Beyond Medications

Today’s guest blog is by J. Russell Ramsay, PhD.

If adults with ADHD could only have one treatment for their symptoms, research indicates that pharmacotherapy, particularly the use of stimulant medications, is the single most effective option for reducing the core symptoms of ADHD. However, medications alone may represent insufficient treatment for the many difficulties experienced by adults with ADHD, such as disorganization, procrastination, poor time management, mood and anxiety issues, and low self-esteem, to name a few.

During CHADD’s Annual International Conference on ADHD, my session on adjunctive treatments for adult ADHD will be held on Thursday, November 10. The session will cover the current status of various non-medication treatments for adult ADHD that are often used in combination with medications in order to help individuals achieve improved overall well-being and functioning in addition to symptom relief. Here is a brief overview of those treatments.

Psychosocial treatments. Many standard psychotherapy approaches have been modified in order to more effectively address the typical coping difficulties faced by adults with ADHD. In general, cognitive-behavioral therapy (CBT) approaches for adult ADHD, which focus on modifying self-defeating thought and behavioral patterns, have been found to be a useful adjunct to medications in several published studies, including recent randomized controlled designs comparing CBT with other active treatments. Sessions focus on the development and consistent implementation of coping skills in daily life. Psychosocial treatment, namely CBT for adult ADHD, stands out as the adjunctive treatment with the strongest research support.

Coaching. Although not the same as CBT, ADHD coaching shares the goal of helping adults with ADHD to employ more effective coping strategies to fulfill their personal goals. ADHD coaches target specific coping difficulties, such as disorganization and poor time management, and help clients develop and follow through on action plans. While the benefit of coaching support makes logical sense and it is an increasingly available option, to date there has been only one published study of its effectiveness for adults with ADHD adults.

Academic support and accommodations. Similar to ADHD coaching, while academic accommodations targeting specific areas of impairment make logical sense, such as extended time to complete an exam, these adjustments do not have research support. There are many informal steps that students can take to manage the effects of ADHD on their academic performance. However, there are preliminary studies of learning support and coaching approaches for college students with ADHD that have yielded positive results, making it a promising option.

Workplace support and accommodations. Workers with ADHD whose impairments fulfill the legal definition for a disability may be entitled to reasonable workplace accommodations, though most adults with ADHD do not pursue official accommodations. As with students, there are many informal adjustments in the work setting, assistive technologies, and other coping tools that may be helpful for adults with ADHD. As with academic accommodations, the effectiveness of these coping efforts has not been systematically studied.

Relationship treatment. Research on the effects of ADHD throughout the lifespan has increasingly identified its negative impact on family and social life for both children and adults with ADHD. The parents and caregivers usually participate in treatment programs for their children with ADHD, though they are rarely screened for ADHD despite high heritability rates. In fact, parental ADHD (even in sub-clinical form) is likely a common reason for dropout in family treatment programs for child ADHD and/or oppositional behavior.

Similarly, there may be unique difficulties faced in marriages and committed relationships in which one or both partners has ADHD. No studies have yet been published on either marital or family therapy involving adults with ADHD.

Neurofeedback and working memory training. Proponents of neurofeedback training cite numerous studies of its effectiveness, though there have been few studies using samples of adults with ADHD. Critics of neurofeedback, on the other hand, point out that many of the studies are case reports or have serious methodological flaws that cast doubts on their findings. A review of the few studies involving adults with ADHD suggests a middle-ground conclusion that neurofeedback has tentative support. There have been some recent studies of neurofeedback for children with ADHD that used improved research designs.

Computerized working memory training has yielded some positive results in samples of children with ADHD and such training would seem to be helpful for adults, though there have not yet been published reports involving adults with ADHD. However, as with neurofeedback, even if the therapeutic effects are reliable it remains unclear precisely how these interventions work and whether the positive effects generalize to improved functioning in day-to-day life.

Complementary and alternative treatments. There is a wide array of what are deemed “alternative” treatments for ADHD, such as nutritional supplements, specialized exercise programs targeting certain brain regions, dietary approaches, etc. There is preliminary evidence that omega-3 fatty acid supplementation may result in mild improvements in some ADHD symptoms, though these are based on studies of children. Likewise, pilot research of mindfulness meditation suggests it is associated with some improvements for adults with ADHD. There are obvious health benefits of mineral supplementation in cases of identified deficiencies; likewise, exercise, healthy diet, and other good health practices should be part of an overall wellness plan rather than being considered “treatments” for adult ADHD.


There are a number of treatment options for adult ADHD that can be used in combination with medications to target specific areas of impairment. A few of the treatment options have relatively strong support and some others have promising but preliminary evidence for their use while still others have not been found to be helpful. It is important to personalize the combination of treatments to meet the needs of the adult with ADHD in order to optimize functioning and well-being.



J. Russell Ramsay, PhD, is associate professor of clinical psychology in psychiatry and co-director of the Adult ADHD Treatment and Research Program at the University of Pennsylvania Perelman School of Medicine.

Making Homework Simple

Today's guest blog is by Ann Dolin, MEd.

Helping with homework can be a humbling experience, and this is especially true when you are the parent of a child with ADHD. All too often, parents find themselves cast in the role of the nightly homework police, and the divide this role creates can be one of the most painful aspects of parenting.

My presentation during CHADD’s Annual International Conference on ADHD in Orlando this November will bring you proven solutions for even the most challenging homework issues.

In this workshop, parents and professionals will learn specific strategies for each of the common, yet challenging homework profiles that students present when pressured by homework. They are:

o The Disorganized
o The Rusher
o The Procrastinator
o The Avoider
o The Inattentive
o The Easy Frustrated

Novel strategies to address each issue will be shared. These include:

• Easy solutions for setting up the Simple Solution binder system, including an accordion file and one dedicated homework folder.
• Identifying optimal homework spaces (there should be more than one!) and organizing portable materials.
• Simple tips for encouraging students to record their assignments accurately whether it be a paper assignment notebook or one of the cutting-edge electronic calendars.
• Prioritizing, planning, and managing long-term assignments. Quite often, students with ADHD have great difficulty breaking down large tasks into smaller increments.
• Ways to reduce procrastination and eliminate last-minute stress by using a timer, study groups, and other self-regulation strategies.
• Novel study skills for academic success such as easy note-taking ideas, using color for comprehension, creating study guides, and proofreading strategies.
• Strategies to encourage on-task behavior such as the use of the Tangle Jr., Wikki Stix, timers, and software.
• Solutions for finding the balance between helping too much and not enough.
• And for educators, best practices for assigning homework to ADHD students.

Above all, participants will learn how to help children do the most important things when it comes to homework – focusing and finishing!

I look forward to seeing you on Saturday, November 12th from 3:30 to 5:00. This workshop is DEFINITELY worth staying for until the end of the day!

Most sincerely,

Ann Dolin, MEd


A recognized expert in education and learning disability issues, Ann Dolin, MEd, sits on the board of CHADD of Northern Virginia and the International Dyslexia Association. She is the author of Homework Made Simple — Tips, Tools and Solutions for Stress-Free Homework.

“Hey, I Need Help Too!"

SURVIVAL TIPS FOR THE NON-ADHD SPOUSE

Today's guest blog is by Terry Dickson, MD, ACG.

The profound impact ADHD can have on marriage is well known. Less emphasis has been directed toward what a non-ADHD spouse married to an ADHD spouse truly experiences and what competencies, skills, and techniques are most effective for strengthening the relationship with a partner who has ADHD. A few of the questions a non-ADHD spouse may have are:
1. How can I understand the hard-wiring of my ADHD spouse? What are the traits of ADHD that tend to get in the way of the relationship?
2. How can I effectively communicate with my ADHD spouse when he/she has challenging communication skills?
3. How can I effectively cope with the frustrations of daily life with my ADHD spouse?
4. How can I work with my ADHD spouse to reach his/her full potential in the context of a healthy marriage?
5. Am I to blame for my ADHD spouse’s behavior?

Who are non-ADHD spouses? What do they experience that brings them to their wits end, that makes them want to divorce, or yell, feel unloved, tense up in a ball of frustration, or scream in anger?

Come join me as we explore these questions and more on Thursday, November 10, 2011 for a pre-conference institute from 9 am until noon at CHADD's 23rd Annual International Conference in Orlando, Florida.

During the presentation, my wife (who is a non-ADHD spouse) will talk about her experience being married to a person with ADHD (me). We will discuss how we have been able to work together effectively to strengthen our relationship. You will also hear the experiences of other non-ADHD spouses I have videotaped. You will gain a better understanding of the impact the behaviors of a person with ADHD has on a non-ADHD spouse and tips for strengthening your relationship for a lifetime.

To your success,

Terry M. Dickson, MD, ACG

Terry M. Dickson, MD, ACG, is an ADD Relationship Coach. He is also the founder and director of the Behavioral Medicine Clinic of NW Michigan, and has been principal study investigator for several clinical ADHD medication trials.

Understanding Cyberbullying

TRENDS & FREQUENCIES, ANXIETY & INTERPRETATIONS

Today’s guest blog is by Meghan K. McCoy, MEd.

Bullying—the repetitive, targeted and intentional, peer-on-peer abuse inflicted among two people in an unequal power relationship—has been in existence for as long many of us can remember. High-profile cases, tragic consequences, and increasing legal sanctions have aided in bringing this important topic to the forefront of our consciousness. Now that we all recognize the problem, it’s imperative that we begin to understand it from an evidence-based perspective!

This peer-on-peer abuse is not restricted, or even most rampant, in the hallways and classrooms of our schools. It has also invaded the online world of children and teens. We call this online abuse cyberbullying. In a world where youth are spending increasing amounts of time online, educators and professionals working with these digital natives will inevitably be faced with the fallout of this online abuse. A better understanding of digital natives, those who have “grown up online,” as well as the trends, frequencies, methods, and motivations of cyberbullying behaviors is crucial in helping to keep youth safe and responsible in their online use.

Join me at CHADD’s Annual International Conference on ADHD in Orlando to learn best-practice tools and techniques for preventing and responding to bullying and cyberbullying.
• What advice can we offer to victims and bystanders?
• What specific principles do the kids need to know about their online behavior?
• How can understanding the common characteristics of digital natives help us in combatting these issues?

Come to CHADD’s conference and let me share the some of the newest research with you!

Meghan K. McCoy, MEd, is the program coordinator of the Massachusetts Aggression Reduction Center at Bridgewater State University.

Friends Are Important

This week's guest blog is by Ari Tuckman, PsyD, MBA.

I always look forward to the CHADD conference. As a psychologist and presenter, there's no better place to learn about ADHD from the biggest names in the business. But honestly, my biggest reason to look forward to it is that I have so much fun with my friends there (my wife calls them my "CHADD buddies"). Unfortunately, since most of these friends aren't local, I only see them at the conference. Sure, phone and email are good but they're not as good as the real thing of being together in person.

So it's fitting that this year I'll be presenting Everyone Needs Friends: Even (Especially) Adults with ADHD. It's hard to find the time to stay in touch with friends, whether they're local or far away. I know this very well from personal experience, as I juggle work obligations, giving time to my family, and staying in contact with friends. Far too often, work and family get most of my time and my friends get a quick email. I know I need to keep a better balance, but it's a real challenge. It also seems like I have more and more clients talking about similar struggles. Like me, some don't feel like they have enough time for friends. Others have the time but don't know how to make those friendships happen. In both cases, we feel like we're missing out. And we are.

So that's why I wanted to present on this important but often overlooked topic this year. It's a universal struggle, but folks with ADHD often have some additional challenges because of the way that typical ADHD behaviors tend to be interpreted. This then influences how others see the person with ADHD which feeds into how that person sees himself. Self-esteem and self-image interact with relationship dynamics. My goal for this presentation is to help attendees better understand themselves and others, so that they can create friendships where everybody feels better.

Hopefully I'll see you at my presentation on Saturday morning at 10:30. But you can look for me and my friends each night at the hotel bar. We'll be the ones laughing and making a bunch of noise.


Ari Tuckman, PsyD, MBA, is a psychologist in private practice who specializes in the diagnosis and treatment of children, teens, and adults with ADHD, anxiety, and depression. He is the author of More Attention, Less Deficit: Success Strategies for Adults with ADHD (Specialty Press, 2009).

Saving SSI for People with ADHD

This week's guest blog is by Soleil Gregg.

Imagine that you have a child with very severe ADHD symptoms, serious behavior problems, and a recent expulsion from school. Then imagine that you have no job and very limited resources to pay for treatment, medication, or assistance for your child.

This is the plight of many families who apply for Supplemental Security Income for their child with a disability. SSI is a program of Social Security that provides assistance for children and adults with disabilities who are living in poverty. Recently this program has been threatened.

Since its founding in 1987, CHADD has worked tirelessly to improve the lives of individuals with ADHD through education, advocacy, and support. The fruits of this labor have been increased understanding of ADHD as a neurobiological disorder and recognition that the disorder can be debilitating throughout the lifespan. Thanks in part to CHADD’s efforts, eligible children with ADHD are now able to receive education services under Section 504 and IDEA, college students and adults with ADHD may be eligible for accommodations under the ADA in the classroom and workplace, and children and adults who are severely affected by ADHD and meet incomes guidelines may qualify for SSI to help with their care and treatment.

But just when we are feeling good about the strides we’ve made over the years to improve the lives of people with ADHD, something comes along to shake us out of our complacency and make us aware of just how tenuous these gains might be. Such was the case when we learned that SSI for children with ADHD was in jeopardy.

Last fall the Boston Globe ran a series of articles on SSI fraud, claiming that some low-income families have their children diagnosed with ADHD and give them “drugs” solely to get SSI, implying that a substantial number of children are being misdiagnosed with ADHD and unnecessarily medicated by doctors and parents. While CHADD certainly doesn’t condone fraud, the Globe articles presented no real evidence that there is fraud in SSI—only a few anecdotes.

In fact, the number of children who are approved for SSI for ADHD is relatively small, given current knowledge of the incidence of ADHD. In order to be eligible for SSI, a child must have a diagnosis of ADHD (or another disability) and meet very restrictive functional criteria and income guidelines. SSI is intended to be reserved for those in financial need with the most severe impairment. Recent SSI data showed that nearly 71 percent of children applying for SSI for ADHD were denied approval, ranking ADHD in the lowest quartile of approval rates for childhood mental disorders.

Nonetheless, the Globe series raised concerns in Congress and prompted several members to request an investigation of SSI by the U.S. Government Accountability Office (GAO), particularly focusing on children with ADHD, depression, and other mental impairments.

CHADD began working with the SSI Coalition for Children and Families, spearheaded by the Bazelon Center for Mental Health Law, to address Congressional concerns and to preserve SSI for eligible children with ADHD and other mental health disorders. Then, to make matters worse, we learned that the House Budget Committee had added language to its budget report to remove “incentives for parents to place their children on medication solely to receive SSI benefits” and, more recently, to specifically eliminate ADHD from SSI altogether as part of spending cuts.

During the week of July 21, the SSI Coalition managed to arrange a briefing with Senate Finance Committee staff despite the looming debt ceiling crisis. CHADD identified a mother, Suzanne Poe, whose child receives SSI for ADHD and who was willing to come to Washington on a moment’s notice and share her family’s experiences. Suzanne and CHADD CEO Ruth Hughes met with staff from seven Congressional offices in addition to Finance Committee staff.

I am happy to report that these meetings were very successful, and Suzanne was a fantastic voice for families. The very best news we heard is that the proposal to take ADHD out of children’s SSI is now off the table and no longer part of the overall budget negotiations—that ADHD is no longer a target.

But we are not out of the woods yet.

There are still discussions about limiting the SSI program, and many programs will surely face cuts under the debt ceiling agreement. In addition, the Homeland Security and Government Affairs Committee has requested the GAO to look at “waste and abuse of prescribing practices” for children in foster care, and another group of senators and representatives has asked the GAO to look at rates of mental health conditions and medication use in children in Medicaid, the Children’s Health Insurance Program (CHIP), and foster care. We have also learned that Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services has a special interest in medications for mental disorders in children enrolled in Medicaid and CHIP.

CHADD will review the GAO reports when they are released. We will keep you posted on events as they develop and let you know what you can do to assist us in protecting the rights of people with ADHD.

Rest assured that CHADD will do its very best to educate policymakers on Capitol Hill about the challenges facing children, adults, and families with ADHD. CHADD will work to preserve the hard-fought gains we’ve made in recognition, treatment, and services over the past 24 years.

Soleil


Soleil Gregg is past secretary of CHADD’s board of directors and past chair of the public policy committee and editorial advisory board for Attention magazine. She represents families with ADHD for CHADD on AACAP’s Pediatric Pharmacology Initiative and is a member of the SSI Coalition. She is a retired education consultant and worked as a disability and policy specialist at one of the regional educational research laboratories and regional technical assistance centers. She is a mother of two grown children with ADHD and is also an adult with ADHD.

CHADD's NRC Needs You!

by Mary Durheim


To all my friends and colleagues in the world of disability—this is a National Call for Action!

Those of you who know me know that I do not Tweet, seldom correspond via Facebook, avoid blogs, and never participate in chat rooms. The mere fact that I am writing this blog posting is a sure sign that we who are touched by disability—either as a person with a disability, or as that person’s parent(s), sibling(s), relative(s) or friend(s)—are facing something important.

I’m writing to tell you of a national challenge with potentially devastating consequences for millions of Americans with physical and mental disabilities. I’m writing to ask for your help!

I write specifically on behalf of CHADD’s National Resource Center on ADHD (NRC), but this issue directly impacts millions of people with disabilities and the organizations that are usually the only voice for individuals and families like ours.

For Fiscal Year 2012, the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the Centers for Disease Control and Prevention (CDC) is planning to eliminate specific funding for programs that support people with disabilities such as ADHD, spina bifida, muscular dystrophy, limb loss, and paralysis.

Instead of sharing the burden of decreased funding among all of the disability programs it currently supports, government bureaucrats have decided to play a game of winners and losers. In this game, some programs or conditions will continue to be funded at current or even higher (!) levels, while others will simply not be funded at all.

Does that seem fair? Does that seem right? If there’s not enough stew in the dinner pot, is any mother going to feed two children their full portion and tell the third child, “There’s none for you”? Of course not! Everyone should still have a place at the table and the burden of less should be shared by all!

Instead of sharing the burden in these tough economic times, the bureaucrats call their plan “consolidation.” But to us, it looks more like “elimination.” Over the past few months, a coalition of disability organizations has met numerous times with CDC officials to learn more about what this “consolidation” means. Like many of their colleagues, CHADD representatives came away from these meetings wondering where ADHD fits in.

NCBDDD and ADHD

Established by an Act of Congress in 2000 (P.L. 106-310), the NCBDDD impacts the health of millions of our nation’s most vulnerable citizens: infants and children, people with blood disorder, and people with disabilities. NCBDDD is the only CDC center whose mission focuses on these populations. (In FY2010, NCBDDD was funded at $143.6 million and at $136.1 million in FY 2011, a decrease of 5.25%, while the National Resource Center on ADHD had a decrease in funding of 7.16% during the same period).

Consolidation of programs or elimination of the NCBDDD disability division would be disastrous.

For families dealing with ADHD, these changes would continue to seriously jeopardize the funding base that supports CHADD’s National Resource Center on ADHD (NRC). Think back to when you, your child, or family member was first diagnosed. Where did you go to find reliable information? Where will you go in the future to stay up to date with the most current research and appropriate interventions?

I still painfully remember when my son received his diagnosis, including but not limited to ADHD. I was scared, had little to no information, and had no one to talk to. Don’t you remember the day you received the “diagnosis”? Yes, there’s a lot of information online, but not all of it is reliable or unbiased.

In addition to providing only science-based information, the NRC is the only resource center that has trained specialists that people can actually talk with. Elimination of public funding for the NRC would essentially destroy much of the progress that has been made over the past ten years.

NCBDDD and NRC Successes

It is currently estimated that one in 33 babies in the United States is born with a birth defect and approximately 13% of children have a developmental disability. The NCBDDD funds surveillance, research and prevention activities aimed at helping us track, understand, and ultimately prevent these disorders. The success of NCBDDD programs has contributed to a 26-36% decline in neural tube defects, as well as significant advances in the identification of preventable risk factors for birth defects and improved screenings.

As for ADHD, since the NRC opened its doors in 2003, trained health information specialists have responded to over 27,000 individuals seeking information, guidance, or sometimes just a listening ear. And then there are the millions of visits to the NRC web site; the special projects reaching out to African Americans and Spanish speaking persons; the monthly Ask the Expert chats; the newsletters; the information sheets… the list goes on!

Business in Washington, DC, is and always has been centered on party politics. My call for action to maintain the current structure and funding of the NCBDDD, its disability divisions, and especially funding for the NRC, has nothing to do with whether we are Republicans, Democrats, Independents, or however we may classify ourselves. It has everything to do with the lives of our children, our friends, ourselves. It is about our future and those who will be born in the future and the quality of life future generations of people with ADHD or other disabilities will have.

We urge you to become involved and let your voices be heard. Help us to save not only the National Resource Center on ADHD but also the NCBDDD disability division.

Yes, these times are tough. But certainly no one—not the President, not Republicans or Democrats nor leaders in either the House or the Senate—wants to be known as the ones who undid a decade of work done through CDC that positively impacted the lives of people with ADHD and other disabilities.

How You Can Help

In the coming days, while Congress is in recess and our senators and representatives are in their home states and districts, we will be asking you to contact these elected officials and let your voice be heard. CHADD will provide you with the facts on the accomplishments of the NRC and NCBDDD.

We will post sample letters for you to assist in communicating with your representatives. We will give you tips on how to tell your story—because nothing has an impact like the power of a personal story! We will ask you to make sure that your elected officials know how important it was—and is—to have access to solid, science-based information that has the ability to change lives and help people with ADHD reach their full potential.

Congress must hear these stories—by the thousands—if we are to continue to make progress.

Thank you… and stay tuned!

Mary Durheim


Mary Durheim is a past president of CHADD and one of the founders of CHADD’s Parent to Parent program. An educational consultant, she is active in numerous county and state interagency organizations as a trained mediator, Section 504 hearing officer, and behavior strategist. Durheim is the mother of two adult children with ADHD.