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HOW OLD DOES A CHILD NEED TO BE FOR ADHD TO BE DIAGNOSED?
Have you noticed how much quiter things are since the kids have been back in school? hehehehe The first couple of days they were back in school I was just in shock, the boyfriend at work, both kids in school, the house all to myself...I actually had control over my own t.v. set :) Lifes little pleasures :)
Dr. David Rabiner has a wonderful colum for us this month but before I get into that I want to remind everyone that the ADHD Research Update that is authored by Dr. Dave is now available. I believe that parents of ADD/ADHD children will find this newsletter very helpful in keeping up with all the new research and up to minute information on treatment and studies that affect our children. For more information on this newsletter and to see the first edition, please visit the ADHD Research Update web page at http://adhdnews.com/dave.htm. Here you will have an opportunity to see for yourself how valuable this information can be for you and your child.
Dr. Dave's ADDvice
In this month's column I'd like to address several important questions that I was not able to address previously. I'm also pleased to let you know that a web site I've been working on all summer is finally up. The address is
I've received several questions in which parents have indicated that their child was diagnosed with ADHD at 3 - or even 2 - and started on medication. I would like to suggest that parents should be very cautious about this. Although many children with ADHD will begin to display symptoms at such a young age, it is difficult to diagnose ADHD with any certainty in a child so young. This is because many extremely active toddlers will calm down as they develop and mature. In addition, excessive activity and impulsivity is characteristic of many toddlers, which makes it hard to determine when it is unusual enough to possibly reflect a disorder.
Here is a quote from DSM-IV - the publication that specifies the diagnostic criteria for all psychiatric disorders, including ADHD:
"Most parents first observe excessive motor activity when the children are toddlers, frequently coinciding with the development of independent locomotion. However, because many overactive toddlers will NOT (emphasis mine) go on to develop ADHD, caution should be exercised in making this diagnosis in early childhood."
Now, if parents are having difficulty with a young toddler because of excessive activity and/or other symptoms that may possibly reflect ADHD, it certainly is important for these problems to be addressed. This is true regardless of whether or not that child turns out to have ADHD. In a child so young, however, many mental health providers believe it is more appropriate to begin with non-medical interventions. In fact, the treatment guidelines recently publihed by the American Academy of Child and Adolescent Psychiatry state the following:
"In this age group (i.e. preschoolers) stimulants have more side effects and lower efficacy and should therefore only be used in more severe cases or when parent training and placement in a highly structured, well staffed treatment program has been unsuccessful or is not possible."
I would thus urge readers to be cautious about starting their preschooler on stimulant medication and to consult with their child's doctor about nonmedical interventions that can be tried. If your child was diagnosed at such a young age, and you are uncertain about the accuracy of the diagnosis, you might also want to consider having your child reevaluated
"My 20 year old daughter is feeling really frustrated because she is seeing what she might have become if not for her ADHD and learning disabilities. How can she learn to cope with this?"
This is an excellent and important question and one for which a definitive answer is not possible. I have worked with several adolescents and young adults who struggled with similar frustrations and disappointments. Because of the many difficulties that ADHD can cause, some look back and see years of squandered opportunity. Some individuals in this situation feel confused and uncertain about their ability to successfully handle the demands of higher education, developing a fulfilling career path, and handling the responsibilities of adulthood. This can be especially difficult when peers seem to be moving forward.
I'm afraid that anything I suggest here may sound somewhat trite, but here are some ideas to consider. First and foremost, talking about these feelings can help. Most of us have at least some regrets about the choices we've made or failed to make in our lives, and being able to discuss these openly with a supportive and empathetic listener - whether that be a family member, friend, or professional therapist - can be enormously helpful. For someone with ADHD, it can be especially important to develop a realistic understanding of how this condition influenced the course of their development and may have contributed to some of their struggles. Although this can not change one's history, this understanding can help protect against unreasonably overemphasizing (e.g. blaming all one's difficulties on the condition) or underemphaszing (e.g. refusing to acknowledge that the disability played any role).
Through these discussions, a young adult can also gain a better understanding of their strengths and weaknesses. Ideally, this self understanding can help guide their future plans in a way that realistically incorporates the role that any ongoing ADHD symptoms could or should play in these plans. When this occurs, shying away from areas where one can succeed should be less likely, as should pursuing paths that may not be ideally suited for one's personality and temperament. This process would not be expected to be something that happens suddenly or even quickly; rather it would be expected to occur over a period of time, and at different rates for different individuals. Ideally, it will help someone develop a perspective on their past that enables them to look towards the future with a greater sense of confidence and purpose.
A very important issue raised by this question concerns a child's understanding of ADHD during their development. In my experience, children are often not told that they have ADHD, or may have heard that they have "it" but have no real idea what "it" is. Some children take medication for an extended period without every really understanding why. In these circumstances, it is not uncommon for a child to have a vague sense that something is wrong with him or her, and the teasing that some children experience when peers find out they take "hyper pills" certainly doesn't help.
My own feeling is that it is quite important for a child with ADHD to have a realistic understanding of what ADHD is and what it means to have it. Parents I have spoken with are often concerned about saying anything to their child because they don't want their child to think there is something wrong with them. When a child is provided with an age appropriate explanation about what it means to have ADHD, however, I believe that this is actually less likely to occur. This knowledge can also help protect children against teasing they may receive from some insensitive classmates. It may also help them during adolescence and young adulthood when most individuals deal with the important developmental task of deciding about the type of future they hope to build for themselves. Because they have realistically incorporated the awareness of having ADHD into their overall self-understanding, they may be better equipped to deal with this task than if they first begin coming to terms with what it means to have ADHD at this at this time.
Deciding how, or even if, to discuss these issues with your child is an important decision for parents. Several very good books are available to help parents with this task. Among those that I would recommend are Shelley, The Hyperactive Turtle by Deborah Moss (written for children 3-7); Putting on the Brakes by Patricia O. Quinn and Judith Stern (for children 5-10); and Distant Drums, Different Drummers: A Guide for Young People with ADHD by Barbara Ingersoll. You should be able to find these at most larger bookstores in the parenting section. There are also several places where these can be ordered on the interenet (try
That's all for this month. Please continue to send your questions to Brandi and I'll do my best to get to them. Also, if you'd like to receive a sample issue of ADHD RESEARCH UPDATE, a newsletter I've started to help parents stay informed of the latest research findings on ADHD, please send me your request via e-mail.
David Rabiner, PhD
I wanted to share this note I received from Jeni. Jeni wrote to share her son's thoughts on the "ADD Trap".
Brandi, Thank you for all the effort you put in to make a newletter that helps so many of us. I wanted to share a term my son came up with on his own, "The ADD TRAP." I asked what he meant and he said, "you know, the things teachers do that will catch the ADD kids." I said to give me an example and here is what he said. "In fourth grade my teacher would surprise the class with the 'oink' award for the messiest desk. The winner recieved the generous prize of sitting out at recess for a week. You know the winner would always be someone with neatness problems." Then for seventh grade there was the "hip" card. hat was a card that started with 50 points and you lose a point for late homework, being prepared or not following directions. If you had 35 points left you could attend the party at the quarter final. It didn't officially say "No ADDers allowed" but it excluded many ADD students. I wish teachers could begin to see the "traps" that they set for our children which really discriminate against them. This will be a new term for our family when we get "caught in a trap" and hopefully we will get better at identifying the traps ahead. Just wanted to share....
As many of you know, after almost 5 years of "traditional" treatments for my son James, including 50mgs of ritalin a day, I decided to look into other ways of helping my child cope with ADHD, and got involved in the world of nutrition. I have since become involved with a nutritional program that Alternatives for Families provides and have been very happy with the results. I can remember back to when James was on Ritalin and how our lives revolved around that 4 hour window that ritalin provided. Compliant and able to function on ritalin and totally unable to fuction and remain under control when it wore off. James has been on the program and off of ritalin since February of 1997 and the biggest improvement I have seen is his ability to remain functionable and calm on a daily bases and not an hourly one. No longer do I have to carry extra meds with me in case the "window" closes while we are away from home. I want to share my pride in James and how he conducted himself after being robbed at knife point on his way to school on September 12, 1997. He complied with all of his aggressors demands, maintained a cool head, and was able to report to the proper authorities with a discription of his assailant as well as perform in school throughout the day. I'm very grateful that he was unharmed and proud that he was able to maintain himself and I believe that this also speaks favorably of the benefits he has reaped from being on a nutritional program which is with him 24 hours a day and not just 4 hours.
Speaking of nutrition......... :) I want to be able to address all issues when it comes to ADHD and I am excited to announce that starting soon, I will be featuring articles about nutrition in upcoming newsletters!
Under the American Disabilities Act (ADA), there are two definitions of disability: 1) The diagnostic definition which meets a certain set of criteria. This includes ADD. 2) The legal definition of disabled. Since ADD is defined as a named disability, the act provides protection, at least in theory. However, since ADD is not readily apparent (as opposed to a lost leg, or obesity), documentation is required. Before disclosing anything to anyone, be sure to get a written, professional diagnosis. Failure to do will undermine any claim.
In applying for a job, the ADA protects a diagnosed ADD'er. You have no obligation to tell the potential employer about the disability. S/he can ask if you can do the work, and within limited confines, how. If you need an accomodation during the application process (computer, larger print, more time, etc.), you can disclose in order to receive it. The prospective employer cannot discriminate, and must provide any reasonable concession. In order for s/he to pass on hiring you, there must be a more qualified applicant.
Now, let's get real. How hard is it to find a more qualified applicant. Everyone is more qualified than everyone else at something. And in this tight job market, there's no such thing as being the only prospect. There are many reasons an employer wouldn't want a disabled employee. First, its much tougher to fire them. Second, there's the added time, expense, and burden of legal compliance. For these reasons, I always advise non-disclosure until after getting hired, unless absolutely necessary. The law protects you. Take advantage of it.
Once hired, your secret will remain concealed until you divulge it. Choose the time and place carefully. YOU HAVE NO RIGHTS UNDER THE ADA UNTIL AFTER DISCLOSURE. That means, the best time to come forward is when you need accomodations. With the ADD'ers undying affinity for procrastination (it's always a good time to do nothing), don't wait until things falls apart. By that point, the employer could have other, non-disability related complaints. While it won't afford him/her the luxury of avoiding a lawsuit, it could provide a valid defense.
Prior to doing anything, speak with an attorney. There are thousands of employers nationwide not complying with their federal obligations. Confusion, misinterpretation, and outright disregard for the law are rampant. The small amount you spend on legal consultation up front could save you time, money and your job on the back end. Call your local Bar Assn. for a disability lawyer near you.
A Bedroom Story
Have you ever been in the position that this one mother found herself in? She asked her daughter to go downstairs and clean her room. Yet two hours later the room was still not clean. A messy room can be an overwhelming task to say the least for any child, and the distractions are many. Many children will resort to playing with the toys and other paraphernalia strewn across every horizontal surface.
Reality invades their play only when a perturbed parent not so gently reminds the child to get back to leaning. This mother was no different. Angrily she scolded her daughter and trounced loudly away. However, mom decided that her response would be different the next time she checked up on her girl.
A half an hour passed and mom checked again. Still no progress! At this point, mom grabbed a clipboard, paper and pen. How would like to have mom help you clean your room? she asked her daughter. Relieved, the girl said cool. What do we need to do first? questioned her mother.
The child replied, I don’t know. (ADD children and ADDults have a difficult time breaking large tasks into smaller units and then becomes overwhelmed.) Just think of one thing we can do to clean the room. What is the messiest part of the room?
Well, the child replied, the clothes; we need to pick up the clothes. That’s good, we should pick up the clothes. What are we going to do with the clothes when we pick them up? mom asked. We should put the dirty clothes in the laundry basket and put the clean clothes away. It was obvious that the girl was now involved in the process. That’s good, but wouldn’t that be hard to do as we pick them up? How ‘bout, mom suggested, we take all the clothes around the room and put them on your bed. Then we can separate them by clean and dirty. After we are done doing that, we can put all the dirty clothes in the laundry basket, and I’ll do laundry. We can then hang up the clothes that belong in the closet and fold the clothes that go into the drawers.
The girl agreed that this would be a great idea. Mom wrote down the steps they agreed on, and they went right to work.
Then mom said, Now we are done with the clothes, what is the next messiest part of the room? (ADD children and ADDults by definition have a difficult time remaining on task, mom’s prompting helps the girl refocus) Mom and the girl both agreed that the next thing that needed to be done was to take the stuff that didn’t belong in the room and put them where they belonged.
Dishes and old food needed to go to the kitchen. Dad’s tools needed to go to the garage, and the hair dryer to the bathroom.
They sorted the stuff by where they should go and then returned the items to their rightful place. They continued this process until the entire room was clean. At the end they had a clean room ..... and a list!
A few weeks later, the room needed to be cleaned. Mom again told the girl to go clean her room. However, this time she handed her daughter a copy of the list. Here, follow this list. Do every step in order and when you are finished and have done everything on the list, you can have some ice cream, promised mom. (Rewards for completion can be very useful. Notice mom is using the completion of the list as the criteria for the reward, not the clean room.)
The child cleaned the room in very little time, a new household record was set.
Mom had several copies of the list and gave her princess a copy to use each time she had to clean her room. However, eventually she ran out of the list. No problem, when mom could not give her a list, the girl created her own and put it on her cork message board. Not only did the girl follow this list to clean her room, but she began following the list anytime the room began to get messy. (One of our goals with our children is to train them to create their own lists and systems of coping. By creating the list on her own the girl has taken ownership of the solution.)
This is a good story to illustrate the power of the RIMS system. (The Rims System is covered extensively in my book.) Not only does it provide a system to approach the problem through routine, increments, onitoring and structure, but it demonstrates how this system can begin as an external control and end up as an internal system the child can use.
Clean room Routine Done on demand or on a regular day and time. Increment Make and follow a detailed list
Monitor Check list for completion, reward or consequence based upon completion of the list, not the task. If the list is incomplete, change the list.
Structure Keep list in a predictable place, have predictable places to put stuff like toys, books, art equipment, etc.
We will need to make sure that when we monitor multi task activities like cleaning the room that we monitor the most important step: following the list.
Both consequences and rewards should be based on list completion, not specific items on the list.
For example, let’s say that the girl in the story decides to short cut the list and put all clothes, both clean and dirty, into the laundry basket. As mom checks over the room, she actually checks the list. She discovers the short-cut and asks the girl to show her the clothes that she folded and put away. When the girl can’t do that, the mother withholds the treat until the list is completed and possibly gives another consequence if this was not the first time she tried to short-cut the list. The previous short-cut would not necessarily have to be the same short-cut in order to receive the consequence.
This approach ensures that the ADD child will have a routine strategy to approach any multi-task situation. Eventually, she will learn that success is possible through good planning and consistent adherence to the plan, an important life long lesson.
Should a room be allowed to get messy in the first place or should we make a child clean everyday. Actually, I believe that the best approach is somewhere in between.
It may be asking a too much to have the room clean everyday. For many parents with ADD kids, they have a hard time getting their students to pick their clothes off the floor, let alone keep the whole room clean.
On the other hand, the one ideal place to train an ADD child skills like organization, routine, respecting one’s self and one’s property is their own bedroom. If a parent allows the ADD person to keep their room the way they want to, they will again prove the fourth law of thermodynamics, all matter eventually moves from organization to chaos. It is much more difficult to clean a messy room than to maintain a clean room.
I suggest that the daily goal should be uncluttered instead of clean. This can be accomplished by establishing steps like pick up clothes and make bed as part of the morning routine. However, this will only get done if these tasks are checked each morning by a simple glance into the room.
-- Rick Pierce, The Hyperactive Teacher
ADDvance Magazine, A Magazine for Women with ADD
ADDvance magazine wants to hear from women about tips for surviving the holidays. We are going to have a holiday survival issue in November and will publish the best ideas and coping strategies for making the holiday season de-stressed rather than distressed. Your readers can e-mail us at Editors@addvance.com
ADDvance is starting to post a listing of womens ADD support groups, and will also have an "in search of" listing of names, town and e-mail address of women who would like to help form a support group in their area. Tell your readers that they can send us their group information or their name for the "in search of" listing by writing us at SupportGroup@addvance.com.
That's it for this issue!! Please remember to send me anything you wish to share or contribute to the newsletter by the 10th of each month. Also if you have anything in paticular you'd like to see addressed, please email at <a href="http://www.adhdnews.com/contact_us.htm">Contact Us</a>. Also, I've expanded the site to include depression so feel free to send me any ideas or feedback.
Once again, many, many thanks to those who make my site and this newsletter possible.. DAVID RABINER and ADHD RESEARCH UPDATE,
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