ADD/ADHD

[MuxsBug]

My son has been diagnosed with having ADD/ADHD and was put on Atterall and then a year ago the doctors took him off the medication and his schooling has suffered because of it. My question is would home schooling him help him or hurt him in anyway? And What else can I do to teach my child how to help control his symptoms?

[Sandman2]

   Certainly agree with you about pharmaceutical trying to manipulate data.  Biederman's study however was funded by "This work was supported by National Institute of Mental Health Grant RO1-HD36317 (J.B.) and by National Institute of Drug Abuse Grant DA-R2911315 (T.W.).
   But actually I just noticed that you are now referring to a study done by Dr. B in 2008 and not his 1999 study.  Gets confusing doesn't it?  Here is the link to his 1999 study.  http://neoreviews.aappublications.org/content/pediatrics/104/2/e20.full.    And the conclusions are pretty easy to follow in the 1999 study simply because the numbers involved are so small that it doesn't take much math to figure them out.    But, the point is that his studies have been replicated many times by different people using different samples and the results are the same.  
     As far as Lambert goes - you gave one of the conclusions in your earlier post - I simply gave the other one since you had already given one.
     But you know what - we really agree about the important stuff.  I get a little compulsive about research articles sometimes (I probably taught science too long), and I get picky.
      Ya, I wish you and your friends never had to go through what you went through.  Makes me really curious as to how many actually had ADHD or just had parents or teachers that couldn't deal with them.
         And by the way, if you haven't seen it you might be interested in the newly released clinical practice guidelines for ADHD. In October 2011, the American Academy of Pediatrics (AAP) released new clinical practice guidelines for the diagnosis, evaluation, and treatment of ADHD.   The article can be found here -  http://www.medscape.com/viewarticle/759086?src=nl_topic.  I noticed that "assent of the adolescent should be obtained"  was specifically mentioned.  Thought you would like that.
       While not perfect, the guidelines are better than they were in 2000.  In fact, I will try and look up and see what the guidelines were in the 90's  - if they even had them.  Really curious about that now.
      Oh - we kind of have highjacked this link.  We ought to start a separate one sometime where we can just comment on research studies, etc.  If I can find what the clinical guidelines were like in the 90's maybe I'll use that as a post.  Peace.

[CBL1984]

I have a typo in the fourth paragraph of my last post. Should read: She was told that if she did NOT arrive at the results that they wanted she would never work in the field again.

Also, I definitely appreciate your second to last post. Thank you for that. Doctors and parents should not look at the pill as magic fix. And there are so many natural approaches that can be tried before meds even have to come into the picture. I also feel that six years old is too young to medicate a child given research on brain development and delayed cortical thickening in some individuals. (NIH/National Institute of Mental Health (2007, November 13). Brain Matures A Few Years Late In ADHD, But Follows Normal Pattern. ScienceDaily. http://www.sciencedaily.com/releases/2007/11/071112172200.htm) I'm not completely anti-med. I just feel that there is very little caution when it comes to these drugs. So many of my peers ended up on these meds or had these meds recommended by doctors. Some took them, some didn't. As you said, everyone is different. For some people these meds may not be the right thing. Everyone I know who took Ritalin with the exception of one person, feels that being on Ritalin was a nightmare they never want to relive.  But even though I have strong opinions about them, I'm not going to say that they don't work for some people. The main thing is to listen to child and ask the child how they feel on the med. I hope things have changed since I was given meds 22 years ago.

[CBL1984]

I would give anything to go back in time and not take Ritalin. I have nightmares about growing up on that horrible drug. I had so many crazy, scary thoughts that disappeared as soon as I got off of it.

I do read the studies and articles I quote. The Pelham quote you mentioned is one opinion regarding the studies. Here is another quote from the article from the woman who did the study:

"There are two possible explanations," Lambert says. "Kids self-medicate. They try a drug and it makes them feel better." Or, she posits, stimulants like Ritalin may sensitize kids to be susceptible to other stimulants. "This explanation has support from the animal literature. There are benefits," she says. "But parents should be aware of the possible risks."

She is offering two possibilities not just one.

Also in regards to Biederman, I still would not trust the study. The article says "The team led by Biederman assessed 112 young men 10 years after ADHD had been diagnosed." It sounds like he was heading up the study. Research can be manipulated to display the desired results. My friend knows someone who works in research who was asked to manipulate data on a study of ADHD three and four years olds. Basically the researcher was having trouble diagnosing ADHD in that age group because all of the children were behaving similarly. She felt that she was unable to complete the study. She was told that if she did arrive at the results that they wanted she would never work in the field again. We are dealing with pharmaceutical companies who are out to make a buck and couldn't care less about the people who take the meds.

I prefer Lambert's approach to the research. "There are two possible explanations." She says. I think we have to look at two possibilities: these drugs can do a lot of good and / or they can do a lot of damage. And for some people they may be a Godsend and for some people they may be a life ruiner. I would give anything to go back in time and not have taken these meds.

[Sandman2]

   Read my earliest post first as this deals mainly with research articles.
         Actually Ashley said that (p.163),  STUDIES have consistently found no association between stimulant medication and increased risk of later drug use."   Its not just one study.  Its many studies (and they are easy to find - one is here , and its fairly recent - http://www.psychiatrictimes.com/adhd/content/article/10168/1166781 .  And even the Biederman thing you mentioned was not a study but a meta analysis of existing research by him and three other people (I actually took the time to look it up and can send you the link if you want).  He did not compile the information or do the math for the associations - he was involved in the conclusions - which were pretty easy to figure out given the results.
     I guess the point being - you do have to be careful with studies.  I always read a study before I quote it.  I have found too many people just quote the part that benefits their opinion.
    For example you quoted an article that said, '"Recently, the media has reported that Ritalin is a possible gateway drug to other stimulants."  The problem is that it was not recent.  That was from an article published in 2001 and referred to a study done in 1998.    And later on in the article it said,  "William E. Pelham Jr., PhD, professor of psychology, psychiatry and pediatrics at State University of New York-Buffalo and Molina's research collaborator, agrees. "It's not the Ritalin, it's the ADHD that might lead to smoking or substance abuse."  Which would make the article not quite as conclusive as you might have been lead to believe.This article can be found here -     http://www.apa.org/monitor/jun01/ritalin.aspx
    So, I guess my point is to really read any study you quote - because I will.   Your personal experience is important.  I think that what happened to you was horrible, but everybody and every-bodies experience is different.  I guess in the end it comes down to how we are able to handle it or cope with it - and those people that only get the magical pill (and no other skills) may get the short end of that stick.  Peace.

[Sandman2]

   boy, I agree with you about doctors listening to their patients.  And I would put parents listening to their kids right up there too.  Hopefully, the psyc world has gotten better in the 22 years since you were put on meds.  I know that the new standards would have eliminated some of the problems you had (if the doc paid attention to them).  
   I think that in 1990 so many people still thought that the med was a magic pill.  You could give it to your child and then ignore the kid completely cause they were somehow fixed.   And, I am afraid that with the overworked medical system - and overworked parents - that some (or a lot) of that still exists today.   That is one reason I always like your input - to remind people that this is something that is not magic.  In your era and before you (and even probably now), kids were diagnosed with ADHD that did not have it.  To put them on stem meds was the worst possible thing to happen.  To me the next worse thing was to put them on stim meds and then never give them the tools they needed to succeed in life because the pill was gonna take care of all the problems.  So information is key!!! and the more information that you can give a person to help themselves or their children deal with ADHD is great!
    In regards to some of the studies you mentioned.  I will do that in the next post.

[CBL1984]

I think this is the study you are referring to...

"In 1999, Pediatrics published research by Joseph Biederman, MD, of Harvard Medical School, which concluded that ADHD boys treated with stimulants such as Ritalin are significantly less likely to abuse drugs and alcohol when they are older than ADHD boys who are not treated."

And it was conducted by Biederman as I suspected. He was employed by Novartis, the makers of Ritalin, at the time the study came out. Because he was receiving money from the makers of the drug I would be hesitant to put a lot of stock in his studies.

I'm not trying to make trouble here. I want parents to get their children the help that they need. But I do think that parents should have a complete picture of the possible outcomes of giving their children stimulant medication so that they can make an informed decision.

[CBL1984]

Also, a study published in Neuropsychopharmacology at the Finch University of Health Sciences/Chicago Medical School found that adolescent rats given repeated doses of Ritalin, proportionate to doses for children, are more likely to self-administer cocaine as adults.

[CBL1984]

I'm so glad to hear of your daughter's achievements! That's wonderful that you followed your gut as a parent and avoided ADHD meds. Wish my parents had done the same. I was a very bright, fun kid and probably just needed time to develop social skills. I am an only child who lived on a farm so a lot of my behavioral problems could have stemmed from lack of socialization, no siblings or neighbors. I was also the youngest kid in my class and may have just needed more time to grow out of certain behaviors. Anyhow, so glad to hear that your daughter is doing well and that you found out that the actual difficulty was not ADHD.

[CBL1984]

I would say that the most important thing is that if a child is not responding well to the medication, the child needs to be taken off the medication. I felt violent and angry while on the med and had bizarre thoughts. It made me feel out of it and crazy. When I told the child psychologist about what I was feeling, they diagnosed me with another disorder instead of looking at the med. I definitely agree that ADD / ADHD can be a comorbid disorder with depression. But everyone I know who was diagnosed with it as child and didn't take meds is fine now. And everyone I know who took Ritalin has a mental health issue, usually depression and anxiety. I just don't really think it's a coincidence. But maybe they were reacting badly to the med like I was and no one took them off so the med caused damage. If someone is having a bad reaction to a med and then continuing to take it, it can't be good for the brain. I actually read a different study from the Ashley one that you quoted that said that children who were on Ritalin were more likely to use cocaine and tobaccol. See excerpt below from the American Psychological Association. Also, was the study that Ashley quotes a Biederman study? He is employed by the makers of Ritalin so I would be fearful of taking any of his studies seriously.

"Recently, the media has reported that Ritalin is a possible gateway drug to other stimulants, a conclusion that stems from research by Nadine Lambert, PhD, director of the school psychology program at the University of California at Berkeley. Lambert identified a relationship between both ADHD and the use of stimulants in childhood and dependence on tobacco and other stimulants as adults. She found that half the youngsters in her study who had been treated with Ritalin had become regular smokers by age 17. Only 30 percent of those never treated smoked regularly. And 36 percent of adult cigarette smokers treated with Ritalin as children, compared with 2 percent of those who never smoked or took prescription stimulants, were dependent on cocaine as adults."

[allmymarbles]

Still, the school exerts such a strong influence that the emphasis is on scholarship. In an ideal world, doctors and therapists would examine all facets of the child's life. But if one-tenth of all boys age 10 are diagnosed as ADHD obviously this is far from an ideal world and a great many of our children are seriously harmed.

Given those statistics I would be very wary of such a diagnosis. Those medications can have serious side effects, many of which the child cannot recover from. And, let's face it, there are medical fads. No more prefrontal lobotomies - right? They have gone the way of the routine removal of tonsils.  And Freud has fallen into disfavor. Indeed he has. Psychology is not a true science and is extremely fallible. Let's not forget that.

[Sandman2]

   The problem is that ADHD has to be going on in at least two places to be diagnosed.  This means that typically the school is the other place that doctors look to.  That is done to eliminate poor parenting.  Theoretically, a school could complain all they want and if the parent says the kid is fine at home and in the public then the diagnosis could not be made.  Having said that a school can put a lot of pressure on the parents - and many times unjustified.   I still can remember an older teacher in the grade above me who had one of my ex students moved to a special ed class because she had so much trouble with him.  I was really mad cause this was a great kid.  The next year he is put into a gifted class.  Turns out he was bored in her class and created his own fun.  She couldn't deal with it.  I never forgave her..
    Anyway,  ya - the whole diagnosis thing can go wrong.  The new guidelines are more helpful, but I am sure too many people still take the easy way out.

[allmymarbles]

In addition to poor diet being mistaken for ADHD, so can lack of sleep which may be caused by sleep apnea. I note that ADHD is almost almost defined in terms of school performance. This can be very damaging to the child. He lives perpetually the doghouse, even though he may be a delight at home and a pal to his siblings. As a rotten student he loses his worth.

When my child received this questionable diagnosis I decided to  pay no attention to it. I told them I did not care about her grades. As a result my daughter did not suffer the emotional guilt and loss of self estime. She was, in fact, a marvelously funny and mischievous child and just as clever as her three academic siblings. After puberty she suddenly became motivated. She still hated the boring school environment, but saw it as a means to an end. She was accepted by a very prestigious college and went on to an equally prestigious university for an MA where she received a fellowship.

The ADHD turned out to be sleep apnea. When it comes to diagnosis, don't rule out a mother's instincts.

[Sandman2]

   Hey CBL welcome back!!!!
Although, we will probably have some disagreements, I totally agree with your web site about checking into other factors that can cause AD/HD symptoms.  I think too many doctors (probably usually pediatricians cause they tend to be way too busy to have the time) go for the simple fix.  Things like sleep apnea, allergies, toxins, etc. are definitely worth looking into.
   And I do agree with you that the long term effects need more study.  I mean there have been long term studies done that "found that stimulant medication reduced the risk for substance abuse by approximately half in adolescents.  Teens that remained on medication during adolescence had a lower likelihood of substance use or abuse in their young-adult years."
"The ADD/ ADHD Answer book," by Susan Ashley, page 163.
     But essentially, once the safety studies were done, the studies stopped.  I am not aware of any follow ups after the child reached about 18.   So there is a lot of unknowns.   Even in your case.  Ashely says that  "10 to 30% of children with AD/HD are thought to have depression (p.63).  And the reasons why are not linked to medication.  So I would guess that the same kids - if they don't get the proper treatment (what ever that is) will continue to have depression later on in life.
    What is really important is how does one deal with this depression in later life?
    So I am glad to have you posting again.  The ways you have learned to cope (hopefully you are successfully coping!) can really help others.

[CBL1984]

I appreciate you taking a look at the study, but the problem is that they haven't tested the long term effects on the mental health of children with ADD / ADHD. And the tests done so far were done on rats not children, so your comment "The depressive effects were seen when normal kids were exposed to stimulants" is incorrect. How do we know that giving a child with ADD / ADHD ritalin will not cause them to be depressed over time? We don't because no long term studies have been done on children (with or without ADD / ADHD). All of the individuals who I know who were diagnosed with ADD / ADHD as children and did not take stimulants are all fine now. Everyone I know who was diagnosed and put on stimulants has mental health problems. Yes, they could be comorbid disorders that would have showed up anyway. The bottom line, which I think the study is illustrating, is that these are powerful drugs and the long term mental health effects should be studied. Even though these doctors are saying that these results highlight the importance of a proper diagnosis, they are still not able to give us the answers of how these drugs impact the ADD / ADHD brain long-term. How do we know that the medication won't make both normal children and children with ADD / ADHD depressed? We don't. The study is evidence that more testing needs to be done on how these drugs impact the brain long term for both ADD / ADHD individuals and individuals without the disorder.

[Sandman2]

     Researched the study you mentioned.  Very interesting.
However, the study related to "normal" children.  Those without ADHD or ADD.  The authors stressed the importance of knowing that your child really does have ADHD.  The depressive effects were seen when normal kids were exposed to stimulants.  You can read the study here.   http://www.mclean.harvard.edu/news/press/current.php?id=65

[CBL1984]

This may not answer your question about schooling, but have you tried natural approaches for treating ADD / ADHD? First make sure to eliminate any foods that may contain pesticides from the diet. They have been linked to ADD / ADHD. Supplements that may help are fish oil, flax seed oil, DL-phenylalanine or tyrosine, and SAM-E. Also make sure that your child is eating a balanced diet (try to eliminate processed or unhealthy foods such as sodas, sugary cereals, etc) and getting plenty of exercise. It is good that your doctors are taking him off the medication. Prescription stimulants may treat symptoms in the short-term, but in the long term they wreak havoc on the fragile dopamine system. Studies with rats at Harvard McClean University have shown that Ritalin use during juvenile years leads to depression in adulthood. This is similar to what happens to chronic users of illegal stimulants. My parents put me on Ritalin as a child. I cannot work because my depression is so disabling. You can read my story here at: www.ritalinawareness.com. I wish you and your child all the best.

[Sandman2]

  Beside the book I mentioned, a very detailed book is, Sandra Rief’s "How to Reach and Teach Children with ADD/ADHD".  It will give you a ton of ideas for working with your son.  It is a big book and covers a lot of very specific areas.  If you are going to keep home schooling it will definitely help you.
  However, being realistic - you are avoiding the problem.  Sooner or later he is probably going to have to re-inter the public schools.  You need to learn the process to get him help immediately.  In Ashley's book on p.82, she gives the timelines that schools must follow if a written request is made.  Basically, they have about two months.  Since he has already been diagnosed, it should go fairly quickly.  There is no legal way if you make a written request that they can take a year to figure things out.
  And frankly, I would look for a pediatric psychiatrist.  A family doctor that simply takes a child off of medication with out trying other means is a cop out.  Or he was not explaining things to you.  And frankly, I don't have a very high opinion of family doctors dealing with ADHD.  If the med is correctly prescribed, you don't get used to it that quickly.  I obviously don't know what went on, but it sure could have been handled better.  
   The books I have mentioned will help you a lot.  But unless you have a good mathematical and scientific background - home schooling will get a lot more difficult.  While I don't advocate meds, if things are not working out without them, then you have to reassess certain decisions and at least try something else.    
   What I am not sure about is if you can make a written request while not enrolled.  I would call the school districts special education department (at the district level).  Tell them that you have been getting the run around which is why you are home schooling and you feel that your rights have been or are being violated.  Essentially, you don't want him to start school without having done the ground work first.  
  Hope some of this helps.  It is going to take a bit of work on your part.  But it will be worth it!  Best wishes.

[MuxsBug]

My son is 10 almost 11 years old and he is in the 4th grade. We had a family medicine Doctor. Dr.Gassinburg took him off, because he was so use to them that it didn't effect him at all. The school distric here is so slow on the rez that it takes them over a year to go through the hoops. He is not on a 504 plan and I have been home schooling him since. When he is on his meds he does great, but while he has been off them now for a year now it is very hard for him to do anything even think. PLease help us!

[Sandman2]

   The problem with home schooling is that you are not dealing with the cause of the problem.  If he is fairly young, its easier to home school.  Around 5 or 6th grade the subject material - especially math becomes more difficult and thus harder to teach.
    There is a lot that you can do.  But I do need a bit of info.
How old is he? What grade is he in?  Is he in special education or does he have a 504 plan?   And I am very curious why the doctor took him off his meds?  And when the doctor did this did he give you any counseling on how to help your son?  What kind of a doctor did this?  Most doctors (well psychiatrists) will continue to try different meds until they find one that is effective.
    But to answer your question about helping him.  The first thing that you can do is to learn all you can about ADD/ADHD.   There is a book that will really help you.  Its
"The ADD/ ADHD Answer book," by Susan Ashley.  It covers everything from meds, to schools, to discipline, to helping study, etc.  the list goes on and on.
  Probably the most all inclusive website is - http://www.healing-arts.org/childre/ADHD/    
   Hope this helps.