Have others heard of this new test?

Headline: Pearson’s Quotient® ADHD Test Shown to Detect “ADHD Fakers”, October 1, 2013
link - http://www.pearsoned.com/

This is the way it is touted on pearson's website. The headline itself sounds harsh, negative, even accusatory and adversarial. The tone of the article is the same.

Anyone attending the U.S. Psychiatric and Mental Health Congress 2013 in Las Vegas, NV today (October 1, 2013) or tomorrow, as mentioned in the article? Have thoughts to share?

While it is wise to avoid any potential overuse and abuse of controlled substances which may be used to treat ADHD, many have become aware of the possible misdiagnosis and dual diagnoses among the gifted, thanks to SENG (www.sengifted.org) which has presented information framed in a loving, supportive, liberating, and eye-opening context.

Links -
1) youtube Webb at UW-Madison
2) book http://www.greatpotentialpress.com/misdiagnosis-and-dual-diagnoses-of-gifted-children-and-adults
3) article http://www.davidsongifted.org/db/Articles_id_10308.aspx
4) youtube video http://www.youtube.com/user/SENGchannel?feature=watch

Ugh.


Well, given what I've personally seen with Pearson's much-touted (or is that "self-aggrandized") testing supremacy...


I don't buy it. There's no bright line here between "normal" and "impaired."

Well, I also don't buy that ANY behavioral 'evaluation' is ever going to be completely capable of teasing this one apart, but that's probably my own biases talking.

I'm also firmly of the belief that much of what IS diagnosed as AD(H)D in this country and many others is asynchrony which is temporary, and that pharmacology is applying a permanent solution to what is inherently not really even a major LIMITATION in the right circumstances for those children...

Because sure, one can look (with fMRI and PET) at ADULTS who have persistent executive deficits and tell them from nt controls, but the picture is WAY less clear when you look at "mild" impairment, or in immature subjects. Bottom line is that administering stimulants to immature brains may well leave them dependent for a lifetime. That's one facet of the pharmacology there that most clinicians simply do not grasp. It's certainly true in rats, though; if you chronically administer (even short term) stimulants that impact the biogenic amine transport system, there is PERMANENT re-regulation in that system's transporter expression, kinetics, and in receptors. Permanent as in those brains are conditioned to respond more robustly to those stimulants (regardless of mode of administration) and to exist in an altered state at baseline.

There's also the pesky fact that it's a myth that stimulants don't have the same effect on everyone's neurochemistry. If that were true, then coffee in the morning would only be helpful for about 20% of the population, at MOST. Clearly not so. There's a reason why these are "study drugs" and frankly, with respect to testing, they are performance enhancing drugs. Just like steroids or growth hormone, there is a place for them in legitimate medical treatment... but there is also GROSS misuse.



It makes me very angry that childhood institutions have become so inflexible about actually giving more than lip service to (neuro)diversity that such measures seem to be the only real solutions for many parents when faced with kids whose executive function development is behind the curve of "average and above" agemates.

I don't think that pathologizing not-quite-in-the-box development is the answer, in other words-- but I'm so not on board with Pearson's apparent tactic of victim-blaming, either.

Parents aren't DECIDING to label their kids because they're too lazy or negligent to do anything better for them. Sheesh. Most kids who are medicated are simply reaching the endpoint of years of struggling to find another way to cope with inappropriate demands.

Maybe the system IS the problem here, and not the solution, eh?

I don't think anyone can have a strong opinion about ADHD and medicating or not medicating unless they actually have a kid with the disorder and see the effects. I don't know what the situation is with HowlerKarma, but I have run into a shocking number of judgmental people who know next to nothing about ADHD, have not lived with it, but still have an opinion about medicating vs. not medicating. I have a kid with ADHD. It is immediately and obviously apparent when she is or is not on medication. When she isn't, her ability to focus her thoughts and stay on task is at about the same level as it was when she was 4 (she is now almost 8)--she hasn't matured one bit in that area. I am hoping that when she hits adolescence, maybe whatever part of her brain is misfiring will "catch up" or "mature" or whatever the appropriate term might be. But until then, there is simply no way she can learn or work towards her potential. Even here at home with no distractions, if she is not medicated and I have her try to learn math facts on the computer she dissolves into tears. But she is, for the most part, fine when she is medicated. What does it do to a child's self-esteem to not be able to perform certain mental tasks that other people take for granted? So it would be a punishment and a crime (IMO) to deny her something that so clearly helps her. I don't see any major "inappropriate demands". I think it's completely reasonable to expect an 8 year old to stay in their seat for 20-30 min. at a time rather than turn somersaults across the classroom or sprint down the hallway, to draw a picture, write a few sentences, and learn basic math facts. Without medication, I'm not sure if DD would do much of anything in school except get extremely annoyed at every other student that makes the slightest noise. Maybe there are inappropriate demands placed on kindergartners expected to sit still in their chair and cut and write. And there is still a lot of maturity happening at age 5. But most kindergartners are too young to be diagnosed anyway.

It irks me that people without ADHD abuse these substances and use them just so they can stay awake and study for a test, when there are people with an actual brain disorder. And every month I have to go in and get a paper prescription for DD and run around (or call) trying to track down the drug that she needs. If there was actually a way to easily detect the "fakers" that would make it easier for those who do actually have the disorder. I wish there was a simple brain scan or blood test that said "yes" or "no"--then maybe I wouldn't have to argue with everyone about whether this is a) a real disorder and b) whether I'm harming my child by medicating.

Okay--I think Pearson is to be viewed with some skepticism here given their potential motives. But I do think this is a real problem. In particular, high school and college students fake ADHD to obtain and resell the meds. We need better diagnostic tools...though I also agree that the system is to blame for some (many?) ADHD misdiagnoses.

I think that everyone wishes that, Blackcat.

My "situation" (as you put it) is that I got an advanced degree investigating the changes in midbrain neurochemistry initiated by the administration of a variety of drugs of abuse. So I do know that what I'm saying is factually correct with respect to the molecular neuroscience at work behind the pharmacology. I also have a basis for my opinion which is neither personal nor anecdotal.

I'm not suggesting-- at all-- that it's "abusive" to medicate children who clearly require intervention. That's not my place, and I truly-- in spite of many parents' (understandable) defensiveness on the subject-- don't judge those parents who DO opt to medicate children so that they are functional while they are children. I agree that waiting it out isn't always an option. I find many of those situations to be heartbreaking-- but I definitely don't think that it's bad parenting or anything else but biological misfortune at work. I don't really judge parenting (in general) on the basis of child behaviors unless I've seen enough examples of poor management/coping to warrant concern.

What I am saying is that there is not an "undo" on medicating with any of the drugs that treat ADHD/ADD. They really do cause permanent regulatory changes in the reward and learning centers in the brain. Does this set up kids who have been medicated to be dependent upon those same drugs as adults? I'd consider that (professionally) to be a distinct possibility, based on what I know.

Maybe that's a price that parents feel okay paying, and maybe some of them don't KNOW that this is a thing they are choosing. Clinicians sure sell AD(H)D meds as harmless-- and they most certainly are not. THAT is my axe to grind on this subject. Nothing more and nothing less. I personally feel increasingly convinced that general practitioners probably ought not be prescribing drugs with this kind of addiction liability. But that's me.

My larger question is still-- WHO SAYS that "normal" 8yo children are capable of sitting still for 30 minutes? WHO SAYS-- and how do they actually know this is true? Maybe some kids just need a radically different kind of childhood than seems within reach for most families now...

Large motor breaks in primary school settings really have shifted dramatically over the past 40 years. Not all children can meet those expectations now, and I don't think that all of them have pathology as a reason why they can't. Why are so many more BOYS seemingly incapable of meeting "typical" expectations now? Used to be, it was girls who couldn't-- because they were not as aggressive by nature (or perhaps nurture) and schools were set up to favor that more aggressive/assertive, physical style. Times have changed.


I definitely think that ADH(H)D is real, and I wish that it WERE clear during childhood which of them SHOULD (versus should not) get medication. Some kids can have behavior which is truly extreme. In those kids, yes-- it is WAY clear that they are not anywhere near the center of the distribution. I just think that it is a distribution-- so not so clear where to draw the line at "dysfunction."

I actually agree with you on most points, blackcat. I'm sorry that your experiences with others judging your parenting have left you expecting judgment from others. My apologies if my post was unclear.

I think that Pearson's article is heinous.

PEARSON has NO business addressing the issue. PEARSON is a CORPORATION making money encouraging stuffing every child into the same box....pushing them down the road to the next grade stop and stuffing them into the next box. PEARSON needs to be STOPPED!!

Particularly objectionable terminology used in the Pearson write-up:

"malingered ADHD symptoms"

"detect individuals attempting to fake attention deficit hyperactivity disorder (ADHD)"

"fraudulently obtain controlled substances"

BARF.

More "information" from Pearson:

http://www.quotient-adhd.com/

Gosh, I wonder what Pearson's motivation was here? Anyone want to bet on whether or not they're offering this at cost? Or at least at a reasonable fee?

(I'd bet no, but that's me. I'd also bet that their tool is no better than anything else at ferreting out those determined to "fake" symptoms.)

I'll take that a step further and suggest, from my professional that specialists in psychiatry feel similarly. GPs operate best as a referral pathway to specialists.

Naturally, the idea of a test taking administrator condescending to suggest it is somehow an authority on AD(H)D--logically, a CHECK against psychiatrists and neurologists--is reprehensible at best, and potentially criminally negligent. Any bets when the first lawsuit will surface? I give the franchise a quarter before it implodes.

I hear what you're saying and would be interested in seeing research studies about these permanent brain changes that you're mentioning. But even if that's true, what is a parent to do, other than feel horrible? If I sent DD to school without meds, I think there's a strong possibility she would not pass the third grade, not to mention she would have the teacher "on her case" literally all day (doing what to her self esteem?). Even if we got her a 504, there would still be penalities. Instead of the focus being on her learning, it would be on her behavior and ability to get things done. She would not only not be doing any work, she would be a disciplinary problem. She may very well be one of those kids who just "gives up" and drops out of school in high school--a strong risk factor for kids with ADHD. But as it stands now, with her meds, she's at the top of her class, the teacher loves her, she's a star student. It's that dramatic. On the day that I sent her in without her patch (because I ran out), and only 1 ritalin pill, she started to decline at 10:30 AM. After that, she got no work done and spent half the day poking the kid who sits next to her. When I picked her up, all the teacher could do was drop exhausted into her seat, sigh and shake her head and say "meds." If meds just helped a kid minimally (or there were severe side effects), then I think parents would have reason to question it more. There are definitely pros and cons to weigh but I think sometimes people are so strongly anti-med, fearing that their child will be permanently damaged, that they fail to see how their child is damaged by NOT being medicated. One of my friends has a 6 year old who is gifted but has ADHD. The mother refuses to try medication. But the child needs a para for most of the school day just to keep him from running around yanking cords out of the wall or pushing down other children. He is constantly in trouble. Part of it IS the system, if a teacher has 25 other children to deal with and the only solution is to plop an unruly distracted ADHD kid into a timeout chair, but there has to be a balance and kids need to be able to sit still, do a reasonable amount of work, and listen long enough to learn. There also should be better ways to diagnose a kid and differentiate between those who are just active and immature (the stereotypical unruly boy) and those who do truly have ADHD.

The eye-tracking test that is being hyped for fake detection is one such non-subjective measure for attention. Fairly interesting reading: http://www.quotient-adhd.com/

Has anyone used cognitive behavioral therapy in coordination with drug interventions?

It is like any other medical intervention - there are risks. It is a matter of determining what the risks are of either medicating or not medicating and whether there are other options. But if you have a stressed lifestyle due to other kids and finances and are at the point where you are scared you will be fired because you have to go to the school so often and the doctor offers you a pill with the comment that lots of kids thank their parents for medicating them then ... We have the system we have and most people don't have an opt-out button they just do the best they can with what they have.

Wow! Definitely lined up for a lawsuit when their test for "fakers" falsely accuses someone...

I share the grave concerns that HK mentions. I fear the misdiagnoses especially among gifted boys that has been noted as well.

My husband's family has rampant ADD among multiple generations. It's one big ADD-fest with any family gathering which drives my excessive planning personality to utter frustration regularly. I live a life where I am the only non-ADDer in my household. There is no ADD on my side and it has been quite a learning curve for me.

When my child started exhibiting ADHD behaviors at 5, I had some idea of what I was in for. There were unfortunately also inappropriate expectations and environments at that time. However, ADD is highly heritable. We chose to go through an Amen Clinic to not only look at symptomology, family history, and computerized testing but also have scans of his brain both at concentration and at rest. There was no question that he showed classic ADHD patterns.

So we knew answers. I wish all children could have brain scans rather than behavioral checklist based diagnosis. Unfortunately the scans are expensive and often not covered by insurers.

One of the interesting thing about Amen's approach is that he is not anti-pharmaceutical but rather holds them as a last resort trying treatment through managing nutrient deficiencies first. I was surprised at how low my son's Iron and Vit D were in particular. We have had substantial improvement from supplementing and monitoring levels through blood testing. He is a different kid when his levels are right. We also have found food sensitivities which impact his ability to absorb the nutrients in his diet. He also uses different classes of drugs for different patterns (on scans) of ADD and has developed his methodology by looking at the RESULTS through taking future scans and seeing the change in brain activity.

I hope that the NIMH recent support of taking a more scientific approach to diagnosis and management rather than the checklist DSM model will bring more RESULTs and diagnostic tools. Pearson is clearly stepping backward to the approach that has been used for the past hundred years rather than embracing the future for verifiable diagnostic standards.

Blackcat-- Sorry your road has been a tough one with your daughters illness. I don't think those who have posted so far intend to criticize anyone's individual choices but rather look critically at a broken system that has left many parents with precious few options.

Thanks HappilyMom. My younger kid may also have ADHD (we're in the process of evaluating him), but if so, it's not obviously a huge handicap, so I would be much more cautious about medication. It is a broken system in terms of the diagnosis--all we had to do was fill out an inventory, get an inventory from the teacher, and we had a prescription for Concerta. When I asked about having DD go to a psychiatrist or neurologist for a diagnosis, I was told "that's not done around here--pediatricians handle it." Luckily in her case there is such a dramatic difference in functioning between meds and no meds, it is obvious she has ADHD and that she needs to be medicated. So I always get somewhat annoyed when I feel that someone is criticizing that. Her teacher last year was "anti-med" and since DD functions so well on her meds I always got the feeling the teacher thought we were medicating her just for fun and she doesn't really have a disorder. I needed feedback from her about the meds and whether they were helping and the communication was zero. I felt like sending her in without meds just to prove my point--yes, she does have ADHD, and Yes, she needs to be medicated or the consequences will be disastrous.

We live everyday with the judgement from teachers and family members as described by blackcat. And the fears of exactly what you are talking about HK. But honestly forget sitting at a desk for 30 mins, I consider the following to be reasonable expectations for a 7 yr old:

Parent "Child,"
Child looks up and makes eye contact
Parent "Go get dressed, I suggest jeans and a long sleeve tshirt"
Child either negotiates preferred clothing or says "Sure"
Child comes back dressed after no more than 5-10 mins
Parent "Great work, let's go..."

My 7 year old is not capable of dressing herself without medication. How is she supposed to grow into a well adjusted and functional adult, let alone one that fulfills her HG+ potential, when she's unable to follow basic one step instructions, succeed and enjoy her success and the positive interactions with other people that result from success?

And I also look at my DH and his family (the source of this particular issue in our family tree) and their "all things natural and therapeutic" approach to their complete executive dysfunction has not produced adults who don't need medication either. OMG. How does one assess whether a child grows into adulthood needing meds because they had those meds as a child or whether they were always going to need life long treatment? Oddly the women in my DHs family are an order of magnitude worse than the men, I wish my DH would actually take the medication that was prescribed only after he turned 40. But that pales in comparison to how much I wish his mother would acknowledge that she and all her sisters have a very real issue....

And then there's the bipolar in the family.... Is my 7 yr old more at risk for developing bipolar if we DO medicate her and she continues to succeed and thrive (because the medication messes with her brain)? Or if we do not medicate and she spends her life failing to succeed in the most basic tasks, feeling angry, anxious and frustrated and on the receiving end of constant adult frustration and social failure (she's not easy to be around off medication)? She's VERY like the close family member with severe bipolar....

I'm not a scientist, just a frightened parent and honestly I have no freaking idea. I can't even get her dressed off medication, I can't see how homeschooling would work of meds (she actually does better at school where, at least for now, she can copy all the other kids and the expectations are so low that she can still pass). But we hate medicating her, especially my DH.

Also, I get what you are saying that stimulants don't "only work for people who have ADHD", thats clearly just absurd, but on the flip side i do think what they do to people with and without ADHD is different. We have tried two children on Ritalin (because my eldest was incorrectly diagnosed with ADD before correctly being diagnosed with AS). Eldest child was maybe mildly different but it was certainly not clear enough to her, or us, that it was doing anything and we stopped pretty fast (2 weeks tops). Second child, who actually DOES have ADHD, she has the classic jaw dropping "OMG is this the same child?" response to medication, that medication worked for her was blindingly obvious right from the first half hr of the first tablet... Stimulants might make studying or staying awake easier for most folks but they don't radically change focus, bodily control, etc the way it does for my DD (who also can't reliably stay dry off medication, has radically different handwriting on and off medication, and various other things).

Not that I trust Pearson's motives here, because I don't. And BTW, don't they need FDA approval for this test? Sounds like a diagnostic test to me.

But: to be fair, as Ultramarina pointed out, the problem isn't kids. It's college students. They really do fake having ADHD as a way to get stimulant prescriptions. They take the meds when they need to stay up all night studying. Think of this approach as adderalling my way to success. Alternatively, there are also students who fake the symptoms so that they can sell adderall/ritalin/various stimulants. If you don't believe me, look at these search results for adderall college students. If you've never heard of this problem, you're in for a bit of a surprise.

And as HK has pointed out, these drugs aren't benign. For example, look at my basic search for adderall college students deaths. You'll find peer-reviewed papers among the results.

This is true ... I was shocked to find it somewhat common in law school. I didn't delve much into it personally b/c I am afraid of putting drugs in my body and "messing with my mind" (lol - yes I will mess slightly with my mind using a good bottle of wine, though... ha ha! I do contradict myself!) However, from what I gathered one person had adhd (legit apparently) and was "dealing." Not sure if he faked or was really legit but he was dealing his meds for exam time. When I was first practicing I had two good friends at my firm - one had failed the bar ... when she was studying for it a second time the other friend said she would get her adhd drugs from her father who was doc to use during the bar exam. I was freaked out by that, honestly.

Ooops just reading other posts now - I want to add that I do not think giving a person or child with true ADHD/ADD "messing" with their mind ... I only meant that in reference to me taking a drug for a disorder I don't have - that would be "messing"... Just do not want to belittle/hurt anyone who does have adhd/add in any way!

Right--as Val says, the abuse and resale of the meds is nothing to sneeze at. The NYT has done several pieces on it, if anyone is looking for some info.

I know of working people who use it when a project really HAS to get done.

Me too... I go back and forth with my DS - sometimes I think "yes" sometimes "no" it is hard to tell with his other issues causing similar symptoms. I'm sure my twin has undiagnosed/unmedicated ADHD and it has almost ruined much of his life... The entire family is in complete denial about it.

Totally agree with all of your points here! Good post!

Yep, that's what we see with DD, although very low doses of meds don't make much of a difference (or only last a couple hours). Adults who DON'T have ADHD talk about getting a high or ramped up feeling from stimulants, kind of like you'd get on high doses of caffeine, but DD acts "high" when she is not medicated (kind of like a happy drunk) and calm when she is. Does your DD have dysgraphia? I'm wondering if meds would somehow help DS with his handwriting (if he also has ADHD). I know a significant percentage of people with ADHD have handwriting issues.

While I am sure there must be SOME inappropriate use of stimulants in our universities, I get the impression it's not nearly to the same degree as what you guys are talking about. ADHD can only be diagnosed and medication prescribed by a specialist here, it's not trivial with a child, it's generally a months long multidisciplinary process with an adult (particularly young adults from what I can see)... Your local doctor can prescribe anti depressants (and anti anxiety meds too I think), but not stimulants.

It does seem unlikely that huge numbers of students are going to the effort and expense of getting themselves diagnosed incorrectly.

Er yes, puffin had made my point for me - it SHOULD be hard to get diagnosed and be prescribed medication for ADHD, but the pearson thing is just icky. Having stricter controls on who diagnoses/prescribes and how would surely be more effective? For us, even when seeing the appropriately qualified specialist they still have to call the government for permission to write the script, every single time "this is Dr X calling re script Y for patient Z, yes they were on a different medication/dose last time, reason ABC. Ok. thanks..." We listen to this every six months, more often when adjusting at the start. Questions were asked when multiple changes were made in a short while...

According to this article, there are schools where the abuse of stimulants is widespread. I wonder if there will someday be drug-testing for takers of standardized tests.

http://www.nytimes.com/2012/06/10/education/seeking-academic-edge-teenagers-abuse-stimulants.html
Risky Rise of the Good-Grade Pill
By ALAN SCHWARZ
New York Times
June 9, 2012

Yes; we use a blend of CBT and ABA methods alongside meds. It has been extremely helpful.

For some kids, meds do appear to be truly necessary for learning; the stigma of being "that kind of parent that just medicates their kid into submission" is real, and we feel it deeply; yet the stigma for the child of being "that child who behaves badly" is even worse.

By 2nd grade my elder child was convinced (by his teacher and his own observations of himself) that he was a bad person because he could not behave. This still makes my heart ache.

No easy answers here.

Thank you for sharing this article. While it is discouraging to learn of the widespread and ingrained nature of stimulant abuse, the implications may be far-reaching. For example, to the degree that stimulants are described as being the "culture" among wealthier families, might the abuse of controlled substances be part of the demographic "excellence gap" and the "achievement gap"?


Time to begin adding legal notice to standardized tests, managing expectations as to what the consequences will be for those who test positive? For those with Rx, there may also need to be a signed waiver allowing access to review the student's Dx & Rx history.


Sounds like the interviewed students, parents and doctors are looking for an easy out, as "pressure" does not necessarily encourage "abuse", it merely presents a circumstance which tests one's character, confidence, and ability. At best, pressure presents a temptation to cheat or game the system. Individuals acting in concert or alone still have choices.

Looks like William might be identifiable by mention of his school... unless there are many Williams there?

These data are from 2012:

Adderall made my DD who does actually have ADHD a little crazy. I cringe to think what it might do (at large doses) to someone who is "normal".

Some of the meds are more addictive than others. For instance the patch she is on now does not reach peak blood level concentrations til 9 hours after it is put on. It kicks in gradually and wears off gradually. So no one would get a high from it.

I would NOT agree with this statement.

I have heard parents even openly discussing doctor-shopping for a diagnosis in order to obtain accommodations for middle and high school students in order to enhance performance. They view it as being very much like hiring a tutor.

The real abuse problem in terms of the meds is on college campuses, though. It is ubiquitous, and has been for at least a decade. College kids think of these as "no different than coffee-- just more effective." They certainly are, and there seems to be little down side to those students, as they are able to do more with less sleep, retain information better due to increased focus, etc.

That's a MUCH better system.

Dee Dee's post is just so heartbreaking. No child should be made to feel "bad" like that.

I think it is so sad that whatever the choice a parent makes for their child with ADD(usually the dichotomy of drug or not drug) that so many others think it is their responsibility to share their own opinions despite the fact that your child is under the care of professionals with whom you are working to make informed appropriate treatment decisions.

It amazes me how so many can have so little information and such strong opinions that their belief is the only truth about ADD. I think it's one of those challenges that comes with so much baggage.... Beyond the medical debates, there are those who believe ADD is just poor parenting and that there is no disorder--just unruly child and indulgent parent(s). Parents of these children really need support and kindness. An ADD child is one of the most challenging children to parent well and most parents are...just...so...tired! The last thing those who live it need is yet another hurdle to getting help.


Irena, you would likely find Dr. Amen's Six Types of ADD book incredibly helpful and may be something you could share with family. It was life changing for us. I sent a copy to my inlaws and some undiagnosed in the family found themselves in this book realizing for the first time why they had challenges they had never understood.

Addiction is rampant with ADD and much destruction stems from that. Many use drugs, alcohol, or even addictive behaviors to self-medicate trying to just feel "normal". Others had used more healthful activities to manage their brains such as running or other intense exercise.

Interestingly enough, my husband was the last to recognize his own ADD (his family and I came to those conclusion much sooner) and it as well as how he had dealt with it are primary factors in our marriage issues.

Another terrific book we have read is ADD in Relationships also by Dr. Amen. My favorite title was Is It You, Is It Me or Adult ADD?...still make me giggle a bit.

Howler - I'm curious, were the changes you were speaking about in regards to stimulant medication only? Would you expect to/have you seen the same changes when dealing with non-stimulant ADHD medication?

We give DS9 Intuniv and it's been completely, 100% amazing for him. It seems to have a bit of an anti-anxiety effect as well as helping him control his impulses. But I know it's not a med that's been given to children for ADHD for an extended period of time, so I do wonder about the long-term effects on his brain. (In my son's case, not medication is 100% not an option. He'd have been institutionalized or harmed himself by now.)

Yes, I believe this happened with my twin. It is what really worries with regard to DS - seems like medication carries a big risk of addiction and non-medication in a case a true ADHD does as well. And I can't seem to get to a place where I am confident that he does indeed have it.


I will check this book out- Thanks!

epoh, in terms of medications in this class (meaning what they are prescribed for, mind) all of the selective reuptake inhibitors are pretty much the same from a mechanistic standpoint. They may differ in terms of transporter/receptor selectivity and off-rate, downstream metabolites, etc. But fundamentally, the mechanism is the same.

Each works to increase concentrations of post-synaptic biogenic amine neurotransmitter(s) in the midbrain, via blockade of transport of that transmitter substance, (or, in the one mechanistic exception, to prevent its metabolism as in MAOI's); it's functionally operating via the same mechanism as the rest if it sits in a site that would be occupied by the neurotransmitter and locks up the active site.

It's worth noting, as well, that chronic (or just repeated) usage of anything in this class readily leads to habituation in a regulatory sense-- the system is remarkably well-protected from manipulation, having multiple feedback loops that result in up-regulation when you block transport. The upshot is that "rests" from medication may result in potentiated symptoms-- because of the system's determination to circumvent the pharmacology you've been applying.

This includes Adderall, Ritalin, SSRI's like Prozac, Xanax, as well as drugs like cocaine (which is horrifying in terms of being non-selective, btw). Withdrawal from ANY of those drugs is known to be a nightmare filled with anhedonia-- it makes addiction treatment incredibly refractory, because every additional use is not only "reinforcement" through the pleasure/reward pathway, but also because the withdrawal produces a LESS pleasurable baseline than in an untreated brain.

Are those drugs all "stimulants?" Well, clinicians judge "stimulant" on common responses to the drugs. Pharmacologists and neuroscientists don't classify things that way. Some of those drugs have known cardiac liability, of course-- but that is because they are pharmacologically "dirty" and act at cardiac receptors the way some biogenic amines do. Consider the structure activity relationships involved in a transporter/receptor that responds to dopamine or seratonin (5-HT), and then look at epinephrine (adrenaline). ALL of these drugs are, mechanistically speaking, analogs of one or more of those amines, in some way shape or form. Those which act elsewhere in the CNS as adrenomimetics are "stimulants." Caffeine is the one that most people are familiar with, but first generation AD(H)D drugs are generally this sort, as well. Those that act that way ONLY in the midbrain are considered "non-stimulant" drugs, or second gen therapeutics.


In terms of addiction potential-- there really is a genetic component to one's personal risk there. I have no idea how that overlays with AD(H)D, but drugs which act in this particular pathway in the brain? Yeah-- there is a range, of course, but generally speaking, some relatively small percentage of primates will NEVER become "addicted" and some also small percentage are addicts from the first use. In between fall the majority, which require from 3-25 uses to become permanently altered. It's an epigenetic effect, in other words, when you're talking about stimulant addiction potential. Methamphetamine is one of the most well-known drugs in this respect, though I'm more familiar with the literature re: cocaine, which was mostly produced two decades (or more) ago. Some people can use casually with impunity (but there are very few of them)-- and most people can NOT do that. That is a bit outside my area of expertise-- my recollection is that behavioral researchers were pretty busy trying to tease apart markers for which group an animal test subject belonged with, back in the early 90's (at least with amphetamine and cocaine, which were that era's "study drugs" of choice).

Howler - Interesting. I was curious because Intuniv, in particular, is in a completely different class, from what I understand, than the drugs you listed. It was originally a blood pressure medicine, iirc. Wikipedia says it's a "selective α2A receptor agonist" which means pretty much nothing to me. I hated (and still hate) that I don't fully understand the two meds (Intuniv & Risperidone) that my son takes, and some of the side-effects and long-term effects are concerning... but on the flip side, without them he nearly landed in the psych ward, so.... I don't really feel I had a choice? The psychiatrist doesn't seem particularly concerned about the long-term effects, and the therapist is a big fan of Intuniv.. so I just keep going along for now.

Yeah-- that one IS a different class, but it's still ultimately tied into that biogenic amine system. The other thing worth noting is that the use of both is almost entirely empirical at this point-- there's little reason why it SHOULD work from a mechanistic standpoint, just that it seems to be a "lever" which can be used in therapeutic interventions. The up-side, of course, is that such levers may be few and far between, making these drugs MIRACLES for some individuals... and the down side, naturally, is that you don't really know what you're getting as a package deal with them down the road.

http://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptor

This is also a relatively new use for that class-- the link is reasonably non-technical and accurate so far as I can tell.

More specifically--
http://en.wikipedia.org/wiki/Guanfacine

I'm assuming that you have VERY close monitoring, but in the event that you don't-- I would really encourage you to be alert for some of the signs of the drug's other activity (most concerning are the hypotensive features).

Risperidone is better-understood from a mechanistic standpoint (at least kind of -- the receptor function/blockade has been well studied anyway, but that sheds little light on WHY it works)

http://en.wikipedia.org/wiki/Risperidone

http://en.wikipedia.org/wiki/Atypical_antipsychotic

That one is a receptor blocker, so it doesn't impact signalling in the same was as many SSRI's and ADHD meds, which serve to increase post-synaptic neurotransmitter concentrations and duration of signalling. But it's the same dopaminergic system, at any rate. This is where all anti-anxiety, anti-depressant, AD(H)D and most stimulant drugs of abuse act. Just different facets of that system.

DD was on tenex for a few weeks, which I believe is a short acting version of intuniv. I was really hoping that something "non-stimulant" would work for her (thinking it would be safer). It turned her into a literal zombie--she was not the slightest bit hyperactive but seemed to have no affect at all and looked like she was going to drop dead. She had zero focus, so it didn't help that at all. Her teacher called me alarmed, saying that she had never seen a child act like that before.
It's weird (and scary) how one drug can work so well for one kid and be a disaster for another. I wish I understood it better.

Thank you. I make it a point to never judge or criticize parents who medicate their kids, because I believe that each situation is unique, but HK clearly you and I are on the same page about this.

My DS9, never medicated and diagnosed with "severe" combined type ADHD is making massive improvements. Interestingly, we're only one month into this current school year and he's like a different kid - why? New teacher. Her teaching style suits his learning style. It's that simple.

Blackcat you have my sympathies... (and this is what I mean when I say I don't judge those who use medication). Every kid is different.

While your DD hasn't improved, my DS9 HAS (although at your DD's age he still struggled). He's now 9 yrs 3 months, and he will sit and do his homework from start to finish without any assistance. I generally try and have the TV turned off during homework time, but if DH is watching something, then DS will go into his room and do it. When I check on him, he is quietly working (and not distracted by his toys the way he used to be, lol).

His written output has dramatically improved. He can now sit, formulate his thoughts, and put them on paper (paragraphs!). He can also move from one task to the next with no assistance from me (although his teacher still has to prompt him at school - he's not a self starter, but once prompted, will sit and work). At home, if he has three items for homework, he will finish one, then move onto the second, then the third. I'm still trying to figure out who this impostor is and where my real son went, lol.

He's never been medicated (but we have gone through some struggles, let me tell you.. and it has tested my patience and persistence to the extreme).

He still has issues, let me tell you. He has trouble keeping his chair still and his feet on the floor at school (although his teacher says he is very good natured about being redirected). Do I wish he'd sit still? Of course. Do I believe he will learn to? YES. He used to chew on EVERYTHING - destroying shirts, eating pencils, etc etc, and now that has stopped... completely. He has had all these disruptive ADHD behaviours that are disappearing one by one, sans meds.

HOWEVER... not all kids progress the way that he has.

I'm on the opposite side of the fence in that I've had to justify why I haven't medicated, and I'm constantly having to recount examples of his growth and development without it.

I've just stuck to my guns, supporting what I think is a good fit for my particular child, which is all any of us can do.

glad to hear he has made progress without meds. Maybe there is hope and it's evidence that many kids eventually outgrow it, or at least develop coping methods. If we ever come to the point where DD doesn't seem to need meds in order to function, then we would obviously stop.

My DS9 wasn't either at 7 without constant nagging and micro managing, but now at 9 he's fantastic at managing his morning routine.

BUT... how did I know he would be? I had no crystal ball (wouldn't that be nice )

I didn't know... which is what makes this so hard for all of us. My decision to skip meds for him was based mostly on maternal instinct.

I firmly believe that (providing we're invested and emotionally connected parents) we all make the best decisions for our own kids, based on our knowledge of said kids combined with our own self awareness and past experiences.

The best thing parents can do for our children in cases like these is listen to the child and follow our own inner voice. There will always be critics and naysayers no matter what you decide.

I was told by a psychiatrist who specializes in ADHD that he has problems with parents seeking diagnoses where there really are none in order to get meds to improve their kids' grades. He also told me that there are adults who don't actually have the disorder who try to manipulate the system to get meds so they can function better at work (he specifically referred to "CEO's" and similar high ranking business people). This doc is nearing retirement and has seen this go on for many years.

I find that so chilling. Seriously.

Yeah... it bugged me quite a bit. I felt like quite the outlier. The doc said that I was "highly unusual" not wanting to medicate because he spends most of his time trying to talk parents (of the non-ADHDers or only mildly affected kids) out of it. My DS, meanwhile, has a combined type diagnosis that was initially described as "severe," so this doc was trying to talk me into it. It was a weird appointment. It was at our provincial children's hospital ADHD clinic, which I'd heard fantastic things about. I left not wanting to return.

Though I agree with most of what you've written on this thread, I have to disagree here. I haven't always made the best decisions regarding my kids. I make mistakes. Everyone does. And I think that being a parent who loves her kids and is invested in them doesn't mean that all my decisions are above reproach.

I agree that there will always be critics and naysayers, which is why I try to find evidence to support my decisions rather than relying only on an inner voice (which is often emotional rather than rational). If someone criticizes one of my actions and has reasonable evidence (rather than emotion), I try to listen. I have to overcome my initial negative feelings, but if the person is making reasonable points, I overcome them and listen.

Drugs that affect brain chemistry can be dangerous, especially to a developing mind . Here's a review about amphetamines. It's got plenty to say about neurotoxicity and also notes that questions about it haven't been adequately addressed. While sitting here on hold for a while, I've found that amphetamines damage brains. What I haven't found is a solid body of evidence defining how much, for how long, and in whom. Is it genes? Is it age? Both? Something else? No one knows. IMO, this is a bright light flashing BE CAREFUL in very big letters.

I'm not commenting on individual cases here because I don't know anything about the kids who've been discussed in this thread.

What I am saying is that US society's expectations of children have changed in the last 30 years, and that many changes expect too much of kids. This includes the lunacy of reduced recess and over-emphasis on standardized tests. IMO (and I'm far from alone here), it's far more likely that we're pathologizing normal childhood development rather than facing a sudden epidemic of ADHD.

CNN - when I say she can't dress herself I mean that I physically have to do it myself, usually after 10-15 minutes of trying to get her into doing it herself. And she's harder to dress than my 3 yr old because she doesn't pay enough attention to assist the process. She could dress herself perfectly at 2, when getting dressed was exciting, undies on the right way, zippers... It's not that she has motor or direction problems, it's attention.

I would consider that fairly normal. Getting dressed is just not very interesting.

But drugs are great if you need them but shouldn't be abused for non-medical reasons.

We have a somewhat more restrictive system. Being surrounded by water and having basically only one jurisdiction makes it harder to get stuff illicitly (not impossible as there are always ways to get around things) but it would require a lot of effort to get it through legal channels and most students are poor.

I don't think having to physically dress one's 7yo is normal, FWIW.

Having to remind them a few times, yes.

I have known several kids who were blatantly, obviously ADHD. DD had one in her K class who took about 40% of the teacher's time every day (he desperately needed an aide, but the school was a charter and everyone was in denial). I have known several where I thought--okay, yeah. I have known a LOT where the parents were going--could it be? And the teachers were saying--we feel there MAY be an issue...and everyone was going around in circles. None of these people have put their kids on meds because I run in very anti-med circles, but they've all at least considered it. Category 3 is very concerning to me, and it has included not only my child but the children of about 30-40% of my circle of friends, which seems WAY off. Just--how can that be?

I wonder what happens on meds with kids who do not really have ADHD? Is it just a mild difference, and what exact changes in behavior are there? In my ADHD kid, you can tell immediately whether she's had her meds or not. She calms way down.

I accidentally took a Concerta or Adderall one day instead of my own med (wasn't paying attention to what I was doing) and didn't notice any difference in how I felt.

Some days were like that with my DS, and others involved repeated reminders that culminated in yelling, and resulted in he and his sister being late for school. Both kids had horrible late records, but this has now been resolved.

I had several professionals tell me to medicate, and the school principal HOUNDED me for months and months. (Only my pediatrician was reluctant - she suspected that there were other things going on, and that DS was a bad candidate for stimulants because of his tics and the fact that he's underweight. She suggested Strattera in passing one day but agreed with me that we should wait).

I just couldn't bring myself to do it, even though one of my friend's kids is currently thriving on Strattera and did really well on Biphenton (similar to Concerta - methylphenidate). It just didn't feel right for my son... I can't explain why, nor can I judge or analyze different decisions made by other parents (lol - I've been made to feel like a bad, neglectful mom for not medicating, so I'm a little defensive - isn't it funny the way, at the end of the day, we're all in the same boat - under the microscope )

This is a really good question... I'd like a clear answer myself. According to a psychiatrist I saw, meds will improve focus for everyone. Yet our cousin's son has massive inattentive symptoms and tried ALL THREE classes (methylphenidate, amphetamines, and atomexatine) and NOTHING happened at all.

I think it varies from person to person... it must.

You're right in that we're all human and subject to making mistakes. I should have added that I also do massive amounts of research and consider many factors, so my decisions are not just based on emotions. I think the emotions come into play when I advocate for what I've decided.

This alone would be enough to deter me...

"This withdrawal effect is common. Adderall users often complain that they feel tired, "stupid," or depressed the day after. After running on overdrive, your body has to crash."

Hmmm, DD has had the exact opposite. She has been on Adderall and Concerta before (not at the same time), and there have been times when we either forgot to give her her pill or I ran out, or we just decided to stop and try something else at a later date. The effects have been awful. The day of the missed drug she starts to get "happy" and also has lost focus. But it's the second day that's really bizarre. She becomes euphoric (mind you, this is on no meds) and acts like a drunk person. And extremely hyperactive. It's like she's "on something" even though this is what happens when we take her off. I remember taking her to a store and she was shrieking with glee and everyone was staring at us. She was overly happy 10 times over. This is the opposite of what Adderall abusers say happens when they stop.
I do also have to say that both Adderall and Concerta seemed to make DD moody when she was on them, which is why we stopped them. She is doing great on Daytrana, even though chemically, it's the same stuff as Concerta. Adderall was the worst for DD--she seemed slightly neurotic or psychotic on it.
I'm not sure what would happen if we stopped the Daytrana patch, but I'm guessing in 2 days she would be euphoric and drunk, just like what happened with Concerta and Adderall.

Exactly, Ultramarina-- and most of the group that I've run into there has been offered meds. Okay, and when I say "offered" what I really mean is something more assertive. More like the "offer" that one sees in The Godfather. If you see what I mean.

It does seem true that most parents now (and I include myself among them) have no really clear idea just WHAT reasonably normal expectations are for kids at various ages. We rely on what seems situationally intended in terms of relative demands, and think that this automatically means that children SHOULD be able to meet them-- rather than the other way around.

We've lived in this stew of constant stimulation and distraction for so long that we probably don't appreciate how toxic that is for the development of executive skills in children. There IS evidence for it-- and anecdotally, most old-school elementary teachers have a one-sentence bit of advice for parents suspecting AD(H)D in young kids-- "No computer, no television, regular bedtime, add exercise; try it for a month." Video or other environmental inputs do have the ability to change cognition in developing brains.

My mother taught for 40 years and claims that about 85% of the kids she EVER saw with (actual) EF problems was more or less cured by one of the following:

a) better sleep/wake hygiene
b) complete, cold-turkey elimination of screen time
c) more regular, assertive, and consistent discipline at home.

She also claimed that most of the kids that landed in her classroom (which was the preferred one for ADHD students in particular) did NOT have anything "wrong" with them other than their own idiosyncratic development. It broke her heart that some of those kids already thought of themselves as "bad" by second grade. The vast majority found my mom's classroom (which was quiet, but highly structured) a supportive and nurturing environment. Their parents thought she was a miracle worker.

Having seen WHAT she did for those kids over a period of many, many years? She had "the touch" for little kids, true-- but she also didn't try to rigidly control them and never, ever expected MORE than a child was capable of delivering. She simply accepted that it wasn't the same thing for all 6-8yo children. She also shook her head at colleagues that didn't understand the value of games/large motor activities in the classroom, or who used shaming/berating or similar methods to try to "modify" kids who were, well-- children.

Her basic hypothesis was that children are now subjected to more chaotic home lives than EVER before-- that we don't have a daily "routine" anymore because of modern life. I see her point. Most of us have a schedule that varies by WEEK-- which is fine for adults, mostly, but maybe that isn't very healthy for many children. Maybe they need to more slowly expand the temporal variation in their lives to have it make sense. Otherwise, perhaps it requires too much mental energy and keeps them anxious/highly attuned to surroundings and less able to keep reserves for EF tasks.

It is true that the right "set point" there seems to be HUGE for some kids. It's almost like a unique OE.


I also think that some parents who medicate ought to be aware of the risks for not only psychosis (which is a known risk for 2-5% of stimulant users-- period), but also for other affective disorders.

Come to that, early bipolar CAN look like ADHD. It's a rare doctor that can accurately diagnose it in children, though-- and it's highly controversial AS a diagnosis in children.

Stimulants (regardless of mechanism) in bipolar people can definitely act as "triggers" for mood swings, or can even initiate the disorder to begin with, or make it more severe. This is a well-known thing. It's why people with atypical depression tend to be medicated VERY cautiously indeed-- because some of them may worsen abruptly and then go into mania when withdrawn from the med.

http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html
Ritalin Gone Wrong
By L. ALAN SROUFE
New York Times
January 28, 2012

I haven't read the study, just what is posted here, but maybe by 8 years, a lot of kids had outgrown the ADHD. So what happened to the kids that had seen an improvement on meds? Did they get worse after 3 years? I guess I don't understand the study.

This mania is what happens to DD if we take her off. But not right away. It takes a couple days. Do you have any links or anything that would help explain this? She has never had any signs of depression, but she has always been "spirited", like a lot of gifted children.

I don't think you're supposed to outgrow ADHD, are you?

I've read that study for work, I think. It's fairly damning, and there's some other stuff along the same lines, IIRC. Basically, the meds seem to reduce the problem behaviors and make life easier but somehow, they don't do much for long-term success. There are also some interesting findings re medicating and risk for drug and alcohol addiction--no difference either way.

However, there have been some other studies finding small positive effects on school performance. I don't think we have really conclusive evidence just yet.

Cognitive-behavioral therapy is looking better for ADHD, I believe? Diet has also been prtety convincingly shown to be a factor for many. Sleep issues are also thought to be an undiscovered factor for a lot of kids. Sleep is huge.

My understanding, based on the understanding of our team of professionals, is that meds without behavior therapy or other teaching supports get you a win on the day the child was medicated, but not necessarily long-term gains. Most kids who have ADHD can't access CBT or other behavior therapy without meds; the therapies themselves require some focus and self-awareness. But if you use the meds to get them able to work on the issues, and then actually do the work of CBT or other therapy, you get growth that matters.

YMMV, of course.

I'll see what I can dig up for you today.

One of the drug classes which is a known epigenetic trigger for affective dysfunction is steroids. Regardless of the reason for them, I mean. That one in particular I'm familiar with because I have a child that has both the right genetics for susceptibility, and also has occasionally fairly urgent need for steroids.

Here's one that is relatively recent, though I don't KNOW that I love the methodology here since I think it fails to account for genetic differences in the compared populations and also for differential diagnostic methods.

http://www.sciencedirect.com/science/article/pii/S0165032702001805

There is quite a lot of research in this particular area-- but I'll warn parents that this is some VERY frightening reading.

http://online.liebertpub.com/doi/abs/10.1089/104454603322163925

This is a very good review article (I highly recommend this one as a balanced and thorough examination of risk):

http://www.sciencedirect.com/science/article/pii/S0028390804001820

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898838/

If nothing else, I think that those amply demonstrate that these drugs that tweak the catecholamine neurotransmitter systems are complex things in terms of risk-benefit, and that it is FAR from clear what those risks and benefits are to any one individual.

Wikipedia tends to be my "go-to" place for trying to find unbiased info, and it says that the proportion of children meeting the criteria drops by half in the 3 years following diagnosis. So I would guess they either never had it in the first place, or they grew out of it (brain maturity or whatever).


"An 8 year follow up of children diagnosed with ADHD (combined type) found that they often have significant difficulties in adolescence, regardless of treatment or lack thereof.[120] In the US, less than 5 percent of individuals with ADHD get a college degree,[121] compared to 28 percent of the general population aged 25 years and older.[122] The proportion of children meeting criteria for ADHD drops by about half in the three years following the diagnosis and this occurs regardless of treatments used.[123][124] ADHD persists into adulthood in about 30 to 50 percent of cases."

HowlerKarma--thanks, I will take a look. As I said before, I'm not sure what I could do differently because she seems severely affected and non-functional in school when not on meds. But I still want to know what the risks are (as long as it is good solid research and doesn't just raise more questions than it answers). The "mania" when taken off is scary to me, although I think it only lasts a day or two. I thought Ritalin has been prescribed for years so why aren't there good studies of the long-term effects?

"Growing out of it" may be the wrong term. It's possible that they just grew up a bit. Kids develop at different rates.

Statistically, (based on heaps and heaps of stuff I've read over the past seven years) between 40-70% of childhood ADHD cases are outgrown.

(so... what does that mean, really? is it actually ADHD or misdiagnoses? ...and how scary is it that as many as 70% of ADHD cases could be misdiagnosed?)

...OR maybe kids really CAN outgrow it.

But if they are "outgrowing" it, doesn't that mean that it's, um...

how to say...

normal, developmentally, for those particular children? See, this is the same thing that I wonder with ASD. What if we're lumping all of these underlying etiologies together on the basis of SYMPTOM similarities? I mean, "shortness of breath" isn't always asthma, right? (In fact, it CAN be completely normal!!)

So what if "inattentiveness" and "poor follow-through" or "impulsivity" isn't dysfunction or at least not the same KIND of dysfunction in everyone, either?

Honestly, THAT is what bothers a lot of neuropharmacology people about pediatric psychopharmacology. There's a lot of tweaking of neurochemistry happening there, and we KNOW that it alters development in some specific ways... but what we DON'T know is what constitutes authentically "dysfunctional" in a mechanistic sense in that population to begin with.

Children are very difficult to study in placebo-controlled groups. The bar for ethics there is (rightly) extraordinarily high. So mostly, nobody knows what happens to the control group-- or to the experimental one-- because it's unclear right away whether or not physicians and parents are selecting different treatment options on the basis of something relevant to a different level of severity, a possible different underlying 'dysfunction' to begin with, etc. Some kids "outgrow" asthma, too, and others worsen-- dramatically-- even WITH treatment. Did they all have the same condition? Probably not.


As others have noted, the FLORID cases of out-there behavior, sure-- everyone can see that those are "non-NT" in some way, even if we don't always have any idea what it means in terms of brain activity or diagnostics.

Where there's no such bright line between yes/no, then maybe it isn't actually "disease" at work so much as some kind of spectrum. Maybe in the case of EF, it's (for the majority) a heritable developmental delay, and not a permanent impairment.

If one googles "Can you outgrow ADHD?" one gets "Probably not! and "Sometimes!" from a variety of reputable sources. Interesting.

It seems to me that a lot of these "outgrowing" incidents must be either misdiagnoses or children learning to compensate.

Yes, I tend to think along these lines as well. Or that it's a spectrum, like ASD. Actually, they're finding more and more ASD/ADHD overlap.

In the work Dr. Amen has done with SPECT imagining of brains, he has found the blood flow to the pre-frontal cortex (home of executive function in the brain) diminishes significantly when those with ADD focus on an activity. This is the opposite of how a neuro-typical brain responds. I saw it in my son's scans.

My child in particular has a type of ADD brain pattern on SPECT scans (Amen calls it ring of fire) that looks identical to a Manic/Depressive brain pattern. The Hyperactivity and impulsivity can be Mania rather than ADHD and lack of focus and lethargy can be depressive symptoms. They were careful to tease out whether DS had any depressive symptoms or ideation. I was told what HowlerKarma was sharing about Bipolar when discussing appropriate treatment at my son's psychiatrist's clinic.

I've read a bit about the "outgrowing it" theories for ADD/ADHD. The most plausible thing to me is the proposition that adults have more freedom to work out their own environments. An adult can choose a job with constant movement or take a walk down the hall or even buy a treadmill desk (have you seen these?). I've heard it suggested that ER doc was the ideal career for someone with ADD.

My husband (ADD) is a phenomenal multi-tasker. He also raises the adrenaline level by managing multiple clients on the side while maintaining a fulltime job. There's always someone needing something. Focusing on ONE job is death to him. He can't stay awake or get it done. In college he had 12hrs of classes and 12hrs of independent study when we started dating. He's never been medicated and he does frequently leave the milk out overnight and is horrendous at home maintenance tasks. If he had a job that didn't allow flex scheduling, he would certainly be fired. But as it is, in the environments he has chosen, he's been a mostly high functioning individual.

My BIL chose a career as a gym teacher and both he and my FIL include time to run each day which allows them to sit and work as needed.

Nutrition is huge as has been stated. Changes there (including therapeutic levels of vitamins and minerals) and with aerobic exercise, including choosing flexible environments make coping with adult ADD more manageable.

So many of you touched on these things I had to chime in with experience with our extended ADD family. It's been fascinating to me to learn about it.

I read one of Amen's books and wish I could get both of my kids a SPECT scan. Is that what they are talking about now in the news when they say there's now a brain scan for ADHD?

Studies that state medication does not work for ADHD seem absurd to me in light of our experiences with DD. When she's not medicated, she does things like smear poop on the wall like a 2 year old. Draw on the walls, sneak things, destroy things for no reason, etc. If I take her out, I fear she will run out into the road like a toddler and get hit by a car. If I put her on the computer and have her practice her math facts, she would do horribly without the meds but all of a sudden medicated, she can remember then all? When she's on meds no one would ever guess she has a disorder. It's that extreme. I suspect that in extreme cases of ADHD, the meds unquestionably benefit most kids but they don't make nearly as much difference in those with mild ADHD (and it's probably not worth the risk to use them). The mild cases are also probably the kids that appear Ok after 3 years because they've "outgrown" it.

I was thinking about the routine or lack of it nowadays. When we were kids we got up at the same time every week day, we ate the same breakfast, biked or walked half a mile to school, had a school day that was mostly the same every day and when there were trips etc we knew in advance, we had classrooms where you worked quietly by yourself and exercise every day, then we biked or walked home had something to eat and played outside until teatime. We did no outside activities, we never went grocery shopping or on errands (it was done while we were at school). We went to bed the same time with the same routine every night except Saturday when were allowed to stay up until 8.30. We had no TV and no computer. My little brother was still on the hyper side but not in trouble just tiring at tines. My kids have such a different life.

puffin, that is the exact same thing that has occurred to me.

Just the level of noise input alone is phenomenally different.

Compared to my childhood (which was chaotic since I lived in a highly dysfunctional home), my daughter's life is a veritable CIRCUS of chaos from day to day. It must have seemed almost random to her until she was 10 or 11.

It is easy to think that these neurological disorders are caused by environment to a great extent; and some studies show that true deprivation does cause problems in brain development that look like ADHD.

However, this kind of claim often moves over imperceptibly but surely into blaming the parents for not providing a proper environment for the child. We were once told by a well-meaning psychologist that if we were doing time-outs properly, our DS would not have the difficulties he was having (not unlike all the docs in the 1950s who blamed autism on the "refrigerator mothers"). We were "doing them properly"; they were simply not what DS needed for learning.

Our household was quite calm in my children's early days, no TV, not a lot of hustle; and yet they became neurologically interesting. Ah, well. I'm probably doing it wrong some other way.

Not in my book, Dee Dee... what I mean is that we can only shield them from such radical changes in the larger world to quite a small degree, when you get right down to it.

As parents we only control so much of their environment.

I'm not sure of that. There have been a few who have found markers for ADD. I think some of the first work was done at Univ. of TN in Knoxville with EEGs. Amen mentioned this study inspiring him. He often says Psychiatrists are the only doctors who never look at the organ they treat.

What I most respect about Amen's work is that he was HIGHLY motivated to pursue better diagnostics and treatment because his wife and children suffered from it. He's lived it and is sympathetic. He is also not ANTI med. For some it is the best choice. He just doesn't START with drug trials. He starts with diagnostics like blood tests, computer testing, and SPECT scans in addition to extensive history. Those results determine the plan. Rather than try this drug, come back in a few weeks and we'll see how it goes. IF you can get the results you need through diet, exercise, biofeedback, vitamins, supplements, etc than certainly with the risks of medication it would be good to have that option available.

It is expensive to do the SPECT scans. I've seen them run about $1000 to $1200 each and insurance doesn't often cover it. For us, we thought we could easily spend that in psych bills trying to chase down solutions and diagnoses... My husband and I are considering saving for him to get his brain scanned as well. We know he has potential brain damage affecting him from a concussion as a teen. The full work up and follow up is about $3k plus we have to travel to get to one of the clinics. Knowing how helpful it was for my son it seems worth it to us.

I think the length and depth of this post is a testament to the passion and complexity of dealing with ADHD and its increasingly frequent diagnosis.

Our life feels chaotic to me, but particularly in term time our weeks are VERY consistent, DH travels a bit, but the kids have consistent sleep/wake, exact same morning routine every day (down to the same food), exact same chore / work expectations. School is predictable... We have after school activities mon-wed, but they are extremely consistent and generally only the child with the lesson goes out, the others play at home. They have more screen time than ideal. Could we be more perfect at discipline? Yep, sure could, I know I was spectacularly good at thinking before I spoke, carefully formulating consequences and absolute follow through when I had only one child and no health problems of my own. But still we have higher expectations and enforcement than much of what I see around us. And still we have a child with AS and one with ADHD.... Our biggest variability is endless Dr/psych/OT appts. And our chaos and struggles are almost always about just how hard it is to keep these kids organised and on time and looking "functional/normal" in their interactions with the world.

Oh and all the kids are on different, needs based, strictly controlled diets that help them enormously.

My youngest has the most variability in her days (two preschools, a nanny one day and ballet one day, every morning she asks "What am I doing today?"), she's my most NT child and LOVES this, she's always happy to be going somewhere (painfully extroverted) and is generally a happy easy child, she's well behaved, socially/emotionally delightful, gifted & funny - daycare and preschool LOVE her... And really she's received our "worst" parenting and most chaotic start to life. Despite my being less "on" as a parent she's my first child to make it to 3 without needing minor surgery for a facial injury, never has accident reports from daycare, doesn't throw herself into 6 feet of water for fun, or climb inappropriate things, break things, etc...it's astonishing how often you get those looks for being such a crap parent to a difficult-to-parent-child when in fact you work SO much harder for that child than the easy child... Noone blames my bad parenting and chaotic life for how friendly, happy, easy and delightful my third child is...

The presence of this item on the American Community Survey (ACS) of the Census Bureau may be reflective of ADHD as well?
Other questions ask about difficulty dressing or bathing... and for those 15+, doing errands alone such as visiting a doctor's office or shopping?

Indigo I think questions like that are aimed at any of a plethora of problems, sure ADHD is on the list, but probably low down compared to RA, MS, Dementia, severe panic disorders, etc. the adults I know with ADHD forget things, screw things up out of sync with intellect, take ages to get some things done (super speedy with others), etc. But they generally CAN do the grocery shopping, even if they are slower and less reliable than someone without ADHD. As compared to someone who physically can't push a trolley, drive a car, whatever...

Those adults that I know who have truly severe AD(H)D, though-- they COULD have trouble with routine daily tasks if they are unmedicated.

Would you trust such a person to-- pick up a child's prescription from the pharmacy (assuming that it was URGENTLY needed, I mean)?

Probably not-- you'd scaffold reminders, or maybe ask someone else to do those critical tasks. NO WAY could that person do my household's grocery shopping, because that IS such a critical task.

So different kinds of disability produce different impacts on the tasks associated with daily life-- but that doesn't make the impairment "less" on some magical scale of disability. After all, someone who has a chronic medical condition and drives a cab in a large city is far more impaired by AD(H)D than a creative artist who lives off the grid and on their own, and does not drive.

It's hard, because many hidden disabilities require an answer of "yes, probably the person could be reasonably independent...as long as nothing unexpected goes WRONG..."

I have been following this thread with interest and felt compelled to add a couple of thoughts.

First, in response to the idea that ADHD stimulant meds are addictive, all but one of the recent longitudinal studies based on human subjects (would insert link here but can't get full screen reply to work) actually indicate that these meds are effect-neutral or might even offer slight protection from addiction. People with ADHD are more likely to develop addiction with or without medication than an NT population. However, studies that compare ADHD medicated and unmedicated groups over time have found use of stimulant meds to have no effect or sometimes a positive effect.

These studies theorize that stimulant medication actually brings the low dopamine production and transport in the ADHD brain closer to "normal" levels. Unlike drugs of abuse, ADHD meds are low dose and usually slow release so that the dopamine rush of drug abuse does not occur. The scientists hypothesize that medicated kids might be less likely to self-medicate their brains with drugs of abuse if they are properly medicated. Also, ADHD people on medication have better impulse control, fewer behavior problems and higher self-esteem, all of which help them avoid drug abuse.

My admittedly limited, nonscientist understanding of the effect of stimulant drug abuse on the brain is that the repeated dopamine rush of drug abuse causes the brain to produce more dopamine receptors. These extra receptors then must have a regular diet of dopamine that the body can't produce. At that point the person has developed a physical addiction to the drug and feels sick without it. I know what I have just described is not perfectly scientifically accurate but is how it has been explained at a recent conference on the neuroscience of addiction that I attended.

I have read that the rat studies on the effects of stimulants on the brain use amounts of meds that are large multiples of the treatment dose that would be given to a human for ADHD. The rats also don't have ADHD presumably. I would be very cautious about extrapolating such studies to humans.

The reason why I feel compelled to add my sadly superficial and bowdlerized summary above is the ongoing, unrelenting explicit and implicit societal messages faced by parents that we are harming our ADHD kids by medicating them. Almost all of the studies specific to ADHD populations don't support that.

My DS12 has ADHD. His manifestation of ADHD is not nearly as behaviorally severe as some kids I have read on this thread. However, he could not function academically at school without the medication. Worse, he would be a social outcast as well. His impulsiveness, continual overtalking and trying to answer every question, inability to follow rules or pick up the unwritten rules that govern kids' interactions . . . all of these things made him a complete outcast in kindergarten. When he is medicated he is much better but still struggles with impulse control. He has no real friends but he is not ostracized like he was in kindergarten.

ADHD is not simply an issue of wiggling too much in your seat. I expect that those parents who chimed about this never meant to imply such a thing. However, when several people write in that our classrooms are too restrictive (and this is true!) and this leads to more false ADHD diagnoses, it makes me feel that the people who are writing don't understand the full spectrum and impact of ADHD outside of sitting still in a seat. It profoundly affects every aspect of your child's life. The academic impact is actually just a small part of it. There is also occasional crazy emotional dysregulation, constant low-grade anxiety, hyperfocus on undesirable activities, impact on family dynamics, unhappiness at being "different" . . . I could just go on and on. Every day is a struggle, honestly.

I read this board every day and know that none of you are judging or condemning any of the rest of us. You all seem like nice, interesting, thoughtful people. However, ADHD diagnoses have been so consistently judged and minimized that when I read about a more flexible classroom leading to less ADHD diagnosis it feels like you are saying that some parents of ADHD kids are complicit in expecting too much of their kids. Maybe there are such parents. I just haven't met any.

I remember when DS started 5th grade, his teacher told me with a sigh during the first week that three ADHD kids were trying no meds this year in her class. She said "It's just not working but they are going to have to figure it out." This is a teacher that freely allowed kids to move around and sit on the floor to work, gave quizzes using a transponder system, used Google docs for turning in papers to minimize lost papers-she GOT it. She had a flexible classroom. But all those kids were back on their meds by October. ADHD kids and their parents who really need medication don't want to medicate but really have no choice no matter what the classroom is like.

I've been doing a bit of reading on the web and have discovered that Dr. Daniel Amen has received a fair bit of criticism from organizations like Quackwatch and Science Based Medicine. Here's a summary of criticisms.

Also, the National Institute of Mental Health describes SPECT scans for ADHD as not ready for prime time:


If I was investigating ADHD and my child, I would exercise extreme caution with SPECT scans and doctors who have been heavily criticized. As in, I would do a ton of reading with a skeptical eye and probably consult people with very good reputations in the field and absolutely nothing to gain financially from the scans.

And on another note, I can confirm with others who have written that there is truly a tsunami of stimulant abuse for academic purposes amongst college kids. This probably goes hand-in-hand with the purposeful resume padding rampant among competitive college bound high school kids. It's all about the grade/activity on the piece of paper, not about your actual interests and passions or learning to think, explore the world of ideas and start to grow into the adult you want to be. Sad.

The point being that the government may check for consistency between data held by various agencies and the ACS responses for each particular family member.


Use of the word trolley in this context is not typical "American" English, therefore I will ask whether you are in the US and have completed or may become subject to the American Community Survey (ACS) of the Census Bureau?

Agreed.

I don't think environment causes ADHD (sorry that isn't what I meant) I just meant that for kids who have issues the environment must be harder to manage nowadays. My brother would have fed on it and probably become even more hyper, I simply could not have functioned very well in todays classrooms (although there are certain improvements that would be better for my anxiety methods). I also think the amount of time we spent outside must have meant parenting was easier. And I had a SAHM so unlike me she wasn't trying to do housework while the kids weed watching TV.

Right-- the lifestyle that many 40+ yo adults recall from childhood was FAR more accessible then than it is now for most segments of the SES.

NOW, a "kinder, gentler" and more low-key approach is often just completely out of reach financially for parents who require two incomes. But childcare requirements and all the accoutrements of that lifestyle come as a package deal with all sorts of other influences that those parents might well choose differently-- if they COULD, that is.

Similarly, not all parents have the means for private schooling, or quiet, safe neighborhoods.

My ADHD DD actually drew a diagram on a whiteboard this morning indicating her ideal seat arrangement so that "distracting" kids are not surrounding her. She says that she can't get people to stop talking and humming, esp. the boys (although there are a few distracting girls as well). Even in third grade, the teacher has the desks arranged in clusters so there is always someone 6 inches away (usually on both sides) and directly across facing her. I asked DD if they are even allowed to talk to each other and she said "just at morning break". But of course all the kids talk and make noises anyway, so she can't get away. Why in the world arrange desks this way if they not supposed to be talking to each other? Teachers should be aware that most classrooms are going to have at least 1-2 ADHD children, so why set it up for them to fail?
They probably don't have room to set the class up any other way, with 26 kids in the tiny classroom that was probably designed for about 18. Sigh.

Thank you. Your entire post was helpful to me and you said it much better than I could have.

Honestly, blackcat, that arrangement sounds like a recipe for distraction for about the bottom half of kids in that age group-- just from a normal development standpoint.

What is the teacher THINKING??

I don't know, but so far my kids (4th grade and kindergarten) have been in exactly this arrangement for every class in elementary school, both public and private. So she may not be "thinking" at all - just doing what everyone else does.

Also-- fwtxmom's executive summary of the neurobiology and neuropharmacology is not entirely correct, nuanced, or complete-- from my perspective as a neuroscientist with a great deal of experience IN that particular dopaminergic system, I mean.

I don't want her to feel attacked, though-- and truthfully, her assertions are not nearly so inaccurate as many I've seen over the years--

so I'm keeping my mouth shut and not deconstructing the post. But I do want to be clear that my lack of response does NOT signify complete agreement with that summary.

I've posted it upstream and previously for those who are interested, though, and I'm not likely to change anyone's mind by belaboring the points.

(truly not trying to be hurtful or argumentative about this point)

Well, I guess it's fine if all you expect of "school" is social learning. Maybe that's it.

Yup. If I could I would home school but I can't so my kids get public school and day care. It is not ideal but it is life now. I should have emphasised i was a childof the70's in NZ so probably comparitive to the 50's in the US. And a lot of stuff has changed for the better just not that bit (although not having the option to work was pretty bad).

Just out of curiousity what would an American say (in case I visit), mundane things like that are not covered in TV programmes. Also that sort of question is probably common to many such forms in many countries.

and that sort of seating arrangement is the norm here. When we were kids our desks were in rows with spaces. You could poke your neighbour or anything without attracting attention. The main reason for the change seems to be it looks less old fashioned and more friendly to visiting parents and it makes it easier to share limited resources. I once watched kids do handwriting in a table for six kids - one of them was jiggling the table and preventing the others from writing properly. The teacher couldn't see from where she was. Another classroom I was in didn't have seating for all the kids, half of them sat on the floor with lapdesks for handwriting. A little difficult for the teacher who probably didn't supervise the one where she was required to crouch down ad much as the others. Our senior school (year 5/6) have just got "a modern learning environment". Ds6s teacher reckons it will suit him because he will be able to move round more, lounge on beanbags etc. I think half the kids will spend half their time moving around getting distracted but we will see. I need my own space so it would drive me crazy.

A metal shopping container with wheels is a "cart" in most of North America, but can be a "basket" in some regions.

That is a great question.

For the cultural differences in uses of the word "trolley", I believe the American expression in this context would be "cart" or "shopping cart". As in ... "someone physically unable to push a shopping cart."

To many Americans, a trolley is a mode of transportation. One might hear the terms trolley, trolley bus, trolley car, or cable car. Here is one of many possible links with pictures: http://www.cablecarclassics.com/

Often there may also be local differences in word usage. As an example: in some areas a carbonated soft drink is "soda", in other areas, "pop".

Hope this helps.

This is great, it shows she is being creative and also working in a problem-solving mode.


Excellent point, this type of desk arrangement is said to be for cooperative/collaborative work.

There have been studies on various desk arrangements including rows, clusters, circles/horseshoes(semi-circle or "U"), each for different purposes. You may wish to use a search engine to find examples of studies.

Way off the original topic, but DS' classroom is arranged in groups of four and it seems to be working quite well. The teacher also does a great deal of differentiated teaching, so my guess is that this arrangement makes it easier to go work with a small group without moving kids to another area of the room. She does rearrange kids every so often, which has me wondering what prompts the change (one boy is almost always with DS, but the others have varied).

Here's the thing with the desks, though. DD is in the gifted/talented "cluster group" with 3 other kids in her grade. There are 3 classes and all the cluster group kids were put together in the same class. It's district-wide policy starting in Grade 3 at all the elem. schools. But the seating arrangement doesn't have anything to do with that. Each desk group has a mix of kids of all different levels. It is now week 6 of school and DD doesn't have any idea who else is in the cluster (although I know who they are) and she hasn't been given any differentiated work whatsoever. For reading, for instance, the teacher had all the kids read The Boxcar Children to themselves. DD whipped through the book in about 2 days at school and now has read about 8 boxcar children books and some kids are still on #1. So DD will probably read all 40 Boxcar children books (or however many there are) while she waits for other kids to get done with number 1. There aren't even any differentiated reading groups. What the heck is going on? I'm getting very frustrated. I could understand the desk situation if they were indeed leveled groups, but that is not the case.

Blackcat, that does sound frustrating! My understanding is that every child in my DS' class has specific work for the language arts block of the day. I think the desks may just be a way to arrange the kids in a fashion that makes it easier for the teacher to approach an individual child without diving into a long line of desks.

My guess is that there are probably as many different ways seating arrangements are being used as there are teachers.

Thanks ConnectingDots. The more the school year goes on, the more disgusted I am and convinced we need to find a new school. I had high hopes after meeting with both teachers--who seemed to understand the situation-- but nothing is happening. DS is testing 2 years ahead in math and his teacher isn't giving him any differentiated work either.
So as to not hijack this thread, I started a new one about this on the Learning Env. forum.