We also know more about ADHD than before, so we can understand and recognize some of the symptoms more readily.

F. Allen Walker, MD (louisvilleadhd.com)
Board-certified psychiatrist, Louisville, Ky.

Many schools and teachers are not able to keep up with the different learning styles of students. Learning through imagination and creative curiosity (which I find inherent in kids with ADHD) is disappearing in many schools. At home, kids are allowed to spend too much time in sedentary activities and engaged in “screen time” (whether televisions, computers, or video games); in addition, many parents do not understand the importance of maintaining consistent boundaries. I feel everyone experiences symptoms of ADHD to varying degrees at some point during his or her life, and the current fast-paced culture seems to propagate the ADHD phenomenon.

L. Eugene Arnold, MD, MEd (psychmed.osu.edu)
Child & adolescent psychiatrist; professor emeritus of psychiatry, Ohio State University, Columbus

The main reasons are that the disorder is better recognized and that modern stress and the lack of structured discipline bring out the symptoms. But more cases of ADHD may result from things like environmental pollutants, a decrease in nutritional balance (because of food processing, fast foods, and additives), a lack of exercise, and the epigenetic consequences of early developmental experiences and exposures. Also, improved obstetrical care is saving more vulnerable birth-traumatized babies who in the past would have died. The downside of better recognition is the possible misdiagnosis of some who have other problems.

Common Theories About the Causes of ADHD

A variety of theories about the causes of ADHD have been proposed, including problem pregnancies and food additives. Discover what experts have to say about these theories.

Everyday Health: Why are there so many theories about the causes of ADHD? What are the most common?

Patricia O. Quinn, MD (addvance.com)
Developmental pediatrician; director, National Center for Girls and Women With ADHD, Washington, D.C.

ADHD is a brain-based condition and the result of problems with the transmitters that help relay messages in certain areas of the brain. But there may be several reasons that these brain areas are not functioning properly. ADHD tends to run in families, and several genetic variations have been found in different people. However, there does not seem to be one gene that is affected in all people with ADHD. We also know that an insult to the brain, either during development or later in life, can result in symptoms of ADHD. Many things can insult the brain, including infections (meningitis, encephalitis), toxins (low levels of lead or pesticides), poor nutrition (anemia, malnutrition); and problems during pregnancy (bleeding or maternal smoking) or after birth (prematurity).

Lawrence Diller, MD (docdiller.com)
Behavioral and developmental pediatrician and clinical therapist, Walnut Creek, Calif.; assistant clinical professor, University of California, San Francisco; author ofThe Last Normal Child, Running on Ritalin, and Should I Medicate My Child? (will be published in May 2011)

There are no biological tests or markers for ADHD. Because there are neither medical nor definitive psychometric tests, the causes of ADHD are open to varying interpretation. The ADHD diagnosis is a potential political football when it comes to etiology [causes]. The most widely held belief is that ADHD is genetic and biochemical — a disorder of the brain. However, that doesn’t mean that environment doesn’t play a role with regard to the expression and/or management of the problem behaviors of ADHD.

Erin N. King (schoolpsychologistfiles.com)
Nationally certified school psychologist, Virginia

Any disorder that does not have a known cause is open to a number of theories. People naturally want to know why, or want to feel as if it can be prevented in the future. Heredity is the most commonly accepted cause.

Eric Beam, PhD (Ask Dr. Eric)
Supervisor for school psychologists and speech language pathologists, Los Angeles County School District; Board of directors, California Association of School Psychologists

We’ve come a long way, but we still have a lot to learn. There are a lot of unconnected dots. This allows for a lot of theories to exist, and a lot of theoretical purists to act more like cultists than scientists. However, in time, the more that we learn and understand about ADHD collectively, the more the theories start to converge and overlap.

Barry Lessin, MEd [barrylessin.com]
Licensed psychologist and certified addictions counselor, Fort Washington, Pa.

Common theories of causation revolve around genetic (heritability), neurological (specific brain dysfunction — for example, of the frontal lobe), environmental (prenatal issues, diet, and so forth), and social factors. Also, because of the business aspect in the health care industry, competing interests exist among various disciplines/business sectors that provide treatment for ADHD and have a vested interest in their products and approaches.

Is ADHD Treatment Really Necessary for Children?

The decision to start children on drugs to treat ADHD can be tough for parents. Experts discuss the pros and cons of ADHD medication for children.

Everyday Health: How do you explain the value of treatment to resistant parents? For example, a parent might say, “I survived my childhood with ADHD — and I was never diagnosed or treated. Why does my child need ADHD treatment?”

Patricia O. Quinn, MD (addvance.com): When most people with true ADHD reflect on their childhood and adult years, they can appreciate the pain and suffering or lost opportunities in their lives. Most parents want what is best for their child, especially if their child is at a disadvantage or not able to live up to his or her potential because of a short attention span, distractibility, or disorganization. We have a fast-paced learning environment, and if a child is not paying attention, he or she misses out on a lot of skills (both academic and social). I always remind parents that they will never know how well their child can do (and how much easier life will be) until they undergo a trial period with an approved ADHD treatment.

Lawrence Diller, MD (docdiller.com): No parents I’ve ever met were initially enthusiastic with the notion of their children taking a psychiatric medication. Most parents are more open to considering a medication intervention after trying interventions other than drugs — like behavioral modification plans and educational interventions (effective parent/teacher strategies). Parents must consider the choice between using an effective, relatively safe medical intervention and an increasingly restrictive, potentially stigmatizing life for their child.

Eric Beam, PhD (Ask Dr. Eric): My personality is very bottom-line oriented, so I do better with these parents than the more touchy-feely practitioners. I don’t push for ADHD treatment; I push for results and for a plan that is calculated to improve outcomes. If parents ask me about medication, I will not share many opinions or answer many direct questions. However, I may help facilitate their ability to construct a set of questions to ask the appropriate medical practitioner. In the end, it’s not my decision.

Barry Lessin, MEd (barrylessin.com): Once I educate parents by giving balanced, quality information about what we now know — and don’t know — about ADHD and its successful treatment, the more willing they are to embrace treatment options. I work with the family to identify the child’s existing strengths and resources and to develop some behavioral strategies, built on these strengths, for them to use to improve the child’s condition. When parents are given hope and offered effective strategies for dealing with ADHD, they are usually more willing to enter into treatment.

The Challenges of ADHD at School

Children with ADHD need support at home and at school for proper treatment of the condition. How much help can parents really expect from teachers and administrators?

Everyday Health: What role does a child’s school play in helping him or her with ADHD?

Lawrence Diller, MD (docdiller.com): Coordination among a child’s family, doctor, and school is critical in any treatment plan. All potential ADHD children should have a minimum screening for learning or processing problems. Sometimes simply addressing these issues with small-group instruction can sufficiently highlightthe problem behaviors. Similarly, placement in the front of the class and behavior modification interventions — like a daily report card that rewards a child for getting to, sticking with, and completing a task — can reduce the need for medication or lower the necessary daily dose. Finally, feedback from the teacher is critical in determining the most effective daily dosage when using a medication intervention.

Eric Beam, PhD (Ask Dr. Eric): The school’s role is to teach well. First and foremost, students with ADHD need excellent teachers. They need to be engaged in learning, door-to-door and bell-to-bell. They need a structured external environment that offers the right combination of support and challenge. They need to be engaged through a variety of methods and modalities. In addition, students with ADHD often need to receive explicit instruction in certain skills that students are usually just expected to “pick up” along the way — social skills, study skills, time management and organization, and so on. Energy and concentration are precious commodities, and children only have so much that they can deliver in a given day. We need to be wise and strategic because concentration is even more limited when dealing with ADHD.

Barry Lessin, MEd (barrylessin.com): Effective treatment for ADHD is more likely when we take a comprehensive approach. A child’s academic world can be very different from the home environment. Success in school, then, is often contingent on coordinating treatment approaches and working with the school directly to develop an appropriate educational program for the child. The likelihood that a child will improve is greater when the school, family, and therapist are on the same page.

Patricia O. Quinn, MD (addvance.com): Schools and teachers play a critical role in both diagnosis and treatment. The first symptoms of ADHD usually appear or cause difficulty in the school environment. Teachers need to be knowledgeable about ADHD and aware of how symptoms show up in the school setting. They also need to be willing to refer a child for appropriate evaluation. Schools can help a child with ADHD by making the classroom feel safe; teaching organization, planning, and memory skills; and assisting the child in developing social skills. Teachers should avoid public shaming or criticism for not doing work, talking too much, or not turning in homework. Instead, they should design programs to help children with ADHD develop these skills.

Frank Barnhill, MD (drhuggiebear.com)
Board-certified family physician, Gaffney, S.C.

Teachers and the entire school experience must be supportive of the changes needed for effective therapy, whether drug therapy or behavioral therapy, in order for it to help the child reach his or her potential.

Alternative Treatments for ADHD

Which nondrug strategies work best for children with ADHD? Get expert advice on alternative treatments.

Everyday Health: Which nondrug strategies work best for children with ADHD?

Will Meek, PhD (willmeekphd.com)
Counseling psychologist; staff psychologist and director of Counseling Services at Washington State University, Vancouver; adjunct professor, Portland State University, Portland, Ore.

There are two essential components to successful nondrug treatment of ADHD. The first is self-regulation, which focuses on tolerance and the healthy expression of emotions, as well as impulse control. Mindfulness and exercise programs are two areas of note for building these skills. The second is the development of compensatory strategies for the way the ADHD brain works.

Stephanie Sarkis, PhD (stephaniesarkis.com)
Counselor, coach, Boca Raton, Fla.; author of Your Money: A Guide to Personal Finance for Adults With Attention Deficit Disorder (2009) and Adult ADHD: A Guide for the Newly Diagnosed (May 2011)

Counseling is an effective strategy, although studies show that medication and counseling are more effective together than either treatment alone.

Rory Stern, PsyD (thetruthbehindadhd.com)
Child and parenting coach, North Andover, Mass.

Nondrug strategies, or alternative treatments, are quite appealing in the world of ADD/ADHD treatment. But not all of the alternative/nondrug strategies are as sexy as they sound. Many of these alternative treatments require a lot more effort, persistence, dedication, commitment, devotion, and accountability than a prescription pill. That said, I am a huge supporter of implementing nondrug strategies, and I believe these are critical components of effective treatment (even necessary, particularly when medications are being used). The best nondrug strategies for children start with a strong foundation from the parents and family. I always encourage parents to see ADD and ADHD as a difference in brain wiring and not as a disorder or illness. With this approach in mind, we can then build on some of the more active nondrug strategies, including social skills training, study skills training, test-taking strategies, relationship strategies, working-memory training, positive sleep routine, and healthy diet and exercise routine.

Lara Honos-Webb, PhD (visionarysoul.com)
Clinical psychologist, Walnut Creek, Calif.; author of The Gift of Adult ADD andListening to Depression: How Understanding Your Pain Can Heal Your Life

One of the best strategies for a child with ADHD is to focus on the gifts the child already has. When you help children define themselves by their strengths rather than their weaknesses, they can gain confidence and the motivation for patching up the weaknesses of distraction and impulsiveness. Parents can often make small changes that will create big improvements in their child. A simple example is for parents to build emotional intelligence in their child by helping the child label and then let go of intense emotions. So, for example, if a child is picking on a sibling, a parent can say, “It’s okay to be mad at your sister, but it’s not okay to tease.” In this way the child learns to label and handle emotions rather than act them out impulsively.

Rhonda Pawlan, MS (coachmerhonda.com)
ADHD and life coach, Northbrook, Ill.

Because every child is unique, different strategies work better for different children. In general, though, some things that work well include routines (morning, bedtime, homework) and structure to help keep a child on task. The use of timers to remind the child to pay attention is also helpful, as are brightly decorated whiteboards to list tasks.

Linda Aber (lindaaber.com)
Certified Theraplay group specialist; certified family life educator; owner, Tac Tics Resource Services, Montreal, Quebec

Whether parents choose to use medication or not, the following practices benefit all children:

Connection: The messages sent by parents need to encourage, support, and guide children as they traverse their developmental years. There is no stronger indicator of a child’s success than a parent who believes in him or her.
Diet: It is very important to provide children with a diet of whole foods — avoiding junk food, sugar, additives, and dyes. A recent study in the medical journal The Lancet showed that additives can increase hyperactivity, so check labels on the foods you purchase. Many physicians recommend giving a daily fatty-acid supplement in the form of fish oil.
Sleep: Studies reveal that many children with ADHD do not get enough sleep — this diminishes mental performance at school, creating behavioral problems in class.
Exercise: Parents and teachers must never deny children participation in sports nor keep them in during recess. Many physicians agree that daily exercise continues to be a cornerstone of ADHD treatment.
Structure: Establishing consistent rules and schedules both at home and at school helps children manage their daily tasks and activities and lowers their level of anxiety.

Jodi Sleeper-Triplett (jstcoach.com)
ADHD coach, Herndon, Va.; author of Empowering Youth With ADHD

The success rate of any strategy varies by factors such as age, commitment to the process, and level of hyperactivity or distractibility, and coexisting problems like learning disabilities, anxiety, depression, and OCD.

ADHD coaching can address many of the challenges faced by young people with ADHD and may focus on supporting the young person in areas such as improving time management and organizational skills and establishing routines and good habits.
Younger children who are not quite ready (emotionally or cognitively) for coaching can benefit from behavior therapy, also known as behavior modification. This therapy addresses specific problem behaviors at home, at school, and in social situations by structuring time, setting reasonable and clear limits, establishing predictability and routines, and increasing positive attention.
Neurofeedback, a type of biofeedback, uses brain exercises to train the brain to reduce impulsivity and increase focus and attentiveness. The treatment is painless and has been shown in some studies to have lasting effects.
Exercise increases energy and circulation and improves mood, enhancing the ability of children and adults with ADHD to focus. Deep breathing is a valuable tool in conjunction with exercise or as a stand-alone practice throughout the day. Children who stop to stretch and take a few deep breaths before transitioning to a new activity or task report a better sense of focus and well-being.

Can Bad Parenting Cause ADHD?

Experts agree that parenting plays a role in ADHD — but whether lack of discipline or lax parenting may cause the condition is still subject to debate.

Everyday Health: Can too little discipline or lax parenting cause ADHD? Why or why not?

Will Meek, PhD (willmeekphd.com): Part of what makes the picture of ADHD so confusing is that we still do not have an agreed-upon idea of what it is, or enough research to understand what causes it. Most people agree that there is some biological component that may express itself regardless of environment, while others propose that it is a vulnerability that surfaces based on things such as too much TV or permissive parenting. My personal view is that ADHD does have a strong genetic component and that lax parenting either exacerbates ADHD or causes behavior that looks similar to ADHD.

Stephanie Sarkis, PhD (stephaniesarkis.com): ADHD is a genetic and biological disorder. More than 10 genes have been identified as being linked to ADHD. There is nothing a parent can do to cause ADHD. Children with ADHD benefit from structure and positive reinforcement, so pay attention to what your child is doing well.

Rory Stern, PsyD (thetruthbehindadhd.com): Bad parenting, lack of discipline, and lax parenting cannot and do not cause ADD/ADHD. However, that does not mean such parenting styles do not contribute to the severity of the ADD or ADHD that appears in the child. That said, many people believe that children with ADD or ADHD need more discipline. This is simply not accurate. Rather, children with ADD or ADHD need a specific style of discipline that works with them and their biological differences rather than against them. Too many people want the child to change in ways that are not chemically, biologically, or neurologically possible. It’s the old forcing-a-square-peg-in-a round-hole debate. On the contrary, these children can be quite successful, but mentors and parents need to fully understand what they are up against.

Rhonda Pawlan, MS (coachmerhonda.com): Parenting does not cause ADHD. This is a neurobiological disorder, often inherited from a parent. However, parents who learn how to use effective strategies can help their child with ADHD fare better in the world.

Linda Aber (lindaaber.com): Symptoms of ADHD like distractibility, hyperactivity, impulsivity, inattention, disorganization, and forgetfulness are not the result of lax parenting. ADHD is a neurological, biochemical brain condition, a heritable trait that is influenced by genetics. The same genes also promote positive qualities, such as creativity, sensitivity, high energy, imagination, and persistence, as well as thinking that can be characterized as being “out of the box.” These strengths are the hidden gems that parents need to point out daily and celebrate with their children.

Jodi Sleeper-Triplett (jstcoach.com): Children and teens with ADHD benefit from added structure and daily routines, which can be difficult for some parents to implement. But lack of structure and discipline or lax parenting does not cause ADHD. Studies have shown that parenting style has no correlation with ADHD. There is some evidence, however, that having an ADHD child affects the quality of parental care. In one study, the quality of parenting improved after the child was treated with stimulant medication, which reflects the not surprising conclusion that raising an ADHD child is a challenge.

TV, Video Games, and ADHD

Too much screen time has been shown to affect a child’s behavior, but can it cause ADHD symptoms? Find out what experts have to say.

Everyday Health: Does watching too much television or playing video games cause ADHD symptoms?

Stephanie Sarkis (stephaniesarkis.com): ADHD is a genetic and biological disorder and is really an issue with motivation, not attention. Symptoms of ADHD can include inattention and hyperfocusing. That is why a child seems to be “inside” the TV or video game. When you need your child’s attention, instead of asking him or her repeatedly to turn off the TV, just go over and shut it off.

Robert F. De Maria, DC, NHD (druglessdoctor.com)
Author of Dr. Bob’s Series, including Guide to Stop ADHD in 18 Days

A study from the American Academy of Pediatrics shows that toddlers who watch videos may develop ADHD later in life. Children need to be outside playing, and not always in organized sports, but learning social skills with a pick-up game of kick ball or baseball or going fishing or riding a bike. Activity promotes life. Inactivity sabotages and stagnates optimal function of all cells in the body.

Lara Honos-Webb, PhD (visionarysoul.com): Research has shown a correlation between the amount of time spent watching TV and a diagnosis of ADHD. It is unlikely that TV watching causes ADHD, but it does cause many problems, including passivity, negative cognitive affects, and decreased sensitivity to violence. Parents should limit TV for these reasons. The correlation may reflect the fact that because ADHD kids are more difficult to manage, parents let them watch more TV or play more video games.

Rhonda Pawlan, MS (coachmerhonda.com): Absolutely not! Perhaps some people think there’s a connection because when a child with ADHD is watching TV or playing video games, he or she will hyperfocus and have difficulty stopping to do more important things, such as homework.

Linda Aber (lindaaber.com): Neither of these causes ADHD, yet it’s imperative that a child not become a couch potato or video potato. A lack of exercise is bad for the brain, and self-isolation causes social discord. Parents need to set strict time limits for computer and TV use. Children acquire skills such as reciprocity, turn taking, empathy, compromising, and negotiating from peer socialization. They need to acquire a “we” rather than a “me” mentality.

The ADHD-Diet Link

Pesticides, preservatives, and other food additives have been linked to ADHD in children. Find out about the connection between a poor diet and ADHD symptoms.

Everyday Health: What role does diet play in ADHD behavior?

Will Meek, PhD (willmeekphd.com): We do not know exactly how this works yet. However, it doesn’t take a psychologist to point out that food with low nutritional value and high sugar content can alter mood and attention. It certainly never hurts to be eating a well-balanced, healthy diet, rich in vegetables and lean meats.

Robert F. De Maria, DC, NHD (druglessdoctor.com): The body is dependent on whole-food nutrients and proper oils and fats. When improper foods are eaten — like trans fats, for example — the brain cannot send signals to the rest of the body effectively. This affects mood, behavior, and physical health. Eating poor-quality food is like putting low-octane gas in a car that needs premium.

Rory Stern, PsyD (thetruthbehindadhd.com): There’s not enough evidence that pesticides, preservatives, or other additives cause the condition; yet diet is an important factor in ADD/ADHD behavior. Sugar provides a very quick burst of energy and often leads to a crash soon after. For children with ADHD, this can be devastating, given the already complex variables and differences in the manner in which their brains operate and function with tasks of daily living. Because of this, a healthy diet can provide an excellent “alternative” or nondrug approach to managing ADHD symptoms. This is why we often suggest that a child start the day with protein (good sugars) instead of candy and junk food (bad sugars) to provide fuel to the brain and body.

Lara Honos-Webb, PhD (visionarysoul.com): While no research has found that a bad diet causes ADHD, a child who does not eat healthy food will have difficulty concentrating and staying in control of his or her behavior. Obvious problems are not eating breakfast, eating too much sugar or caffeine or too little protein, and other nutritional deficiencies.

Linda Aber (lindaaber.com): Some studies have found that behavior improved when food coloring and common allergens like corn, milk, eggs, wheat, soy, oranges, and peanuts were removed from the diet. It is wise to resist the intake of sugar from candy, soft drinks and fruit drinks, and frozen desserts — such foods may also contain preservatives and dyes. A diet of whole foods — along with fruits, vegetables, and omega- 3 fatty acids, found in salmon, trout, sardines, and fish oil capsules — plays a role in cognition and behavior.

Jodi Sleeper-Triplett (jstcoach.com): A healthy diet rich in protein, complex carbohydrates, and omega-3 fatty acids helps children and adults with ADHD increase focus and sustain attention. It’s been reported that a high-protein breakfast helps ADHD medication work more effectively throughout the day, which is very helpful for school-age children. Too much sugar and caffeine, and too many food additives or artificial ingredients, will zap energy and decrease a child’s ability to focus and perform effectively. Many children and teens experience a decreased appetite because of stimulant medication, so breakfast is essential. In addition, packing small, tasty, high-protein snacks instead of a full lunch will help with children’s focus throughout the day and keep them healthy.

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