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ADHD and Anxiety

Children of all ages with ADHD (Attention Deficit Hyperactivity Disorder) frequently suffer from varying degrees of anxiety. Anxiety may be provoked for many reasons in the child with ADHD: The frustration coming from having to work harder in order to keep up academically is a common and significant stressor. The incessant negative feedback that is all too common in the life of the child with ADHD creates a numbing pressure. Then the difficultly getting along with peers sets the child a part socially and fosters a sense of not belonging. All of these issues lead to low self-esteem which makes the child with ADHD even more vulnerable to stress.

A study reported recently at the American Neuropsychiatric Association meeting found that stimulants administered for ADHD also help relieve anxiety in the patients. In fact stimulants alone were as effective in treating anxiety as stimulant plus anti-psychotic medication.

The study evaluated 134 children and teens with a mean age of ten years. They were evaluated in terms of the change over time in anxiety scores on the parent-completed Child Behavior Checklist.

Eighty children were on stimulants only. Another 54 were on a stimulant plus antipsychotic drug. Twenty four of the patients had clinically significant anxiety, as determined by a baseline Achenbach anxiety score prior to starting medication. After four months of therapy with stimulant medication, 83% of the children had a reduction in their anxiety scores.

This study did not evaluate the reasons why anxiety was lessened with stimulant treatment. Two possible mechanisms, however, could be responsible. First, it is possible that stimulants have a direct anti-anxiety effect when used to treat ADHD. However, this is not proven. A more likely possibility is that with effective treatment of the ADHD behaviors, the patients experienced less conflict with his or her environment and, therefore, experienced a reduction in anxiety.

Those of us working with children with ADHD should remember that they are often dealing with significant stress and anxiety. We need to look for such complications and address them when needed. It is good to know that effective stimulant therapy, itself, has a measurable anti-anxiety effect.

The ADHD Child and Summer Camp

It is that time of year! Millions of kids across the country will be packing up their knapsacks, waving goodbye to mom and dad, and heading for the hills—literally. Yes, they will be off to summer camp.

What about camp for your ADHD child? Is camp good for him? Is she ready for camp? These are good questions. The answer, of course depends on a multitude of factors. The issues condense to two important areas:

Is your child With ADHD ready for camp?

Is camp ready for your child with ADHD?

Let’s look at the second question first. This question is really asking if the camp under consideration is one that is appropriate for a child with ADHD. Does the camp have a philosophy of inclusion in which they are interested and equipped to work with children with varying backgrounds and needs? Does the administration and staff have some knowledge about ADHD? Is the staff trained in the needed skills of reinforcement and behavioral management? If your child is taking medication, is the camp able to administer it properly.

Although few in number, camps for children with ADHD and/or other learning difficulties does exist. These camps are designed to present a general camping experience for the child while at the same time providing specific therapy and education relating to the ADHD. To find out about such camps in your area you might check with the local chapter of CH.A.D.D. or LDA (Leaning Disabilities Association). If you are unable to locate a local chapter, contact the national offices of these organizations.  Also, check with your school counselor. He or she might have a list of specialty summer camps.

Is your child ready for camp? The answer to this question is somewhat more complicated. Most importantly, the child’s attention deficit should be sufficiently controlled so that he will have a positive and helpful experience. His behavior should be at the point that undue re-direction or behavior modification will not be required.

While there is no sure way to know, there are a few points that indicate that your child is ready for the camp experience. Look for the following readiness cues: Does your child make friends easily? Does she adapt well to new situations? Does he respond well to adult supervision? Does she enjoy successful sleep-overs at the homes of her friends or relatives?”

If your child hasn’t experienced success in most of these areas, she or he probably is not ready for sleep-away camp. But she might be ready for a less socially demanding experience such as day camp. If day camp is too big a step, encourage your child to spend a few days with a favorite friend or relative. Then be sure to praise her success at being away from home.

In general, I would suggest that most children with ADHD are not ready for a week-long sleep away camp until ten or older. For many, this time will not come until their early teens. Of course there could be exceptions with the more mature child. Day camp could be a very good alternative for the child with ADHD.

What Are the Benefits of Camp?

Attending camp gives children an opportunity to learn many new skills—how to swim, ride a horse, sail a boat, hit a tennis ball, use a bow and arrow, tie a knot. It also gives them a chance to master important emotional, developmental, and social skills—how to get along with other people, establish peer relationships, tolerate differences, work as a team, and become more independent.  Camp also gives parents and kids a chance to practice the art of letting go. The experience lets children develop autonomy and a sense of self-respect. A successful camp experience can be a big boost to self-esteem. For parents, the separation allows them to take a break, care for some of their own needs, and recharge their parenting batteries. They also need to experience autonomy from their child—in preparation for what is to come in the very near future.

How To Prepare the Child for Camp?

Since children can be fearful of the unknown, it is a good idea to share as much information as possible about the camp. If the facility is within driving distance, you might plan a visit ahead of time. Such a visit allows the child to see the place as well as talk with some of the staff. Much of the mystique as well as the fear is thus removed.

If a personal visit is not possible, ask the camp for whatever information they may have: brochures, pictures, videos of the camp.

Above all, talk with the child about his hopes, dreams, and fears about camp. Listen to what he has to say. Discuss any concerns. Certainly, do not belittle the worries and fears. Let the child know that while you think the camp experience will be good for all of you, you will miss him and will look forward to his return. It also helps if the child is able to attend camp with a friend.

Non-Stimulant Medication Approved for Treatment of ADHD

The FDA has approved a new medication for the treatment of ADHD (Attention Deficit Hyperactivity Disorder). Kapvay is the first non-stimulant approved to treat ADHD in children and adolescents. It can be used either with or one of the traditional stimulant medications or can be used alone in the treatment of ADHD.

Clonidine extended-release tablets (Kapvay) acts on the brain in a different way, and acts in a different part of the brain, than the stimulants. Taken twice a day, Clonidine, in these early studies, improved core ADHD symptoms. In clinical trials, the most common adverse effects were sleepiness and sedation.

We will need more experience with this medication in order to know its long term usefulness. Clonidine in its original form has been around for years. It is used primarily in adults as a treatment for high blood pressure. This older form has been used off label by some psychiatrists to treat oppositional behavior and certain types of sleep problems in children with ADHD.

Most likely, the primarily use of Kapvay will be as an adjunct medication used along with stimulants when the involved child has more impulsive behavior and or/has sleep problems. Those of us treating children with ADHD are pleased to have an additional option available in the management of children with various forms of ADHD.

Structure of Time and Place

Most children as well as adults, when left on their own, eventually will fit their daily routine into some sort of pattern that allows them to function successfully. Due to their internal disorganization, however, children with ADHD fail to do this effectively. They have difficulty focusing on a goal and aiming at it. Their increased susceptibility to distractions makes it difficult for them to stay focused on what is important at any given time.

The more unstructured, disorganized and distracting the environment, the more the child is disorganized and disoriented as to his goals. This, in turn, leads to confusion and frustration which leads to more disorganized, unsuccessful behavior. Thus in an unstructured, unregulated environment the child is caught up in a spiraling web of deteriorating behavior. The more inconsistent and unpredictable the environment, the more disorganized the child’s behavior becomes. This then induces more disorganization and inconsistency in his environment. The downward spiral of confusion and frustration goes on and on…and on.

An environment that calms, organizes, and structures the child’s life is one of the primary steps in a strategy for success. The following techniques are basic:

1. The first step is to provide a dependable time structure to the child’s day. Some elements

of this are:

a. Getting up the same time every day.

b. Regular daily schedule.

c. Regular routine for school, play naps, etc.

d. Regular time for homework.

e. Regular bedtime.

Such a regular, dependable routine does several things for the child. Each planned activity presents him or her a framework on which he can hang his day. The set routine gives him short‑term goals to work towards. The time structure acts like handrails on the stairs which help the child keep his behavior more goal-directed. Having certain activities to do at specific times makes him less likely to wander off into distracting, bothersome behavior.

In implementing such a time structure, the parent first decides on what would be a desirable daily pattern that fits the parents, as well as the child’s, needs. At this point, it would be helpful to sketch out the daily schedule. The parents need to make sure the key elements (getting up, meals, school, bed time) are such that they can enforce them consistently. They then discuss the schedule with the child.

The parents do not have to make a big production out of this scheduling task. They might simply say something like this: “This is going to be our schedule. Let’s discuss it.” If the child is old enough, the schedule can be written and posted in his room or some other conspicuous place. An older child (seven or eight or older) might participate in determining the contents of the schedule. Once the schedule has been determined, the parent enforces it consistently, but gently.

This does not mean that the family must live a totally monotonous, unchanging life for the sake of this one child. But the day‑to‑day routine of the child should be as consistent as possible within the family’s power to make it so. Certainly, there will be times when a break in the routine is needed. When change in this regular routine is necessary, however, it helps to prepare the child ahead of time and clearly state what you expect of him or her.

2. The next step is the structure of place.

“A place for everything and everything in its place,” is more than a motto for the person with ADHD. It is a necessity. A search for a lost baseball glove can be a frustrating experience for a normal ten‑year‑old. But for a ten-year-old with ADHD, it can be a disaster, ending in an emotional explosion. Such problems can be prevented by helping the child organize his world (at least his room and his belongings) so that there is a place for everything.

This could involve other elements such as:

a. A regular, non‑distracting, place to do homework.

b. Labels on drawers and shelves to help the child locate the contents. (Some parents have successfully used color codes on drawers and shelves.)

c. In strange new surroundings, such as on vacation, new school, or visiting friends, it helps to take the child on a tour and show him the layout and locations of important particulars of the area.

These are simple steps but can make a big difference in the life of the child with ADHD—and that of his parents.

Successful Coping Strategies for Adults With ADHD

Many adults with ADHD (Attention Deficit/ Hyperactivity Disorder) have become successful academically and professionally. They have enhanced their success by employing a variety of strategies that help them cope with the bothersome symptoms of ADHD

A few years ago, Dr. Robert Wells, Ph.D., studied  strategies practiced by successful men and women with ADHD. He found that those who were more successful in their education and career were more likely to do the following:

Set up rituals to get through repetitive tasks.

Use lists to retain large amounts of information

Control impulsive behaviors by writing down their thoughts and talking them over with

some one.

Choose jobs which have a variety of different tasks each day and that allow them to be in

charge of themselves and their time but that still have structure and quotas.

Learn to delegate.

Some of the individuals listened to “white noise” in the background to help them concentrate. “One guy had the rule of three: He only allowed himself to work on three things at once,” said Dr. Wells, Director of Pediatric Research at Valley Children’s Hospital in Fresno, California.

Many of the less successful subjects could not identify any strategies they used to avoid distractions, to retain information, or to make them feel successful. Only nine per cent of the variability in success could be attributed to differences in intelligence, Dr. Wells added.

Editors Note: This technique of studying adults who have successfully compensated for their developmental challenges would seem to be an area of fruitful study. We do know that many individuals find success and happiness. It helps to know what tools they use to compensate.  As we now know, few, if any, people “outgrow” their ADHD. But they can learn compensatory tools as the subjects of this study point out.

Overcoming—Rather Than Being Overcome by ADHD

Day-to-day experience as well as scientific observation attests to the fact that different children exposed to the same degree of stress or frustration are not all affected in the same manner. Some are stymied and squelched by their obstacles; others thrive as if the obstacle was more of a stimulus than a roadblock. Those of us working with children with ADHD see this frequently.

Peter Wyman, Ph.D. and associates studied this question several years ago. (The Journal of The American Academy of Child Adolescent Psychiatry, 1992:; 31 (5):904-910)

The researchers looked at demographically comparable groups of children exposed to major life-stress. They interviewed both stress-resilient and stress-affected children assessing perceptions of their care-giving environments, peer relationships, and themselves. Four variables correctly classified 74% of the children in one or the other group. Stress-resilient children, compared to the stress-affected children, reported more:

positive relationships with primary care givers (i.e., parents)

stable family environments

consistent family discipline practices

positive expectations for the future.

These findings support the view that care giver-child relationships play a key role in moderating children’s developmental outcome under conditions of high stress.

This study also points out the extreme importance of a positive parent-child relationship in helping a child overcome obstacles. Children with ADHD and leaning disabilities have many reasons to be stressed. Many will grow into healthy, well-adjusted adults in spite of their difficulties. Stable families, applying consistent, loving discipline in an affirming spirit greatly enhance the chance of success

Affirming Creativity in Children With ADHD

The seeds of creativity are planted in the child from creation. But these seeds must be watered and nurtured if they are to grow to their full potential. Creativity can be enhanced or discouraged depending on the way we as parents and teachers react to the child’s initiatives.

So give some of the ideas listed below a try. These easily implements actions will help foster creative thinking and nurture a love of learning on the part of the child. Once you get started, you can add to this list out of your own experience.

1. Help the child chose a topic to write about. Suggest a word length and make it short so as to stay within the child’s attention span. You don’t want to discourage or frustrate him or her. This exercise develops the ability to follow directions. Consider dressing the writing up as a magazine article by encouraging the child to choose pictures she can cut out and paste illustrating the narrative.

2. Using a recorder to develop a story. You can start telling the story. Make it up as you go. It doesn’t have to be perfect. At an exciting point stop and ask the child to pick up the narrative and add to the story. At this point you add more to the story line but quickly give the child a chance to jump back in. Later replay the tape and discuss the story.

3. Explore the backyard or school grounds with a magnifying glass. Have the child make a list of what he finds. Assist him or her in looking up the discovered items in an encyclopedia or on the internet.

4. When the child asks you a question, don’t automatically give an answer. Respond with, “What do you think?” Treat the answers with respect even when you may add or correct information.

5. While driving, begin a “What if?” game. Start with a sentence such as, “What if you went to school one day, and the teacher said you were all going on a trip in a submarine?” Let the child continue adding all the “what ifs” she can imagine. Once the story gets going, prompt the child for more details. Ask why, how, who, when, etc?

6. Don’t belittle or treat lightly any question. As Lucy said to Charlie Brown, “There are no dumb questions, only dumb answers.” For some questions you will have no answer. A good response is simply, “I don’t know. What do you think?” And then add, “Let’s look it up. Where do you think we might find an answer to that question?”

7. Have the child color, draw, or paint any picture he or she wants. Then tell a story about it.

8. Introduce your child to the computer. De-emphasize games; rather, show him or her how to use the computer to accomplish tasks. For instance, help the child to learn basic word processing and encourage them to write stories. Help them to use the thesaurus and spell check. Realizing that there is more than one way to say something is liberating.

It may come as a surprise to some to realize that many children with ADHD are bright and creative. Their distractible, and distracting, behavior frequently disguises these positive qualities. One theory would suggest that while the ADHD child easily misses details due to inattention, his wide-ranging and rapidly moving focus allows him to make true “leaps of logic” and discover new ideas.

The kinds of activities listed above are “attention-giving” activities which help the child with attention deficits and learning disabilities overcome some of their natural randomness.

Redemptive Features of ADHD

Could there be positive aspects to having ADHD?

One would think so. As a biological condition, ADHD has been around for eons. To persist in the human family, there would likely be some benefits to the individual with these traits.

The negative effects that ADHD symptoms have on socialization and productivity are well known and very real. These disruptive features tend to capture the focus of professionals as well as parents because of the limitations they bring to the child’s life. But redeeming features do exist, even though they may be difficult to see when the child is failing in school and loosing friends.

Some potential beneficial side effects of ADHD are:

The inattention to detail that can be so frustrating to the student, the teacher, and the parent can result in an enhanced conceptual ability which helps the child see the “big picture.” This “big picture” view can result in strengths in global problem solving.

The inability to be easily satisfied can be associated with ambition and initiative. Could this be one reason why Thomas Edison kept tinkering with all sorts of projects leading to his  ownership of thousands of patents for innovative and useful products?

Distractibility is intimately linked to creativity. A student who notices things no one else sees is in a position to detect meaningful interrelationships that elude more disciplined minds.

A certain level of impulsiveness can result in a willingness to try new things, to go out on a limb for a project or cause that is important.

Individuals with ADHD often have a superb sense of humor, appealing personalities, true leadership skills, and striking individuality.

Parents and professionals working with children with ADHD are well aware how limiting the varied symptoms of ADHD can be when they are unmanaged and run amok. In fact, when a person, child or adult, is overwhelmed by inattention, disorganization, impulsiveness, they are set up for failure. But with proper management, these symptoms can be controlled. The ultimate future for children with ADHD can be bright. So we should not give up but use strategies that result in success. The chief purpose of  Strategies Unlimited is to provide practical steps in achieving this goal so that we can see the bright side and enjoy the journey.

ADHD, Medication, and Growth

Over the years, there has been concern that children with ADHD taking stimulants do not grow normally due to the appetite effects of the medication.  Various studies over the years have looked at this issue and the results suggest that there are little, if any, stunting of growth from the stimulants. But questions persist in some circles.

A recent study performed at Massachusetts General Hospital in Boston and reported in the Journal of Pediatrics (October 2010) clarifies the growth tendencies of children with ADHD. This study looked at the growth patterns of over 240 boys and girls with ADHD and compared their growth with that of matched controls without ADHD.

The subjects were observed over a ten year period. No difference was noted in the trajectory of growth in height or weight in the children with ADHD compared with those without ADHD. In addition, there were no significant difference in height growth in those treated with stimulants and those who were not. Nor were there any associations between duration of stimulant treatment and growth patterns.

This carefully done study demonstrates that kids with ADHD, whether treated with medication or not, grow at the same rate as the non-ADHD population.

Editor’s Note: This study is re-assuring to parents and to physicians treating children with stimulants. In spite of this, it is important for children taking stimulants to be seen by their physician on a regular basis with monitoring of appetite and growth factors. Among other observations, their height and weight should be measured and plotted on a growth curve regularly. If there is any evidence in loss of appetite or fall off in the growth pattern, the physician and parents can make appropriate adjustments in type, amount, or timing of the medication.

Association of ADHD to Obesity

A large of study of over 12,000 people in the U.S. has suggested an association of ADHD and obesity in children and young adults. In an analysis that controlled for age, sex, race, ethnicity, education, depression, alcohol use, smoking, and physical activity, survey participants with ADHD had a significant 63% increased risk of being obese compared with those without these symptoms. People with only inattention (ADD) had a smaller increase risk of 23%.  In the study, the more intense and widespread the symptoms of hyperactivity and impulsiveness, the worse the obesity risk.

The study did not evaluate the reasons for this association of ADHD and obesity. However, one of the characteristics of ADHD is impulsiveness. It is possible impulsive eating, maybe related to increased stress of coping with ADHD symptoms could contribute to the increased risk. Further study is needed to get a better picture of the cause of the obesity and how to prevent it. Also it would be of interest to know if optimum treatment with medication and cognitive behavior therapy would reduce this risk. I suspicion is that it would to the degree that intervention helped in the control of impulsiveness.

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