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Can Exercise Help the Child with ADHD?

A recent study suggests that as little as twenty minutes of exercise a day may help kids with attention-deficit hyperactivity disorder (ADHD) function better. The study, to be published in the Journal of Pediatrics (2012), evaluated 40 eight- to ten-year-olds by looking at the short-term effects of exercise. The study compared 20 children with ADHD and 20 without signs of ADHD. All of the children took a standard test of their ability to ignore distractions and stay focused on a simple task at hand. The kids also took standard tests of reading, spelling, and math skills. Each child took the tests after either 20 minutes of treadmill exercise or 20 minutes of quiet reading on separate days.

 
Overall, the study found both groups of children performed better after exercise than after reading. On the test of focusing ability, the ADHD group was correct on about 80% of responses after reading, versus about 84% after exercise. Kids without ADHD performed better, reaching about a 90% correct rate after exercise. Both groups of kids scored higher on their reading and math tests after exercise than after the reading period.

 
The researchers noted that the effect of exercise on adults’ thinking and memory had been studied extensively, particularly older adults’. But little is known about kids, even though some parents, teachers, and doctors have subjectively seen positive effects of exercise.

 
The scientists reporting on the study state that it’s hard to say what the higher one-time scores could mean in real life. “One of the big questions is whether regular exercise would have lasting effects on kids’ ability to focus and their school performance,” they stated.

 
“We’re not suggesting that exercise is a replacement, or that parents should pull their kids off of their medication,” the scientist went on to say.

 
  This research, while preliminary, reflects the experience of parents, teachers, and others working with kids with ADHD. Since most of these kids have a drive to be active, most observers believe that facilitating active exercise during the day, especially the school day, allows the child to “run off” some of his excessive energy. Future studies in this area will be welcome.

ADHD and Self-Esteem

Helping the child with ADHD to grow up with a balanced sense of self‑worth requires care and effort by all who impact on his life. At every turn the child is met with situations that tend to tear down and warp the self‑image. Among these are the following:

 

1. From an early age, he finds himself in constant conflict with the limits placed on him by parents, teachers, and other authority figures. Since much of the behavior producing this conflict is not purposeful disobedience on his part, he is confused and frustrated. He gets the message, “There must be something wrong with me. I can’t do anything right!”

2. Lack of achievement in school reinforces the sense of being abnormal and inferior. A child who sees himself getting further and further behind his peers in achievement easily loses his self‑confidence. If this continues long enough, he may come to say, “Why try, I’m no good anyway.”

3. The child who is uneven in his development and who has significant discrepancies in his abilities may be confused by the contrast between what he can do easily and that which requires an inordinate amount of effort for rather minimal achievement. He may be puzzled as he tries to understand what his capacities really are. The amount of study, including testing, that is needed in the diagnosis of a learning disability also can create worry about himself. The child and his parents may be the victims of professionals disagreeing about diagnosis and treatment.

4. The child may be jealous of other children and siblings for whom achievement comes easily. There may be problems around school work at home; particularly if his brothers and sisters degrade him in any way for his less than perfect work. He may hear from school personnel or family the fallacy, “If you just work harder, you can do better.” The child may be upset by the kinds of work that he must do because of his disability: for example, a fourth‑grade boy cried because he was doing the same kind of work his first‑grade sister was doing.

5. Poor coordination resulting in unsuccessful performance on the playground is also detrimental to the self‑image. Other children often ridicule the one who is poorly coordinated. And ridicule from a peer burns deeply.

How to Help

While it can be difficult to overcome these problems, parents and professionals have some practical strategies to help the child retain a balanced sense of self‑worth in spite of the odds:

1. When the child breaks the rules or oversteps the limits, we should discipline firmly but kindly. We should aim the punishment at the offense and not at the child or his personality.

The child should not be told, “Would you stop? You’re nothing but trouble.” Instead we might say, “Johnny, your jumping around is really bugging me. I think you should go to your room for 15 minutes and see if you can stop.” We then send him immediately to his room. If he doesn’t go willingly and quickly, we take him by the shoulder and lead him to his room.

Rather than say, “Don’t be stupid. I’ve told you that a hundred times,” we should say something like, “I’ve explained that rule before. Please do what I asked.”

Everyone should remember that one can discipline firmly without attacking the person or worth of the child.

2. We should not punish the child for things he really cannot help such as fidgeting or being clumsy.

3. As much as possible we should positively reinforce appropriate and desired behavior. “Catch them being good and tell them so” is a healthy working motto. Always be on the lookout for the opportunity to honestly say something affirmative.

4. If we suspect the child of having a behavior or learning problem, we should seek help as soon as possible so that the proper diagnosis and treatment may be instituted. Often such early intervention can circumvent much of the stress and conflict that blocks their success.

5. We must seek an educational environment which treats the child as an individual, recognizes his strengths and weaknesses, and helps him learn in his own way at a pace appropriate for his skills.

6. We should help the child to discover his good qualities and superior skills. All of us, even those with special problems, do have some good points and superior abilities. We all have a deep psychological need to excel in some area of life. Your child’s hidden talent may be an isolated academic skill, a sport, a hobby, or music ability.

For instance, many children with ADHD are not very good at the traditional sports such as football, basketball, and track because of their lack of coordination. But often these children are quite well coordinated in water and are excellent swimmers. Thus swimming for fun and competition can be pursued as their area of excellence. One boy was a very poor reader but had perfect pitch and became a good musician in spite of his inability to read well.

7. We should not use language that attacks the child’s dignity or personal worth. Children who are belittled as youngsters are likely to grow up with a poor self‑image. They literally continue to belittle themselves throughout life. Such belittling adjectives as “rude”, “ugly”, “stupid”, or “clumsy” should not be used to describe children. Rude, stupid, ugly, etc. may be used to describe actions, if necessary, but they should not be used against the child himself. The danger is that the child may accept such an evaluation and make it a part of his  self‑image. If he thinks himself as rude, ugly, or stupid, he is likely, in the end, to behave that way: it is only natural for a rude boy to behave rudely.

Such precautions do not imply parents should not correct a child or criticize his behavior. There is, however, a big difference between criticizing the behavior and criticizing the child.

Rather than say “You are a rude boy,” a parent can say, “That was a rude thing to do. Apologize and go to your room.” Such a statement is not an attack on the child’s personality but  does show disapproval of his behavior.

To the child who brings home a poor report card a parent can say something like this: “Cathy, this doesn’t look like you. I guess we will have to set up a regular homework time.” To say “I knew you were lazy, but I never expected this from a child of  mine!” is to whittle away at the child’s ego.

It is a hard lesson for us parents to remember but discipline should be directed toward the misdeed and  not toward the child’s personality. Even if the child’s personality leaves something to be desired, to attack it will only make it worse. Remember, we get a lot more out of a child, or anyone else, with positive reinforcement of good traits than we do by criticizing the undesirable traits.

 

Sleep-Disordered Breathing and ADHD

Sleep-Disordered Breathing and ADHD

A large, population-based study demonstrated that early in life sleep-disordered breathing symptoms had a strong relationship to behavior in children later in life. Children with sleep-disordered breathing developed more behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships when compared with children without sleep-disordered breathing. Findings suggest that children with sleep-disordered breathing symptoms may require treatment as young as one year of age to prevent increased tendency for behavior problems.
“This is the strongest evidence to date that snoring, mouth breathing and apnea can have serious behavioral and social emotional consequences for children,” reported Karen Bonuck, PhD, one of the researchers and professor in the Family and Social Medicine Department at Albert Einstein College of Medicine.
In the study, parents completed surveys reporting on children’s snoring, mouth breathing and witnessed apnea at ages 6, 18, 30, 42, 57, and 69 months of age. More than 11,000 children were followed for more than 6 years. Parents then completed the Strengths and Difficulties Questionnaire when the children reached 4 and 7 years of age. The questionnaire has five scales: inattention/ hyperactivity; emotional symptoms (anxiety and depression); peer problems; conduct problems (aggressiveness and rule breaking); and a social scale (sharing, helpfulness and other factors). Researchers controlled for 15 potential confounders, such as socioeconomic status, maternal smoking during the first trimester of pregnancy and low birth weight.
Researchers found that children with sleep-disordered breathing were 40% to 100% more likely to develop neurobehavioral problems by age 7 years, compared with children without breathing problems. The worst symptoms were associated with the worst behavioral outcomes, and hyperactivity was most affected among the neurobehavioral domains examined, according to the researchers. “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures,” said Bonuck. Bonuck K.

This report published in the Journal, Pediatrics, points to one specific condition that can cause, or at least worsen, symptoms of ADHD. In evaluating a child for ADHD, the examiner should look for signs of sleep-disordered breathing with the medical history and physical exam. Causes of sleep-disordered breathing can be allergic rhinitis, large tonsils and adenoids, or congenital abnormalities of the upper airway. Essentially all of these are treatable with surgery or proper medication.
Sleep-disordered breathing is certainly not the cause of ADHD but one of many factors that can affect the expression of this common developmental problem in children.

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 ready for camp?

Is camp ready for your child?

Is Camp Ready for My Child?

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 do exist specifically for children with ADHD. 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 or the website of CH.A.D.D. (Children and Adults with Attention Deficit Disorder) or LDA (Leaning Disabilities Association). Also, check with your school counselor. He or she might have a list of summer camps that accommodate children with unique needs.

Is My Child Ready for Camp?

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.

Look for the following readiness cues: Does your child make friends easily? Does she adapt well to new situations? Does she respond well to adult supervision? Does she enjoy successful sleep-overs at the homes of her friends or relatives?

In addition, if your child hasn’t experienced success in most of these areas, she 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. 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.

 

Redemptive Features of ADHD

Children with ADHD have very real challenges. The disruptiveness of the child’s behavior and the struggles in learning can make life difficult. These dysfunctions tend to drive professionals as well as parents to focus largely on the negative connotations of attention deficits. But redeeming features do exist, even though they may be difficult to see. However, this positive side to ADHD often begins to show itself in adolescence and young adulthood if we look for it.

—The inattention to detail that is so frustrating to student and teacher alike can lead to strengths in conceptual ability. A result can be an enhanced ability to see the big picture. Such individuals can become adept at global problem solving and may be an asset in leadership roles.

—The inability to be easily satisfied can be associated with ambition and initiative. Could this be one reason why so many individuals with attention deficits have been successful in a wide variety of fields?

—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 student who is highly impulsive may ultimately evolve into an adult with a strong bent for closure, a person who accomplishes a great deal during the working day.

—It is not unusual to encounter adolescents with attention deficits who have superb sense of humor, appealing personalities, true leadership skills, and striking individuality.

Yes, the struggles that children with ADHD face are real. It is important to intervene and provide healthy management such as academic accommodations, medical treatment, counseling when needed. In doing so we can avoid some of the unhealthy consequences such as poor self-esteem and discouragement.

However, we should have an optimistic anticipation of the ultimate success of the child with ADHD. We should be looking for ways to help the teen discover his or her strengths and help them see that they can turn a weakness into an asset.

 

Try These Sports for the Child with ADHD

Certain sports are better suited for the ADHD child than others. Baseball, for example, is usually not a good choice. The slow pace and the need for well-developed motor and eye-hand coordination skills make it difficult for many children with ADHD .Stuck in left field, the ADHD child is likely to be off chasing a butterfly when the fly ball comes whizzing his direction.

Some of the more suitable sports for the ADHD child are:

Soccer. Soccer serves as a good building block for other sports because it enhances speed, endurance, and leg strength. It is relatively safe. Too, the hyperactive child does not look much different form other children on the field. Most communities have summer and fall soccer programs and communities in warmer climates have soccer programs year-round. Most children genuinely enjoy soccer; it is now the second largest sport for children in the United States.

Swimming. Swimming, with or without competition, is a good choice for many children with ADHD. The explosiveness of swimming is well matched to the impulsiveness of ADHD. Being a solitary sport, it does not require close cooperation with a large number of teammates as is necessary in the more traditional team sports.

Also swimming is an excellent activity for children with coordination problems. Motor skills needed for swimming seem to be different from those needed for activities on land; a clumsy child can actually be a good swimmer. Swimming, too, seems to enhance over all motor coordination. I have know many ADHD children who were able to experience success in competitive swimming when they failed at all other sports.

Karate. Tae Kwon Do and Karate have proven effective outlets for many ADHD children. Such martial arts are probably the most enjoyable sport after soccer.

Parents sometimes question this use of the martial arts fearing that they may over-stimulate the child or aggravate aggressiveness creating serious social problems. But this does not seem to happen.  The martial arts like tae kwon do and karate are two of the most therapeutic programs for children with  focus and organizational problems. Another benefit is that children can start as young as 6 or 7 years of age. These sports are beneficial because they involve structure, rules, rituals, a stop-and-think attitude. No techniques are taught until the child has learned to stop, listen and think. Classes are usually small. The techniques are monitored carefully, and it is emphasized over and over that these activities are sports and are not be used for any aggressive play. Students who disobey the rules are likely to be expelled from the class.

The martial arts teach and develop control of mind and body. Such control, of course, is the basic need of children with ADHD

The Place Of Sports In The Treatment Of ADHD

Jason was eight and really interested in sports. He also had ADHD. He was signed up for Little League Baseball and eagerly went to practices. Soon, however, his enthusiasm turned to frustration as he struck out, missed fly balls and sat on the bench a much of the time.

Early sport experiences for ADHD children all too often follow a similar pattern. The result is that they are turned off sports altogether. Such occurrences are unfortunate. Although little research exists to document the use of sports and recreation in children with ADHD, the experience of many people working with children suggests that, when used properly, they can make a significant contribution to the child’s overall growth and development.

Carefully chosen activities, perhaps combined with the use of appropriate medication, can enhance the child’s confidence, self-esteem, fitness, and social adjustment. While conventional treatment with medication, behavior modification and academic intervention are mainstays of management, children with ADHD need the physical, psychological and social benefits which sports and other recreational activities can provide.

Integrating recreation and sports into a management plan requires thoughtful planning. We are all familiar with “individual education plans”. ADHD children might well benefit from “individual recreation plans”. In selecting an activity for a child, various factors need to be considered: What are the child’s assets as far are coordination, body strength and attention? Why have previous sports activities failed? What are the child’s interests–what does he or she do in his free time? How mature is the child physically and emotionally.

Thus, it is important for the parents to talk to the coach or recreation leader about their child’s skills and problems before a program begins. Parents worry that this will create a negative attitude in the coach or teacher. On the contrary, most coaches want and need to know about strengths and weakness the child may have. If not made aware of the child’s needs, the coach will probably interpret his negative behaviors or inexperience as lack of interest or rebellion. The end result is a bad impression of the child.

A bonus coming from athletic activity is that as parents participate with the child, barriers are let down and more meaningful communication can occur. While attempts at dialogue at the dinner table may lag, spontaneous and meaningful conversation can usually be elicited while shooting baskets or playing a game of ping-pong.

Too many ADHD children have been turned off sports and physical recreational activities because of bad experiences in the past. These negative attitudes need to be turned around so that the child can enjoy the benefits of recreation and fitness activities. Carefully chosen activities can not only be pleasurable but provide significant therapeutic benefits to child with ADHD.

The next blog will outline the best sports for children with ADHD.

Positive Relationships Sets the Stage for Success

Our chance of success in parenting is greatly increased as we positively meet the normal, healthy needs of our children for love, acceptance, meaning, and mastery. As these needs are met our children will be less tempted to seek a place for themselves through deviant, undesirable behavior.

Our children need to know that we love them in spite of what they do. Our love and concern as parents is not conditioned on their behavior. By honestly accepting our children and liking them while not necessarily accepting or liking their behavior,  we keep the door open to change and growth. Love is, and has always been, the most powerful force in the world.

When it comes to relating to children, patience is a virtue but is not always easy to express.
“Stop acting like a child,” I overhead one frustrated mother say to her six-year-old. Although I could understand why this mother erupted in such frustration in the middle of the supermarket, her remark mirrors our frequent inappropriate expectations of our children. Much of the behavior of children that is so frustrating to us as adults is simply our children being, well, children.

To be effective as parents, we need to  Our love and concern as parents is not conditioned on the child’s behavior.have some idea of what is appropriate behavior for our children’s age and stage of development and not attack them for things they cannot help. A young father got very angry with his three-year-old son for using a paper cup as a football during a formal reception. Actually this was pretty normal behavior for a toddler who was ignored in the midst of all the adult activity.

Another mother was frustrated because her thirteen-year-old daughter ran to her room  slamming the door when her mother disapproved of the dress she was wearing. Actually, such pouting and anger are quite typical of the adolescent. We need to remember that children are uniquely children—growing organisms who have not yet reached perfection. Punishment of the child for things he or she cannot help or does not understand will only create frustration, confusion and, likely, rebellion.

We often use up so much energy nagging and correcting our children that we have little energy left to relate to them in positive ways. This is particularly true with ADHD children. In the happy families I have known, however, the interactions have a positive tone and direction. In angry, unhappy families, most interactions have a negative tone. This is one area where all of us as parents can work toward a better record. We can tip the balance in our families in a more positive direction by applying some of the following principles to our relationships:

Listen to the child. Listen without interrupting or correcting. Listen to just hear what he or she has to say.

Do something the child likes. For some this may be reading and talking, others playing touch football, others working on a craft project, or repairing the car.

Give the child some space. Let the child do his or her own thing as long as the activity does not infringe on the rights of others. We are saying, in essence, “I trust you to make some choices for yourself about what you will do with your time.”

Avoid conflict when possible. Conflict, at times and to some degree, is inevitable. While most parents seek to avoid conflict, some seem to delight in having a head on collision with their children. However, both parents and children gain when potential conflict is avoided. A power struggle only creates hostility and negative feelings which hurts everyone. When you do need to draw the line and establish a limit, do so firmly and quickly with as little verbal combat as possible.

Look for the child’s good points. Everyone has some gift. Everyone does something well. Everyone has some redeeming features. The sparkle is there if we only look for it. Ours will be a much happier family if we look for the other persons talents rather than their faults.

As parents we teach through relationships .

We show our children what love is by loving. We teach forgiveness by forgiving. We teach honesty by being honest. We cannot substitute things for affection. Often adults have been heard to say, “I received everything I needed form my parents except the love and understanding I needed most.”

The child with ADHD draws criticism and negative feedback like a magnet. Relationships in the family often mushroom into a back hole of negativism. Parents find themselves constantly correcting, redirecting, and limiting. The child too often responds in sullenness and more self-defeating behavior. It takes effort to reorient the family atmosphere to a more positive spin. But it can be done. And it is well worth the effort.

ADHD and Handwriting

Even in this day of thumb-driven Twitter shorthand, handwriting continues to be a critical skill. Legible, coherent handwriting is a signal measure of academic success. And it still plays an important role in formal and informal communication.

Educators and other professionals working with children with Attention Deficit Hyperactivity Disorder (ADHD) have observed that many of these children have significant problems with handwriting.

A recent study coming out of the Centers for Disease Control and Prevention (CDC) documents the relevance of these observations. This research, led by Slavica Katusic of the Mayo Clinic was published in Pediatrics (September, 2011).  The study included 6,000 children: all those born in Rochester Minnesota between 1976 and 1982 and who was still living there after age 5.

Katusic and her co-workers evaluated school and medical records to see which children showed signs of ADHD, as well as how well they performed on writing, reading and general intelligence tests over their school career. A total of 379 children fit the criteria for ADHD. About 800 children scored poorly on tests of writing abilities, and most with writing problems had reading difficulties as well.

Writing problems were much more common in both boys and girls with ADHD, with close to two-thirds of boys with ADHD having problems with writing. That compared to one in six of their peers without ADHD. In girls, 57 percent with ADHD had a writing problem, compared to less than 10 percent without ADHD.

There are several reasons why children with ADHD may have problems in writing. Writing is a very complex task that involves cognitive activity and motor activity at the same time. A high level of mental coordination and sequencing is required—tasks that individuals with ADHD have difficulty with. Also, memory and planning problems may affect the writing process. The impairment in sustained attention experienced by children with ADHD causes them to loose track of what they are doing and they will tend to make careless errors and get confused about what is to come next in the phrase or sentence.

Long term observation does suggest that the writing problems do get better with increasing maturity. Individual education plans that address some of those related difficulties can help especially if they’re started early.

It is my observation that when kids with ADHD are appropriately treated with medication, improvement in handwriting can be dramatic. In fact, improvement is often noted immediately

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.

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