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Dr. Dave's Advice
Hello and Greetings from Northern California! We have are very fortunate to be having spring like weather this past week! Although I like the rain, it is so refreshing to have some bright, sunny days where you can get outside and enjoy the outdoors without bundling up. I hope this months newsletter finds everyone well and enjoying great weather and good times as well. I have a lot of information to pass on to you this month so let's get down to business!!
This month I'd like to welcome two new sponsors to our family. The ADD Warehouse and ADDvance Magazine!!
The ADD Warehouse is loaded with valuable tools for parents and Teachers who work and live with ADHD. Be sure to check The ADD Warehouse Website reguarly for week specials and valuable information. You will find their site located at www.addwarehouse.com/indexbv.htm.
ADDvance Magazine is devoted to Women with Attention Deficit Disorder. ADDvance is a bi-monthly magazine is intended to serve as a national forum and gathering place for women with ADD - to address our concerns as individuals, as professional women, as wives, as mothers, and as mothers of daughters with ADD. We have gathered the best known female voices in the ADD world, who will offer their expertise and experience on a regular basis.
You can visit the ADDvance Magazine website at www.addvance.com.
A big THANK YOU!! to my sponsors who help make this site possible.
I ran across a web site that I thought might be useful especially for those Readers who live in Massachusetts.
Federation for Children with Special Needs www.fcsn.org/home.htm has important information on SSI and The Special Education Bill H.5297 (formerly H.5220) which will effect Special education in Massachusetts. Based in Massachusetts, this site contains a wealth Of information for those living in the Common wealth area with links pertaining To special education at the local level as well As the federal level and legislative links to Keep you informed.
The Federation is a center for parents and parent organizations to work together on behalf of children with special needs and their families. We can help! Organized in 1975 as a coalition of parent groups representing children with a variety of disabilities, the Federation operates a Parent Center which offers a variety of services to parents, parent groups, and others who are concerned with children with special needs.
If you live in the Massachusetts area, this site lists Valuable services that may benefit your child. I hope Those that live in the area will find some helpful And useful information here.
Another site with lots of resources for special education Is Special Edges www.blue.net/~goose/ . This site covers ADHD, Autism, Down Syndrome, Tourettes, Dyslexia And more.
Concerned Counsleing online Chat.
For April 1: "Psychopharmacology: Why do drugs work on some people and not on others" with Dr. Robert Hsiung.
Our guests always take YOUR PERSONAL QUESTIONS.
The conferences start at 8 p.m. CST, 9 p.m. EST, 6 p.m. Pacific (3 a.m. GMT).
Here's the link to our chatrooms. Once inside, just select "Conference Room" from the list of rooms. chat.concernedcounseling.com
** Dr. Dave's ADDvice **
In this month's column I'd like to discuss a study I recently ran across that points out an important problem with how stimulant medication is often prescribed in treating children with ADHD. This study will be included in the upcoming issue of ADHD RESEARCH UPDATE, the electronic newsletter I publish to keep parents informed about new research on ADHD and how new findings can be applied to help their child. If you'd like to receive a FREE TRIAL to this newsletter please email@example.com and type "free trial" in the subject line.
The decision to place a child on medication is a difficult one for most parents and if you are going to have your child take medication, you want to be sure that he or she is deriving the maximum benefit possible. Unfortunately, a commonly used procedure that physicians employ to decide on the dose to prescribe - basing the dose on the child's body mass - appears to be problematic.
A recent study in the Journal of the American Academy of Child and Adolescent Psychiatry conclusively demonstrates that a child's size CAN NOT be used to determine what dose of medication the child should receive.
In this study, 76 children with ADHD received different doses of methylphenidate (i.e. the generic version of Ritalin). The doses used in the study were 5, 10, 15, and 20 mg. Children received each dose for one week and also received a placebo for one week. Careful assessments of each child's attention, schoolwork, and classroom behavior were made during each week of the trial. Children, teachers, and adult observers who rated children's behavior were unaware of what dose the child was on each week.
The results clearly indicated that children's body mass WAS NOT related to their response to the different doses. Children's response to the different doses was quite idiosyncratic and the optimal dose for each child (i.e. the one that child did best on) was not related at all to the child's size. Thus, the commonly used practice of basing the dose a child is to receive on their weight is quite unlikely to yield the best possible dose for each individual child.
What procedure should be used, then, to determine the appropriate dose. The procedure used and recommended at leading ADHD treatment clinics around the country involves a careful trial that typically lasts for 3-4 weeks. During a 4 week trial, the child would be tried on 3 different doses. There would also be a placebo week. For a 3 week trial, two different doses and a placebo week would be used. Teachers are asked to complete ratings of ADHD symptoms, academic performance, and side effects at the end of each week. Similar ratings may also be completed by parents.
By comparing the ratings at the end of the trial, you can determine if medication really helped (i.e. did child do better on medicine than on placebo), what the best dose was, whether there were any possible side effects, and what problems may remain even if the medication was helpful. The side effects issue is quite interesting because children and parents sometimes complain of what appear to be medication side effects during the week that the child is actually receiving a placebo.
Once the optimal dose has been identified, ongoing monitoring of the child's behavior and academic performance is required to be certain that medication is continuing to provide necessary benefits and to determine whether any changes or adjustments to a child's treatment are necessary. I can not stress how IMPORTANT this is. A child I saw just last week illustrates why this is the case.
The child was a 5th grader who had been placed on medication two years ago by his physician. No systematic procedure was used at the time to obtain any objective evidence about medication effectiveness. His teacher reported, however, that it "seemed to help." In addition, no ongoing monitoring of the child's response to medication was put in place.
One of the first things I did was obtain ratings from the child's teacher of behaviors specific to ADHD. What was indicated by these ratings was that on the inattentive symptoms of ADHD, this child was still displaying all symptoms at an extremely high level. Thus, despite taking 40 mg of Ritalin per day, there was really very little indication that the medication was being helpful.
What needs to be done for this child is to systematically evaluate his response to different types of medication to determine whether he may derive greater benefits from another medicine. Adjunctive behavioral interventions will also need to be put in place. The important point is, however, that because not systematic procedure for monitoring his response to medication was put in place, he was receiving significant amounts of medication over a sustained period and not deriving much benefit from it. Unfortunately, this is a situation that occurs with distressing frequency.
If you are considering the use of medication for your child, I offer a program that is used by many physicians to conduct this type of careful trial. If you are interested in learning about it firstname.lastname@example.org and type "medication trial procedure". in the subject line.
If your child is already on medication, or if your child's symptoms are being managed via other types of intervention, I also have a simple and cost effective system to monitor how well your child's symptoms are being managed. This will alert you to when any changes or adjustments in your child's treatment may be necessary. You can learn about this system atwww.svr.com/addhelp/monitor.htm.
That's all for this month. Please remember to sign up for the free newsletter trial if you are interested.
David Rabiner, PhD
Get the latest information on ADHD with ADHD Research Update. To request sample email@example.com and type "sample issue" in the subject line.
B O R E D O F E D U C A T I O N
by Rick Pierce, The HyperactiveTeacher
"Mom, school is boring!" Attention Deficit students will often use this as a reason why they aren't doing well in school. Although this may be true, it is true for many students. Sometimes boredom is confused with distractedness.
By definition, Attention Deficit is the inability to control concentration. Lack of concentration can make it difficult to follow a lecture, read along with the class or even do in-class work. This off-track behavior can seem like boredom. Many subjects can never be interesting enough to hold the attention of the A.D.D. student; however, there are ways teachers and parents can help make school more successful.
Teachers can help students remain involved and on tasks through promoting routine, repeating key concepts, using multi-sensory teaching methods, breaking lessons into short segments, and encouraging goal setting and self-competition.
Even though one might think that routine would make school more boring, the opposite is true. A predictable schedule and familiar procedures reduces the distractions and stress. Routine also allows the students to sort out the difference between important and unimportant information. Routine does not mean plodding or drill and kill. Fast paced and lively instruction is important in helping your student remain involved.
Loss of concentration can cause a student to lose track of what is being taught. Therefore, repeating main ideas and important information will aid all students in gaining and retaining the necessary points. Studies suggest that repetition of key concepts can move information from short term memory to long term memory. I suggest repeat key ideas at least three times the day new points are added, then go over those concepts the next day at least once and then review at least once a week throughout the unit.
How a lesson is presented can also help. A picture is worth a thousand words - and an action is worth ten thousand. The more senses involved in the learning process, the better the chances the A.D.D. person will gain the information and find it interesting. Charts, tables, mind maps, venn diagrams and other visual aids are important in aiding the storing and retrieving of data in the brain. Acronyms, catchy clues, rhythmic memorization, reinforcement games and dramatizing points all help in maintaining interests and remembering the lesson. Projects, illustrations, role playing, teaching others, creating songs, puzzles, games, posters, etc. also encourage a deeper understanding. But be careful, the more intricate or difficult the project, the more likely the A.D.D. student will become overwhelmed by the assignment and not complete it.
ADD students can become overwhelmed easily not from inability to understand the information, but from too much information all at once. Ours is a TV world, where programs are presented in 5 to 7 minute segments between commercials. We as teachers should learn from this model. Lessons and lectures should be broken down into smaller segments either by time or points. Between each segment consider a review exercise, related humor, out of seat activity, etc., but try to keep these commercials short (2 to 3 mins) and related to the subject. Incremented lessons allow for time to retain the information and distract the ADD student back on task. This does not mean that you should only teach 7 minutes of history, but vary its presentation on a frequent basis.
Time can slip away from ADD students as well. I remember going to my room to do homework, fully intending to do it, only to realize that three hours later I had only completed three problems! At that point I would feel frustrated and beaten, so I would give up and not finish the work. Many ADD students respond well to short easily attained goals or self-competition. During work time, try setting 5 or 10 minute targets for your students to reach. Or better yet, have them set their own targets. For example, if you assign problems 1-25 in math, try asking them to predict how many problems they can achieve in ten minutes. Depending on the age, you may want to reward achievement of the goal with a sticker. This approach helps to train important goal setting skills and helps the ADD student to gain a better sense of time. Plus it adds some fun to the process.
Teachers aren't the only ones with the responsibility to make school more engaging, parents can do much to help by helping the student maintain a good attitude about school and learning, daily previewing and reviewing information covered in class, and extending subjects whenever possible.
A good attitude is probably one of the most difficult, yet most critical, aspects when helping an ADD student remain interested in school. Failure and confusion can easily contribute to a negative view of learning. Parents can reinforce the value of school by showing an interest in their subjects and their lives at school. This communication is important and can go a long way to encouraging future success. Even though, you may have had difficulty in school or a certain subject, be careful not to communicate that it is OK for them to close their mind and stop trying to learn. We as parents are the most influential role models to our children. Even in the face of failure, it helps to keep being proud of them and encouraging them to do their best and that grades are less important than effort and attitude.
Also involving yourself and them in school activities can help to strengthen their bonds to the school. By volunteering to go on trips, help with fundraisers, organize special activities and overall contributing to the life of the school, you show your child that you are involved in their lives. Also attending activities that they are doing, like plays or sports, will show them that you care and will encourage them in areas they can be successful. High School sports are often the reason many ADD students stick it out and try to finish school. By involving them in activities you help connect them to school and school then becomes more important and less boring.
But interest alone is not enough, ADD students may need help to keep up. One way to help a student pay more attention in class is to pre-read the material being covered the next day. Since ADD students have a difficult time concentrating in class, previewing tomorrow's lesson helps the student follow the lecture even if they miss part. This allows them to participate in discussions and will help peak their interest in the subject.
Reviewing the day also is helpful. This is more than just asking them about their day. It works better to have them show you from their books, notes or hand outs about what they learned. This helps to remind them of the day and reinforces the points that the teacher felt was important. This is a great time to create flash cards that may be used for later study.
Students also may need help in keeping track of tests and long-term assignments. ADD students have a particular difficulty looking ahead and preparing for future assignments. By helping them stay focused on their responsibilities upcoming and helping them work on them in segments, we increase the possibility of success.
Another way to help a student maintain interest in school is to provide subject extensions. In other words, ADD students learn more by doing than sitting in a distracting classroom listening to a teacher. Whenever possible, you may want to go on personal field trips or museums and find activities that reinforce the subjects at school. Many subjects can be extended though videos. When my class studied space exploration, we watched "Apollo 13". This help stimulate interest and they could better understand the space program. By looking for ways to reinforce learning at school, we reinforce the importance of learning both in and out of school.
School by its very nature can be difficult and boring for an ADD student. Any system that makes us sit still, remain quiet, stay focused and all in a distracting environment among 20+ others students, is bound to create failure. However, both teachers and parents can help improve a students interest. If a student can remain positive about learning even in the face of difficulty, then anything is possible. But if they give up on learning, the world becomes a difficult place to be.
Rick Pierce is a nationally recognized author and speaker on educational issues related to ADD. Please visit his newly revised website at www.hyperactiveteacher.com
Also, he is launching his own free newsletter soon. If you would like to be added to this newsletter or would like information on training or his book, please email him firstname.lastname@example.org .
I had a parent take the time to write me about her search for a college For her daughter. Here is what she had to say. Hi Brandi,
I hit your web site last summer to see if anyone had any ideas for 13th year schools for my 17 yr. old daughter who has a math LD and ADD. My husband and I were sure she was not yet ready to go on to college and we were looking for somewhere for her to go. We checked in the Peterson's Secondary Schools book and found special needs schools. We checked into some of these and wanted to pass on to you our findings in case it could be helpful to other parents who find themselves in our situation.
We visited the Shedd Academy in Mayfield, Kentucky. It sounded great in the book, but we were very disappointed in what we found there. The living arrangements were that the kids would live with people in town who had been approved by the state for boarding students. This is to give the kids a home- like environment. The house and occupants where our daughter would have lived was undesirable, to say the least. Once we saw the living arrangements, our minds were made up! We went back to the school and talked with the Headmaster, Dr. Thompson and he couldn't understand what was wrong with the living arrangements. If anyone would like to know they can E-mail us and I will give them all the details.
Next we had a friend (who lives close by) check out The Vanguard School in Lake Wales, Florida. (just south of Orlando). She found it to be a very clean and nice school. So, my daughter and I went down to visit there. We were very impressed with everything!! The staff were wonderful. We were given a tour that lasted an hour and a half. The dorms were nice and spacious. They have about 130 students there this year, including our daughter!! The ages rang from around 10 years old to 20 years. She was evaluated while we were there and we were given the answer if she was accepted or not while we were still there. They don't believe in sending you home to wait for a call or a letter.
She has done very well this past year. She has many friends and likes all the staff. She graduated high school last year, so she has been able to take some fun classes along with some regular ones,such as math, world lit., english, etc. She is in the drama class and is having a ball. She never had any friends at home all through her high school years. She was teased about being in resource classes. At Vanguard, all the kids have some sort of problem learning problem, so they are all in the same boat. She has gotten the experience of living in a dorm and being able to know that she can get along just fine.
I just wanted to pass on this info to you. I know from reading your posted e- mail last summer, that there are lots of people searching for a good school for their kids.
The Vanguard School's web site is www.vanguardschool.org
If you would like to email Dana you can reach her at JOEPRAIRIE@aol.com.
I appreciate any information readers wish to share with me and if you have Something you'd like to share, please email it to me at Contact Us
For those of you interested in NON-PHARMACOLOGICAL therapies for ADHD, here is some information on a conference dedicated to just that.
The ADD Action Group (a non-profit organization) presents:
THE FIRST WORLD CONFERENCE ON NON-PHARMACOLOGICAL THERAPIES FOR ADD & ADHD - (A two day weekend event).
Speakers from around the world will discuss Alternative Solutions that have helped people with Attention Deficit Disorder and Hyperactivity without the use of medications.
For more information, including travel, lodging, speaker, and registration information, email us at email@example.com or call us at (212)-769-2457.
P.S. - This is a one time mailing. Your email address was located in a a website related to ADD or Pediatric issues. We hope this message was welcome information. Thank you for your time.
Whew! That's enough for this newsletter! Hope you have found the Information useful.
Please take the time to visit my sponsors. They help make it Possible for me to keep this site going!!
If you would like to share a story for ADDiaries, submit a Website for Heart of the Web or share information, please Email me at Contact Us or snail mail me at P.O. BOX 473, Browns Valley, Calif 95918.
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