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Attention Deficit Disorder Poses Dilemma

Parents are caught in a double bind when a child is diagnosed with ADD or ADHD (attention deficit hyperactivity disorder). On the one hand, they want to help their child focus and do well in school. Treating the condition can make a big improvement in how well a child does in school or even how he plays with friends.

On the other hand, though, many parents are concerned about stimulant medications. Far too often, a diagnosis is made and a prescription is written for Ritalin or Adderall without adequate counseling. Parents may be taken aback if they read the official prescribing information on these drugs. Adderall, for example, has a scary warning inside a black box:

“Amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence and must be avoided…Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events.”

Any parent who reads such a caution may wonder whether a school year is a “prolonged period of time.” The information also lists side effects such as psychotic episodes, tics, stomach upset, restlessness, insomnia, tremor, heart rhythm disturbances, loss of appetite and weight loss. No wonder parents or grandparents may worry that the treatment could be worse than the condition.

We recently heard from a woman concerned about her 9-year-old grandson:

“He has behavioral issues and has been diagnosed with ADHD.

“During his visit, we did not give him his usual medications. His behavior improved considerably. After five or six days, I took him to visit my friend who is a school psychologist. She found NOTHING: no ADD or ADHD.

“He does have some behavior problems, but they respond to therapy and discipline. I am very worried about the effects drugs are having on his young organs and brain.”

Diagnosing attention deficit disorder is actually more complicated than many people assume. There is no single test for ADD or ADHD. Instead, it must be diagnosed from behavioral patterns. Inconsistent focus and unexplained underachievement are tip-offs, according to Edward Hallowell, MD.

Dr. Hallowell is author of Delivered From Distraction and is one of the country’s leading experts on ADD and ADHD. He suggests that successful management of these conditions requires four basics: adequate sleep, daily exercise, structure with reliable routines and diet. There is growing evidence that junk food with additives may make ADD worse (Lancet, Nov. 3, 2007).

Dr. Hallowell believes that medications can play a valuable role in treatment but the basics must come first. He also recommends dietary supplements including Pycnogenol (pine bark extract), grape seed extract and fish oil. For more details on Dr. Hallowell’s approach to ADD we offer a CD of our recent one-hour radio interview with him. Anyone who wants this CD may send $16 to: Graedon Enterprises; Dept. CD-663; P. O. Box 52027; Durham, NC 27717-2027. You can also find show #663 on this web site.

Kids don’t automatically outgrow ADD. Many adults have a history of inconsistent performance and underachievement. They too can benefit from sleep, exercise, diet and appropriate structure in their daily routines.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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(I love your analogy, Helen — “like taking the Challenger to Pluto and back on one tank of gas.” So true!)
Oh yes, I’m familiar with grandmothers such as this.
Often, they are in denial about their grandchild’s valid medical condition. This is typically because they have ADHD themselves and think it is “normal” childhood behavior. In other words, they lack objectivity.
Some also have Oppositional Defiance Disorder, which is highly associated with ADHD. In other words, they live to oppose — what the school says, what the doctor says, what the non-ADHD parent says, what that awful person their child married says.
This grandmother is obviously not in a position to judge whether or not the child has ADHD, and neither is her psychologist-friend.
In her defense, perhaps the child’s medication was causing unnecessary side effects. This, unfortunately, is too often the case. Sites like this should be helping people understand the proper use of these medications, in my opinion, not reinforcing harmful myths.
As for “structure,” yes, I’ve met many parents who tried only that strategy in helping their children with ADHD. I meet them when their children go off to college — and flunk out. Or when their children try to keep a job and live on their own. These parents are desperate — and often kicking themselves that they were so naive and squandered so many chances to help their child in previous years.
These parents provided all the structure and their children never learned to provide it for themselves. Medication can help a person with ADHD provide their own structure. But some who start treatment only as adults find there are some lessons in life that will be hard, if not impossible, to learn at a later age.
Also, it’s important to remember that treating ADHD is not just about improving schoolwork. It’s about maintaining friendships, driving safely, avoiding unintended pregnancies and sexually transmitted diseases, avoiding bankruptcy, not developing substance use disorders, and more. (Yes, all those adverse events occur at a higher rate among adults with untreated ADHD.)
As preeminent ADHD expert Russell Barkley points out, ADHD is even more impairing in adulthood than it is in childhood. There are many more taxing areas of responsibility, including raising children.
Gina Pera, author
Is It You, Me, or Adult A.D.D.?

My Daughter 25 years ago diagnosed with ADD, after many many tests. We choose not to use drugs and so very glad we did not. We stayed structured a very dedicated routine, sleep and eating and daily vitamins. We actually took an active part in our child’s life and MADE the educational authorities take an active part, yes she is still ADD in Math and English but over all she has excelled and still excelling. She has just learned to compensate for her short comings and still no drugs.

To FS, apparently whomever diagnosed your son, did so incorrectly and should be flogged. Sadly, when I was his age I was not blessed with knowing why I was scoring so low and why I couldn’t sit still. I did as everyone told me to and yet, it was never good enough. Being quiet and sitting still……Now there was another matter…to this day even though I take Ritalin for my ADHD/ADD, I have problems squirming when the situation requires I sit still.
For me finding out about having ADHD/ADD at the ripe old age of 36 has been one of God’s Greatest Blessings in my life and I feel compelled to share the knowledge of this blessing. I also understand that to the detrement of this wonderful, different way of learning and hence teaching (which is something I enjoy finding ADHD/ADD students in chemistry classes I am priviledged to teach) WAY too many children are “diagnosed and drugged” when a creative rather than a LAZY or a teacher having no idea of how to gain that initial control of her class, whines loudly enough to infer a child is ADHD/ADD when all the teacher needs to do is learn the “tone” of her class and teach to that and discipline accordingly.
Teachers wanting children of that age to sit still and “shut up” in my humble opinion are themselves, lazy and ignorant and should be replaced with those who understand what teaching is and paid enough to keep them in the public school systems. I would happily teach in our public school systems in SC however, I feel the pay for teachers is so far below what they have to put up with and the fact they don’t receive and should receive combat pay, is horrndous.
Many blessing to your son in his endeavors in his education!!
As for this article….its rather difficult to “outgrow” a genetic gift handed down from the generations of a person’s genetic coding, the authors and researchers might want to go bank and take or re-take a simple undergraduate genetics course, I can suggest College of Charleston, in Charleston, SC as having one of the best genetics courses in the southeast. I sorely wished at one time your ideas of discipline, diet, sleep, etc., had been the truth. Those ideas are so far from the answer, its like taking the Challenger to Pluto and back on one tank of gas.

My son was diagnosed with ADHD in the 3rd grade. His teacher wanted the kids to all follow her directions, to sit down, and to shut up. My son wasn’t in the same mind set at that time.
I was persuaded to give him drugs. The drugs made things worse. One made him so hyper he couldn’t sleep at night. We tried one new wonder drug after the other. As the boy grew the Dr. would increase the dose until the poor kid was sleeping through his classes and pretty much all day long.
For five years he was under the influence of mind altering drugs. At age twelve my son opted to wean himself off the drugs. He was the ‘smart one’ here. He was so much wiser than his mother.
After getting the drugs out of his system he has gone from d’s to A’s and B’s. That very year he was awarded the outstanding English student award. He has a great group of friends and is now participation in extracurricular activities.

I am an ADD/ADHD adult. I was floored when I read the flippant tone with which this article was written. I was diagnosed FINALLY at the age of 36 and put straight on medication. At the time, I had 7 years of sobriety; in a few short months I hope to celebrate 22 years of sobriety. When I was first put on Ritalin, I was told everything. “Caring friends” in the AA program rushed up to tell me how “addictive” this drug is. I have found that I tend more to forget to take a dose, rather than to “Jones” for it every 4 hours. I take Ritalin Holidays several times a year when I am not working in a job position that requires my utmost concetration. Strangely I am not counting down the days, minutes, hours or seconds until I can take my first dose after a holiday.
I would like to address a couple of postings above about being ADD/HD and its connection to bipolarity. Pretty buzzword for Manic-depressive diagnosis, or shall I say PC for the condition. I ask that you please not draw such a conclusion without considerably more study in both areas and find a very certain path from the former to the latter.
As for good routines of plenty of sleep, proper diet, plenty of exercise, etc., I haven’t found ANYONE that it doesn’t benefit.

This is the caring grandmother referred to in this article. My original letter to People’s Pharmacy stated nothing about stopping ADD drugs. What I stopped were allergy drugs and then noticed my grandson’s ‘ADD’ disappeared. My comments were taken completely out of context for this newspaper column.

I was alarmed to see that this obviously caring grandmother had stopped her grandson’s medication abruptly. Stopping anyone’s medication abruptly without consulting with the person’s treating physician is extremely dangerous. I have stopped taking Adderall after having been on it for some time, but only after I asked my physician if I needed to “taper” off of my high dose, or if it was okay to just stop taking it. With many other medications, it may not be okay. Please let this grandmother know that she could have harmed her precious grandson without knowing why.

According to the Krames MedMedia pamphlets re: bipolar disorder, patients with that diagnosis are to avoid disrupted routine, get adequate sleep, avoid stress, eat well and be active. Also, many children diagnosed with ADD/ADHD are later found to have bipolar disorder.

I really appreciated your pointing out the importance of sleep, exercise, diet, and structure in treating ADHD and ADD. These same lifestyle factors are important in treating bipolar disorder too in addition to medication, but one rarely sees them mentioned in conjunction with bipolar disorder.

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