Approximately 50-percent of children with ADHD become ADHD adults. Find out about diagnosis and treatment of ADHD in adults.

ADHD or Attention Deficit Hyperactivity Disorder affects thirty to fifty percent of adults who had ADHD in childhood. Accurate diagnosis of ADHD in adults is challenging and requires attention to early development, and symptoms of inattention, distractibility, impulsivity and emotional lability.

Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse. While stimulants are a common treatment for adult patients with ADHD, antidepressants may also be effective.

ADHD receives considerable attention in both medical literature and the lay media. Historically, ADHD was considered to be primarily a childhood condition. However, recent data suggest that symptoms of ADHD continue into adulthood in up to fifty percent of persons with childhood ADHD.

Since ADHD is such a well-known disorder, adults with both objective and subjective symptoms of poor concentration and inattention have got the probabilities for evaluation. While the symptoms of ADHD have been extended developmentally upward to adults, most of the information about the etiology, symptoms and treatment of this disorder comes from observations of, and studies in, children (Weiss, 2001).

Diagnosis of Adult ADHD

For several reasons, family physicians may be uncomfortable evaluating and treating adult patients with symptoms of ADHD, particularly those without a previously established ADHD diagnosis. First, the criteria for ADHD are not objectively verifiable and require reliance on the patient's subjective report of symptoms. Second, the criteria for ADHD do not describe the subtle cognitive-behavioral symptoms that may affect adults more than children.

The family physician's role as diagnostician is further complicated by the high rates of self-diagnosis of ADHD in adults. Many of these persons are influenced by the popular press. Studies of self-referral suggest that only one third to one half of adults who believe they have ADHD actually meet formal diagnostic criteria.

Even as family physicians are knowledgeable about childhood ADHD, there is a noticeable absence of guidelines for primary care evaluation and treatment of adults with symptoms of the disorder (Goldstein and Ellison, 2002).

The diagnostic criteria describe the disorder in three subtypes. The first is the predominantly hyperactive, the second is the predominantly inattentive, and the third is a mixed type with symptoms of the first and the second.

Symptoms should be persistently present since age seven. While a longstanding symptom history is often difficult to elicit clearly in adults, it is a key feature of the disorder.

The following are the symptoms:

Inattention: where a person often fails to give close attention to details or makes careless mistakes, often has difficulty sustaining attention in tasks, often does not seem to listen when spoken to directly, or often does not follow through on instructions.

Tasks: Where a person often has difficulty organizing tasks and activities, often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, often loses things necessary for tasks or activities, often easily gets distracted by extraneous stimuli, or is often forgetful in daily activities.

Hyperactivity: Where a person often fidgets with hands or feet or squirms in seat, often feels restless, often has difficulty engaging in leisure activities quietly, or often talks excessively.

Impulsivity: Where a person often blurts out answers before questions have been completed, or often interrupts or intrudes on others.

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There is a growing consensus that the central feature of ADHD is disinhibition. Patients are unable to stop themselves from immediately responding, and they have deficits in their capacity for monitoring their own behavior. Hyperactivity, while a common feature among children, is likely to be less overt in adults. Utah criteria may be called the imperative criteria for this. For adults, it is used like this: What is the childhood history consistent with ADHD? What are the adult symptoms? Does the adult have hyperactivity and poor concentration? Is there any affective lability or hot temper? Is there the inability to complete tasks and disorganization? Is there any stress intolerance, or impulsivity? (Wender, 1998)

Wender developed these ADHD criteria, known as the Utah criteria, which reflect the distinct features of the disorder in adults. The diagnosis of ADHD in an adult requires a longstanding history of ADHD symptoms, dating back to at least age seven. In the absence of treatment, such symptoms should have been consistently present without remission. In addition, hyperactivity and poor concentration should be present in adulthood, along with two of the five additional symptoms: affective lability; hot temper; inability to complete tasks and disorganization; stress intolerance; and impulsivity.

The Utah criteria include the emotional aspects of the syndrome. Affective lability is characterized by brief, intense affective outbursts ranging from euphoria to despair to anger, and is experienced by the ADHD adult as being out of control. Under conditions of increased emotional arousal from external demands, the patient becomes more disorganized and distractible.

Treatment of Adult ADHD

Some treatments for ADHD in adults are as follows:

Stimulants: Stimulants work by increasing both blood flow and the levels of Dopamine in the brain, especially the frontal lobes where the brain's Executive Functions take place. Stimulants will increase the brain's ability to inhibit itself. This allows the brain to focus on the right thing at the right time, and to be less distracted, and less impulsive. Stimulants increase the "signal to noise ratio" in the brain.

Antidepressants: Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine.

Other Medications: Sympatholytics have also been used in the management of ADHD as well as the non-stimulant ADHD medication, Strattera.

Self-Management Strategies: Adults with ADHD benefit considerably from direct education about the disorder. They can use information about their deficits to develop compensatory strategies. Planning and organization can be improved by encouraging patients to make lists and use methodically written schedules.

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next: Feeling Guilty About Your ADHD Child
~ adhd library articles
~ all add/adhd articles

References

Wender, Paul (1998). Attention-Deficit Hyperactivity Disorder in Adults . Oxford University Press.

Weiss, Margaret (2001). Adhd in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment . Johns Hopkins University Press.

Goldstein, Sam; Ellison, Anne (2002). Clinicians' Guide to Adult ADHD: Assessment and Intervention. Academic Press.

Pete Wright is an attorney who represents children with disabilities. His practice is devoted exclusively to helping children with special education needs.

Pam Wright is a psychotherapist specializing in special needs children.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

Conference Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. We have only been open for 2 weeks. This is our third online conference. Our conference tonight is on "Special Education Law: What Every Parent Needs to Know". We are fortunate because we have two excellent guests on the subject. Attorney Pete Wright and his wife, psychotherapist, Pam Wright. Their site is Wright's Law.

Pete Wright is an attorney who has represented children with disabilities for more than 20 years. His practice is devoted exclusively to helping children with special education needs. Pam Wright is a psychotherapist. Her training in clinical psychology and clinical social work give her a unique perspective on parent-child - -school dynamics, problems, and solutions.

Good evening Pete and Pam, welcome to the HealthyPlace.com site. Pete, I want to start off touching on some legal issues. Why is it so difficult for so many parents of special needs children to get what the law says their child deserves when it comes to the education system?

Pete Wright: Wow, what a question to open with.

It goes back decades, to issues of school culture and power within the system, like medical insurance and HMO's. Schools are like production lines and when something disrupts the flow, all hell breaks loose, and the slowdown in production is blamed on the part and the worker, i.e., the student and the teacher. Appropriate is a word defined by the courts and has resulted in extensive litigation, it started with the Rowley case where Amy was doing better on grades and educational achievement tests than her peers, and some courts said the program needed to maximize, others said not that much, and U.S. Supreme Court said all of the lower courts were basically wrong, that the program had to be individually designed to meet the child's unique needs in a program from which the child would benefit. A basic floor of opportunity, but not the best or optimize or maximizes. Those words are fatal in a report or being used by a parent. The best way to lose your fight for your children in education is to say "that I want what is best," or to have that written in the report.

Pam Wright: David, there is little agreement about what children are entitled to. The law says children are entitled to a Free Appropriate Public Education or FAPE. Parents must never ask for what is BEST for their children, only what is "appropriate." So we say "BEST" is a four-letter word that parents must avoid.

Pete Wright: Additional response to your opening question is that it all goes back to dollars and costs, short term.

David From letters I've received this afternoon, prior to the conference, I think a lot of parents, Pam, are afraid to go into the school and ask for what their "child is entitled to". Maybe they feel intimated by that. What suggestions do you have for handling that?

Pam Wright: Many parents feel intimidated by schools, period. So its hard to go to an IEP (Individualized Education Plan) meeting and deal with all the "experts" on the other side of the table. It helps to have someone go to the IEP meeting with you, and parents should dress up for the meetings like they would to go to church! Because "image' is important, especially in schools which are often pretty old fashioned.

Pete Wright: What is the child entitled to? Entitlement is in the eyes of the beholder. The best education? a minimal education? there is no easy answer to that. School staff may say that the entitlement is one hour a week, but a private expert says an hour a day of whatever. We always seek what is best, however, though, we clearly are not entitled to that in the eyes of the law.

Pam Wright Parents need to prepare for meetings - this will help keep their nervousness down.

Pete Wright: Image and first impressions have tremendous weight toward helping your child get better services. Too many parents blow it by sending sloppy letters, appearing disorganized. Look and act professionally.

Pam Wright: In special education, and in so many things, the key to success lies in the preparation.

Pete Wright: A top of the line meal on a mediocre plate vs. a mediocre meal served with all of the fancy trappings, is initially presumed to taste better, even if it does not.

David: Here are some audience questions:

codecan: Hi, my son is in a severe behavior classroom he has ADHD and ADD. The problem is I am fighting the school to give my son either a gym time or recess! They have every excuse going right now. Aren't they in violation of his rights?

Pam Wright: Codecan: Your son is in a behavior class. Is this all the time?

codecan: yes.

Pete Wright: codecan, do other children get gym time or recess? If yes, why doesn't your son? What is the reason given?

codecan: all day long and even eat lunch in the room.

Pam Wright: Most kids who have behavior problems have other problems which cause the behavior problems - you mentioned ADHD (Attention Deficit Hyperactivity Disorder), but most kids with ADHD also have learning disabilities and frustration. So the question is: is this placement appropriate?

Pete Wright: Have you brought this up in an IEP meeting?

CarlaB: Re: IEP- How will parents be regularly informed of progress? (by such means as a periodic report card.) My school district claims that by putting a generic computerized statement on his regular report card, this meets this requirement. The statement reads, "Progress made on IEP goals/obj". Is this legal?

Pete Wright: Doesn't sound legal to me, please read Appendix A about IEPs at our website or in our book. You need to have clear information about whether the goals and objectives are being met, and the goals and objectives should be directly related to the present levels of performance listed on IEP, i.e. scores in various educational achievement tests or other measures.

Pam Wright: So you should get information about the progress your child is making. This will tell you whether the IEP needs to be revised or services increased. Bottom line: is the child learning? How do you know? How do you measure learning? So child's progress needs to be measured objectively and often.

Pete Wright: Progress made. What do they mean by progress made? How did they measure it? With true measures or just subjective feelings and beliefs?

David: One question I have, we all get frustrated and we all know the administrators and other school officials may jerk us around. But getting a lawyer is very expensive and my guess is the school system couldn't care less if you do. How can you best handle a difficult situation and when is it time to get a lawyer?

Pam Wright: The best thing to do is to prevent problems when possible.

Pete Wright: Good question. Real question: how can you get what your child needs without getting a lawyer? Answer: by preparing for a lawsuit.

Pam Wright: You do this by staying organized, keeping child's records organized by date as we discuss in our Tactics Manual. Learn how to measure progress, and about legal rights and responsibilities, and how to write polite letters that create a paper trail. When parents do this, most will never need a lawyer.

Pete Wright: In other words, the best way to avoid litigation is to assume it will happen and prepare for it, and also, parents should assume that they cannot testify at their own special education due process hearing and that they cannot call school witnesses to testify on their behalf. In other words, document by many nice letters and have private sector evaluations and tape record and then TRANSCRIBE the tape recording and follow up meeting with a letter.

Pam Wright: School people know this person has the evidence if it is necessary, so is less likely to draw a line in the sand. One more thing. If parents ask for something, they won't get it so they need to get someone else to recommend it: a private sector psychologist, doctor, etc.

Pete Wright: Schools are like HMO's and are not afraid of you getting a lawyer. Never threaten to get one either, that is counter-productive. We have several articles on our website regarding this. About emotions and crisis situations and about preparing for due process.

Becca: In a previous newsletter, you mentioned education forums that taught techniques to avoid IDEA compliance. Tell me more about this.

Pam Wright: I think you were thinking about seminars by a law company. These are normal ways for each side to get training. Defense lawyers get one kind of training, insurance defense lawyers get training but they don't get the same training!

GAM: I have a child in a private Catholic school who is having problems in school and failed a subject and the principal is keeping him off school sports for the marking cycle. I read an article by another lawyer stating a court case which found the refusal to let an ADHD child participate in athletics to be in violation of section 504. Is this true? Where can I find the precedent for this particular problem?

Pete Wright: One publishing company had a program about "Building Defensible Programs", i.e., which was interpreted as defending in court. The program was actually quite good and said in essence: provide a good program and you wont get sued.

Pam Wright: I wouldn't fight a big battle over one marking period, but I would try to use the time to help your child get focused on school and if sports are what he loves, this may help him. Pick your battles carefully. Also, get an expert to say your son needs sports.

Pete Wright: Is the child off the team because of a good disability or because of poor grades, that's the issue.

pvx: I'm in South Carolina and have an interest in 504 complaints. My county is about to build a NEW and BETTER segregated facility for about 350 from 7 school districts. I'm about to file an OCR complaint. Any advice?

Pete Wright: pvx, more info, new and better segregated, do you mean a special education school, or one that will not have special education kids?

pvx: Segregated, especially OH and MR (Mental Retardation).

Pam Wright: The amended IDEA focuses more on LRE which means more inclusion, read Appendix A, and find a way to structure your complaint so it is easy for OCR (Office of Civil Rights) to rule in your favor.

Pete Wright: OH and mental retardation are out, or in the school?

pvx: We have 7 districts that feed the low incidents to the CDC.

Pete Wright: Try to look at other OCR complaints and polish it up so that it is visually very attractive to read. Assuming you mean it is a school for kids with disabilities only, OCR would be very interested in your complaint.

Pam Wright: But you need to present a very polished complaint!

Pete Wright: So often, letters and complaints are not well put together and have a strike against them before even being read. First impression often controls.

junebotto: I live in NY state. My son was referred in Sept of 1998 and we did not have a Children with Special Education meeting until the following Sept. 1999. I would like the Special Department and the school to be penalized for this but according to my Esq. I have no recourse. Do you agree?

Pete Wright: It would all depend on very specific facts. Did you know of timeline being extended and not act on that. Courts uniformly say, one who sleeps on their rights, waives them. Or, in the alternative: what type of penalty were you thinking about? If the delay did not create harm, Courts say, no harm, no foul, thus it is very fact specific, and also, sometimes you may have a good claim, but to exercise it in the end may create damage to the child. And if your attorney handles special education law, then that person may be advising you based on the totality of the situation. What could you really recover has to be the real question.

David: And again, I think it's important to stress here, when something doesn't go the way we like, as a parent and an individual, we'd like to see some sort of punishment. However, I think what Pete and Pam are saying is, you are better off working within the system, than expending emotional and financial energy trying to fight it, if you can. Here are some more questions.

midwestmom: My son's IEP designation is currently "OHI"; our school district has suggested that if we change it to MI my son could qualify for more services. Are some categories/labels more "powerful" than others? Should I care?

Pam Wright: Child should receive what the child needs, regardless of the "label". The revised IDEA says child should get services, even with NO label!, up to a certain age.

Pete Wright: Label does not drive either services or the IEP. The law was changed in 1997 and is very clear about that. Policies within school districts may not have changed, however. If your child needs the services and suffers from the new, unknown, wrightslaw syndrome, and a heretofore new disturbing label, should that exclude the child from some services and open door to others?

Pam Wright: I imagine the school has Program A for kids with one "label" and Program B for kids with another, and isn't individualizing the IEPs enough just trying to fit the child into their pre-existing program?

Kerny1: I have a daughter with borderline mental retardation IQ. She is in a regular fourth-grade class receiving push-in Special Education services. She is having difficulty mastering the grade level subjects. Can she go to fifth grade and have her program modified to her level even though it is NOT grade 5 level work as the other students? We live in NY.

Pete Wright: To kerny1, issue is acquisition of the basic reading, writing, arithmetic and spelling skills, as primary over all other issues, such as 5th grade vs. 4th grade vs. other curriculum. It is important to master the basic skills, which can be done, but may require more intense services. Children with Down's Syndrome can read on age level. So often expectations are too low. In other words, are you sure you really want work modified, or the total program intensified? That's what I recommend

Pam Wright: Because of the standards movement, and state testing, the issue Kerny brings up will affect many kids.

Pete Wright: What if Helen Keller was in the system today, what would she get to acquire basic reading, writing, arithmetic skills?

Pam Wright: Helen Keller went on to write books, speak, and lead a movement.

David: Pam, as a psychotherapist who has a lot of experience with special needs children, does a child have to get everything from the school system or can tutoring and other special programs work too.

Pam Wright: The most important thing is to ensure that the child gets the services he or she needs. In many cases, its better to get tutoring than to fight a war, if you can do so. The problem is that many people don't have other resources.

David: From the audience, I'd be interested in getting very short responses to this question and then I'll post it for everyone to see. If you've been successful in dealing with your school system, what do you attribute that to? Here are some of the audience responses to my question:

seisen: Success with school system....persistence and information

Dabby: Always dangle the carrot before you bring out the stick! Don't anger them. Try to know more than they do before you go to a meeting. If you feel to close to the situation bring someone with you who can be objective.

brandi valentine: Knowing my rights! Also, having them over a barrel helped a little to :) However, I would never have known they had crossed that line if I hadn't known my rights.

Childsvoice: It came from acquiring as much knowledge about our rights as I could get my eyes on! Many thanks to Pete and Pam for their web site and their publications.

CarlaB: Knowing the law, and following the strategies set forth on the Wrightslaw website :-).

bpmom: Only success we've had (too few) were due to being the "squeaky wheel" and knowing the law and knowing how to make "subtle threats".

Mathilda: Our county school system is fully in support of its SED (Special Education) kids; but it is under contract with the local mental health agency, who is less than supportive, to put it mildly.

green9591: I haven't been. Superintendent cares only for saving $ not the kids.

David: I noticed Brandi Valentine is in the audience tonight. Just wanted to recognize her. She's well known on the internet and also has her site in the HeatlhyPlace.com ADD Community.

Pam Wright: I think Brandi had one of the 1st web sites on the internet. Glad to see you. It contains a wealth of information.

Pete Wright: Re Tutoring: So often private sector tutoring after school can be far more valuable. That is what worked for me. Two years, one-on-one, every day, after school. I was no longer considered emotionally disturbed and borderline mentally retarded. (The story is at our wrightslaw.com website.)

David: Here are some more audience questions:

jackie R: My son is in a section 27 class, and will be losing his placement after June because the school is for kids in residence, and he moved home. :-).

David: What can Jackie do about that?

Pam Wright: Assuming son is 14 or older, he needs a transition plan.

Pete Wright: Jackie, I'm not sure what the question is? Should he be home or at the school? Is there a more appropriate one nearby. Need more info please. The IDEA focuses on the fact that school is a mean to an end so kids need assistance in making transitions.

Pete Wright: PS What is section 27?

Pam Wright: Assuming son still has a disability, son still needs an appropriate education, although he may not need residential placement. BUT placement decision cannot be made until after Individualized Education Plans goals and objectives.

cadkins: What does the IDEA say about Time Out closets in EBD rooms? Is it legal to place children in there for long periods? Can children without IEPs be placed in there?

Pam Wright: Short answer is that school districts are being sued over this. We have 2 cases on our site about this. I think they are abominable and there have been a flurry of $$$$ dollar damage lawsuits because of them?

Pete Wright: Read some of the cases and get some community organization and a lawsuit going.

Pam Wright: The Witte case in Nevada and a recent case in KY or TN.

Pete Wright: There are often very strict state standards for that type of placement in a state mental hospital. Are the standards missing with schools?

Pam Wright: That just came out. If child has a behavior problem, needs to have a functional behavior assessment per IDEA. Another question?

David: Here are some additional responses from the audience to my question about how to deal successfully with the school system.

hsiehfriel: I work closely with the teachers, the school psych and the principal. I met with them even before my child entered first day of class to let them know I was an involved parent, interested in building a team approach.

SED teacher: I am curious about restraints. I have taught in NY, VA, and now FL. This is my first experience with "hands-on". I was trained and continue to use verbal de-escalation and have not used restraint. I am overwhelmed by the frequent application and intensity of hands before words. This is very disturbing personally and professionally. What is my recourse?

Pam Wright: We are getting many questions from special education teachers about things like this, too many children in classes. Can you get help from CEC or a special ed or education group?

Pete Wright: I am amazed by the use of physical force.

Pam Wright: Who can teachers turn to when asked to do things that are illegal or immoral or just plain wrong?

Pete Wright: I worked several years in a juvenile training school as a houseparent and we did not have to use force with rapists, killers, very disturbed children. It was me and 20-25 of them, locked in a cottage ward, or sometimes in an unlocked cottage ward. It seems that some schools are gravitating toward almost a sadistic cruel way of working with children that they do not understand.

Pam Wright: I think special ed teachers are going to have to take a stand against this.

Pete Wright: But the question is, what is your recourse? All I can offer is for you to see if you can get literature and perhaps try to set up some training programs for staff and administrators regarding behavior control without use of force and timeout locked closets. It is done out there and the alternative may be a very large $$$ damage lawsuit. That fear of litigation can be a powerful motivator to change behavior when all else fails.

Shar: I cannot get the CSE Committee to understand the relationship between NVLD and anxiety and that children with learning disabilities can achieve excellent grades while overcompensating. Any suggestions with limited resources in rural USA?

Pam Wright: If you are on a special education teacher list, you may get some help from others. You will need to get a psychologist or evaluator to write recommendations as to what child needs. As a parent, you have little or no credibility when you are dealing with school people so you need someone else to make the recommendations.

Pete Wright: You are a parent, they will not hear you. Bring books, videos, etc, they will gather dust. Have someone else, private sector psych or whatever, be the lightning rod and catalyst for change. Have that person write a letter and send material and advise that they will do a follow up call to see if the info is helpful, for starters.

Julie C: Under the Special Education laws, are children with learning disabilities entitled to a tutor paid at the school districts expense if the child is in need of more educational instruction?

Pete Wright: Re Tutoring: So often private sector tutoring after school can be far more valuable. That is what worked for me. Two years, one-on-one, every day, after school. I was no longer considered emotionally disturbed and borderline mentally retarded. (The story is at our wrightslaw.com website.)

Pam Wright: BTW: Mel Levine's work is excellent in this area. He is in NC.

Pete Wright: Nothing prohibits payment of private tutor, except tradition, policies, never done it before, this is the way we always do it, and other such reasons.

Pam Wright: Some public school supervisors will believe you have insulted their staff, who are of course, the best!

Pete Wright: Gerry Spence's book How to Argue & Win Every Time: At Home, At Work, In Court, Everywhere, Everyday, at our website talks about how to change perceptions.

Pam Wright: It's How to Argue and Win Every Time and it's about persuasion, not argument.

David: Here's a question that I'm sure concerns many parents:

cambridge: Can the "system" force a child to take medications against the will of the parents?

Pete Wright: Meds - I don't think so, get a doctor to advise against it and have it in writing and ask school whose advice should you follow, theirs or the doctor?

Pam Wright: Again, you are getting an outside person to be the lightning rod.

Pete Wright: Meds - follow up, ritatin and dex, etc, I have taken them from time-to-time and found them helpful, was on Dexedrine during middle school years.

David: Here's a question about Individualized Education Plans (IEP):

AnnaB: Is it part of the law that parents receive proposals prior to an IEP meeting when requested in writing?

Pam Wright: You request to receive proposals before the IEP meeting? The reality is that people are pulling stuff together at the last minute.

Pete Wright: Proposed IEP, does not have to be furnished in advance, Evaluations, I don't believe they have to be furnished in advance, but good practice is to provide them, otherwise how can parent offer meaningful input into IEP or even be expected to sign documents at that time.

Pam Wright: Like at midnight the night before. So yes, you should be able to ask but they may not be able to provide what you want. You can always ask for another meeting.

David: One thing I also want to ask and I think this is a legitimate concern among many parents. They go to the school, try and work within the system, but things aren't going well. They may or may not stand up for their child because they are afraid of being a "lightning rod" for retaliation against their child by the teachers or administrators. Can you elaborate on that a bit and make some positive suggestions on how best to deal with this train of thought?

Pam Wright: First, develop a businesslike relationship. One of the participants talked about meeting people before her child started school. It's often helpful to get someone to come to these meetings - this person can validate what happened. The best way to prevent problems is to prepare for them, so get your child's file organized, learn about how to measure progress, get a book about how to write letters. But you will always be somewhat afraid because this is YOUR child.

Pete Wright: Parents often generate staff anger toward them because staff views them as not being appreciative of their efforts. Parents have anger toward staff because they see child falling further-and-further behind. This becomes a catch 22. I hope this stops. Parent must become more professional than the staff, aka Ms. Manners, with thank you letters that are later evidence if necessary. Become calm cool collected tactics and strategy mindset. We have a lot about that in our Tactics Manual.

Pam Wright: There is no way to eliminate this fear because it is sometimes based on reality.

David: Here are a few audience comments regarding this last question:

Donna1: Administrators, or should I say "this" administrator is always willing to work with parents, but don't come in ready to knock the door down when you (as a parent) haven't given me a chance.

shine84: I have a son who is being tested for ADHD . He has already been suspended from kindergarden twice for inappropriate conduct . Also while on a field trip one of my friends saw my son and went up to him to talk and the teacher had such a tight grip on his hand he could not go anywhere, but the other kids where running around and playing. Is this fair and appropriate?

Pete Wright: For the administrator, often the parent was there once before, but as the child or adolescent that was suffering school failure and abuse, and old emotions come to the surface.

Pam Wright: First issue: is it appropriate to suspend a kindergarten child? I'd say "No!" But the teachers often don't have any training in how to deal with the children, so that becomes an issue that parent need to address. Get schools to do more training for the teachers so the teachers can do a better job.

Pete Wright: Bizarre, suspending a kindergarten child. You need a comprehensive private sector series of evaluations and look carefully not just at ADD behavior, but mastery of the 3R's and written language. That is too often overlooked with the ADD child exhibiting difficult behaviors.

David: What about the idea of getting a "child advocate"? Can you explain what that is, give us any idea of what that costs, and what the positives and negatives of that are?

Pam Wright: Child advocate? There are currently no standards so I can be one, Pete is one, many parents are advocates. This is an important question and not enough time to answer.

Costs: Usually an hourly rate, fairly reasonable.

Biggest issue: is training of the advocate!

Pete Wright: Advocate come in all sizes and shapes. Some very qualified, others put gasoline on fires truly believing they are using a fire extinguisher. Word of mouth is the best referral source. There is no national law or standard regarding advocate. One of the best in the country is Pat Howey. There is an organization COPAA, Council of Attorneys and Advocates at www.copaa.net that we are members of, and a good source to locate an advocate.

Mathilda: What do you do when the local behavioral health dept. is breaking the law regarding its obligation to Special Education Disorder kids in a self-contained classroom?

Pete Wright: More specifics?

Pam Wright: There is no law that requires any type of child to be in a self-contained class.

Mathilda: CA has a law -- AB3632 -- that allows group home placement of special education disorder kids if it will help them get the most out of their education. LMHA is refusing 3632 referrals from the schools.

Pete Wright: Sounds like state agency heads need to battle it out. How about CA Protect and Advocacy assisting.

Pam Wright: One interesting side effect from alternative schools is that for many kids, they are making excellent progress because the schools are small and the education is more individualized. So this can be a good thing for some kids.

Kodiak: Do parents have a say in determining what's appropriate?

Pam Wright: Absolutely, that's the law, input at the individualized education plans meeting.

Pam Wright: According to IDEA, parents are equal participants in the IEP process but in reality, many schools do not operate this way!

Pam Wright: However, whatever the parent asserts as appropriate, often damns it, have your private sector expert say it is appropriate.

David: Here's a related question for Pam:

Luvmyson: Pam; what is the difference between what is best and what is appropriate? I have always used term appropriate.

Pam Wright: GOOD FOR YOU! Never use the word "best" - it is fatal! The law says your child is entitled to a Chevrolet (appropriate), not a Cadillac (best)! School people will use the word "best" but parents should always use appropriate.

Pam Wright: Luvmyson, good for you, never use the word BEST, it is a 4 letter word, because, by law, your child is clearly not entitled to it. Never let it sneak into a private sector report either!

Pam Wright: Of course, when we say "appropriate", we are talking about a good program for the child.

hsiehfriel: I have always been careful to use the term 'appropriate,' but the district and I still don't always agree on what's "appropriate." How can parents get past that hurdle?

Pam Wright: Good question and hard to answer here. Your private sector expert should say that XYZ is what the child needs, at a minimum, for an appropriate education.

Pete Wright: That is the hurdle. Read our Understanding Tests and Measurements article at wrightslaw, read it over and over and over, master it, then make charts with power point, take them in to the meeting, visuals are powerful, focus on persuasive skills, ala Spence, that's a start.

DBillin168: Pam and Pete, I have your book and really enjoyed it. My problem is my district ONLY has inclusion, no other continuum of service. My district is saying it can send my child to another district because it does not offer self contained classes (which I feel my child needs) is this true?

Pam Wright: No! The school is required by law to offer a continuum of placements. Inclusion or mainstreaming is the first thing that must be considered, not the only thing.

Pete Wright: They have to offer a continuum, but necessarily within their own district, dependent upon realities and case law. They may have to pay money for the other program.

Pam Wright: Think about it. If the school only offers inclusion, then they aren't individualizing the program to the unique needs of this child.

green9591: If in your individualized education plan for 2000-2001 school year, no mention was made that your child will be attending another program, do you have to send your child to this program even if the existing program may be discontinued?

Pam Wright: The IEP should describe in detail the services the district will provide . . you should read Appendix A which talks about this.

David: Earlier, we were talking about Child Advocates. Here's an answer from one of our audience members:

sheritm: In reference to the question on advocates, the mission of www.amicusforchildren.org is to help parents be the children's first & best advocate by providing them with information that we research for them - based on their individual service requests. Sometimes the situations are so extreme that advocates and/or attorneys are needed. You can look for an advocate through agencies that are specific to your child's disability. And COPAA is a great resource, some state Parent Resource Centers.

Pete Wright: If the program is discontinued where will the child go. The case law replacement and program often waffles about it being the xyz placement at 123 school, and it could be the xyz placement at the 789 school, or the abc placement at the 123 school and schools will often present a change that way and it sells to the court.

Pam Wright: The individualized education plan should specify the child's program, including placement, in detail. You should not sign an IEP if you are uncertain about what your child will receive.

taj gilligan: I have a question regarding the SAT. My daughter has ADD and apart from extended time accommodations, is there anything else I should ask for?

Pete Wright: Whoever in private sector tested your child will have the best answer as to what type of modifications and/or accommodations your child may need. So often written language disability is overlooked with ADD child.

suebell: In a very small, rural school district how do we "politely" request/demand that school staff (including aide) be specifically trained on how to teach and deal with the only autistic child in the district?

Pam Wright: Your school district should be getting help from the state department of education in this area because teacher training and preparation are extremely important and are discussed at length in IDEA. Also essential that aids be trained, and not just be babysitters.

Pete Wright: You try to have them see it thru your eyes. If they view your request as a demand, you will have a long battle and struggle. Their issue with autism is frequently economics. If you are seeking an ABA Lovaas type of program, videos may be helpful. It involves salesmanship, again, a la Gerry Spence.

David: It is getting very late and the Wright's have been here for 2 hours. I really appreciate that and I hope that everyone got something beneficial out of tonight's conference. I also want to thank everyone in the audience for not only coming, but also participating. We can all learn from each other. Pete and Pam Wright's site is www.wrightslaw.com.

Pam Wright: We'd like to thank David for his help on this!

Pete Wright: David, this has been an enjoyable experience. You have done a great job and healthyplace is off to a great start. We thank you.

Pam Wright: I second that! Bye.

David: Thank you again Pete and Pam. Everyone, we will be holding many more ADD related conferences and I hope you will register on our community list so you can be notified of what's going on.

Good night everyone.

Dr. Richfield is a child psychologist the creator of The Parent Coaching Cards. These cards help to develop frustration tolerance and other self control skills in ADD/ADHD children, as well as helping children learn to analyze situations, adapt to them, and restrain themselves rather than acting on impulse.

David: is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I'm glad you had the opportunity to join us and I hope your day went well. Our topic tonight is "Coaching, For Parents of ADD/ADHD Children." Our guest is Dr. Steven Richfield. If you want to know what "coaching" is all about before we get into the conference, please click on this link.

Our guest tonight is psychologist and developer of The Parent Coaching Cards, Dr. Steven Richfield. Dr. Richfield is a child psychologist, parent/teacher trainer, and has been working in the mental health field since 1980. He is based in Pennsylvania and specializes in the treatment of disruptive behavior disorders and sees families with children diagnosed as having ADD/ADHD, behaviors that are difficult for both child and parent to manage.

Good evening, Dr. Richfield and welcome to HealthyPlace.com. I know that everyone here tonight hasn't had a chance to read your article on what a parent coach is. So, can you briefly explain that concept?

Dr. Richfield: Thank you. It's a pleasure to be here. Parent coaching is a prescriptive type of parenting involving tools and goals to help children develop social and emotional skills.

David: What kind of tools and goals are we talking about?

Dr. Richfield: The tools range from Parent Coaching Cards to other concrete strategies developed by parents and children in a partnership.

David: So when you say the word "coaching" are you really referring to "tutoring" in the sense of teaching your child how to deal with various situations that may arise?

Dr. Richfield: Many skills such as frustration tolerance and other self control skills can be coached. The Coaching Cards offer an on-site tutoring forum. Parents can access the lessons right on the spot or prepare their kids for future challenges

David: For instance, what kinds of situations or behaviors is coaching good for?

Dr. Richfield: Let's say a child frequently clowns when in large gatherings - parents can explain how this leads to negative social evaluations. They can use the Coaching Card "Quit The Clowning" to prepare a kid for an event.

David: What age group are these cards good for? And at what age can you begin coaching your ADD child?

Dr. Richfield: Classroom environments, family gatherings, and recess are all coachable places. The Cards target ages 7 - 12 but are used with younger and older kids. Coaching can begin very early - in the preschool years.

David: And specifically, how is coaching effective in working with ADD-ADHD children?

Dr. Richfield: When your kids are younger they require a more personalized approach and parents need to be especially sensitive to their personalities. ADHD kids often do not access internal language - coaching gives them a roadmap to do so. By preparing them for challenges, rehearsing thinking side solutions, you carve out a path of adaptation. One very critical component is the "talk to yourself" message.

David: In other words, what you are saying is you simply analyze the behavior or emotional situation the child is or maybe facing (sort of like role playing) and work though that together. So if the situation arises again, the child will be better able to handle it.

Dr. Richfield: This refers to the content of thought that we are coaching in our ADHD kids that replaces the impulse discharge that so often characterizes their response to a stimulus. Yes, the analysis is compared to a video tape that is rewound and stopped at different points for review. This way the parent and child can revise the child's responses the next time the same plot unfolds.

David: On your site, you say "although there are many social and emotional lessons for children to learn, the Parent Coach accepts the fact that they have much to learn as well. Children will be far more receptive to a parent's attempts to coach life skills if they don't feel talked down to, but sense that they and their parent are 'in this coaching thing together.'" Does this put the parent more in the role of a "friend" to the child vs. being a parent?

Dr. Richfield: Also, the child uses the Coaching Cards in a preparatory way - as does the parent - so there is a partnership. The Parent Coach is all of these - coach, authority, friend, confidante - all wrapped up into one.

David: Dr. Richfield's site is here: https://www.parentcoachcards.com/

I'm wondering, Dr. Richfield, is it the "coach, authority figure, friend, and confidante" role that makes it difficult for the ADD child to figure out what the "parent" role is? Can it be confusing for him/her?

Dr. Richfield: It depends on the child. In order to minimize confusion, the parent is wise to first examine the Coaching Cards and see how they apply to the adult world so that the child understands that learning self control and social skills is a life skill. Coaching comes in when a situation arises that displays a gap between what the environment is asking and what skills the child may lack. Some kids prefer to use the cards without parental help while others will only get comfortable with them by themselves.

David: A couple of audience questions I'm getting center around this: Why is it more difficult for an ADD child to develop social and emotional skills?

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Dr. Richfield: ADD kids are not very good at observational learning - a key component in social skills. Also, their threshold to restrain themselves is lower than the average child. This leads to self control problems. Coaching makes all of this clear and understandable so that they learn how to increase the powers of the thinking side over the reacting side.

David: Here's an audience question:

Pepper48: Does the lack of skills become a fear instilled in these children?

Dr. Richfield: Good question. Yes, many do recoil from social encounters because they fear rejection and have learned to prefer the company of their video games or other solitary pursuits.

David: What is the key component(s) of being able to help your child deal better or more effectively with social and behavioral issues?

Dr. Richfield: A warm, loving, and goal-oriented relationship that stresses safety, open communication, and clear tools for adaptation. The parent coach must stress that they are on the same side as the child. Too often the child feels like the parent is an adversary - an unfortunate residual effect of family conflict.

David: Here's an audience comment about observational learning:

zenith: I could only learn by observational learning since I couldn't concentrate enough to read or do something else.

Dr. Richfield: I think I understand your point. When a person observes they also must reflect upon those observations and compare them to previous learning and decide what strategies to keep and which to let go of, so observation is only the first step. There is much more cognitive process that goes into the growth of social skills.

David: Sometimes it can be very frustrating for a parent to deal with their ADHD child. Do you think that's what causes the adversarial role?

Dr. Richfield: Yes, I do. They test our patience; they make it hard for us to find our coaching voice, but there is a helplessness that they are trying to compensate for in the conflict they create. I often ask parents to ask themselves "What is the coaching response" when conflict emerges.

Help 1: Does an ADHD child usually show violence to others?

Dr. Richfield: No - not in my experience - this is an exception, but impulsivity can lead others to fear violence.

David: A couple of site notes, then we'll continue. Here's the link to the HealthyPlace.com ADHD Community. You can click on this link and sign up for the mail list at the top of the page.

We have several excellent sites that deal with many aspects of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder: Judy Bonnell's "Parent Advocate" site is here and "ADD Focus" is here. There are other sites too.

Dr. Richfield, would you say that repetition works well with ADHD kids?

Dr. Richfield: Impulsivity is the fuel that runs the ADHD child - and it can be confusing to teachers, parents, and friends. Parents can help their kids understand how their energy needs a discharge path and offer alternate outlets. Repetition can be very helpful because it provides a structured pattern for the child to turn to when certain feeling states are triggered.

David: When you say "alternate outlets" for the child's energy, what are you referring to?

Dr. Richfield: I recommend "walking paths" in classrooms and homes wherein the child can freely discharge their energy without feedback from adults.

Pepper48: How do you get them past the point of fear and that is after high school?

Dr. Richfield: The fear can be overwhelming but with our support they can take small steps. We need to recognize that these steps may start as symbolic ones and proceed slowly. Perhaps you have an example to offer?

David: One of the things I think you are saying is that the role of the parent coach is to help bolster the child's self-esteem and sense of being able to accomplish things on her own. Am I correct in that?

Dr. Richfield: After high school the world can appear as an even more confusing place, and yes, we are striving for that result. It comes from taking steps in their life journey, whether it be making a call on their own or applying for a job. Remember that the small social interactions often do not come naturally. These more invisible rules of the social world need to be revealed.

David: Besides the social and behavioral issues, how can we help our ADD children do better in school. Concentration seems to be a tough issue to deal with?

Dr. Richfield: Some interventions offer on-site reminders, such as the "Stay Tuned In" Coaching Card, while others involve the teacher providing feedback for attending to tasks. We can use stopwatches at home to help extend attention processes and challenge them to beat their records.

David: That's a good idea. I had not heard of that one before.

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Dr. Richfield: I work with a lot of kids who enjoy competition, so I try to mobilize that healthy character trait in motivating them to control their ADD. This can be done in school as well. Remember that coaching doesn't always involve the Coaching Cards.

David: Do you think home schooling is a better way for these children to learn?

Dr. Richfield: Again, it depends on the child. I have not worked with many children who have been home schooled so I don't have much knowledge of the benefits and drawbacks.

David: I asked that question because I was wondering if the school environment (lots of kids and things going on) would be too disruptive for some kids - that maybe it would trigger impulsive behaviors.

Dr. Richfield: Yes, definitely. Large groups of children act as triggering stimuli and can undermine learning. I do know that many home schooling parents have e-mailed me about their successes with their ADD kids. They have also told me that they use the Coaching Cards as guidance curriculum.

David: Here's an audience comment:

Pepper48: My son does better in a one on one or by himself situation - less distractions.

Dr. Richfield: Yes, that is very consistent with the experience of most ADD children. The less potential disruptions the greater the on-task behavior. Perhaps you could make him aware of this and help him narrow his focus when with large groups.

David: Here's a question from someone who is interested in helping them-self.

ciceromae: I am 22 years of age, have ADD, and was doing pretty good in school until I started university. I have started the first semester about 4 times and still cannot do it well. Is there anyway I can help myself with this? I am from Mexico.

Dr. Richfield: First, examine where you are getting off track and develop a strategy to effectively manage the environmental or internal barriers. Many false starts in college are due to poor organization, insufficient willpower, and environmental distractions.

David: One final question for tonight: Is parent coaching a substitute for therapy for the child with attention deficit disorder?

Dr. Richfield: No, definitely not, but it can maximize therapeutic gains and diminish the length of therapy.

David: Thank you, Dr. Richfield for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating.

Dr. Richfield: It was a pleasure to be here

David: Good night, everyone.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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We hold frequent topical mental health chat conferences. The schedule, and transcripts from previous chats, are here.

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Dr. Gabor Mate, who is a family practice physician in Canada has ADD himself. He is the author of the book "Scattered," which offers a new perspective on ADD and a new approach to helping children and parents living with the problems ADD presents.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I'm glad you had the opportunity to join us and I hope your day went well. Our topic tonight is "Alternative Thoughts About Attention Deficit Disorder." Our guest is Dr. Gabor Mate M.D., who is a family practice physician in Canada. He too has ADD himself. He is also the author of the book "Scattered," which offers a new perspective on ADD and a new approach to helping children and parents living with the problems ADD presents.

Good evening, Dr. Mate and welcome to HealthyPlace.com. We appreciate you being our guest tonight. You believe that ADD is not an inherited illness, but a reversible impairment (not a genetic disorder), a developmental delay. Could you elaborate on that please?

Dr. Mate: Hi, thanks for having invited me. I have been diagnosed with ADD, as have my three children, but as you point out, I do not believe it is an inherited disorder.

I believe ADD originates from the effects of stressful social and psychological circumstances on the developing brain of highly sensitive infants. In other words, there is a genetic predisposition, but not a genetic pre-determination.

What modern brain science has clearly established is that the development of the human brain does not depend upon heredity alone, but is heavily influenced by the environment. This includes the circuits and biochemistry of the part of the brain where the problems with ADD are located.

David: When you say, "stressful social and psychological circumstances," what are you referring to exactly?

Dr. Mate: In ADD the part of the brain most affected is a piece of the gray matter, or cortex, in the prefrontal area, near the right eye. This part of the cortex has the job of regulating attention and emotional self-control. Now, like all circuits, this part of the brain requires the right conditions for its development.

In this, it is like all other parts of the brain. For example, vision: an infant may have perfectly good eyes and genes at birth, but if you put him in a dark room for five years, he will be blind. This is because the visual circuits of the brain need the stimulation of light waves for their development. Without light, they would die.

In the same way, the attention regulation and emotional regulation centers of the brain need the right conditions for their development. These right conditions are, chief and foremost, a calm, non-stressed relationship with an emotionally consistently available, non-stressed, non-depressed, non -distracted primary caregiver.

In all cases of ADD I have seen, including that of my own children, there were emotional stresses in the environment that interfered with those conditions.

David: So are you saying that parents are, in large part, responsible for these hostile life experiences that create, or foster, ADHD in their children?

Dr. Mate: I am certainly not suggesting that parents do not love their kids, or that they do not try their best. I certainly love my kids, and always have, however, conditions in present day society have put terrific stress on the parenting environment. Many of us lead very stressed lives, and the supports of extended family, village, and neighborhood that used to be there for parents are largely gone. Hence, we are seeing so much more ADD. So I am not talking about bad parenting, but I am talking about how parenting under stressed conditions does affect the development of brain circuits.

David: Dr. Mate also has ADD himself. He is also author of the book "Scattered," which offers a new perspective on ADD and a new approach to helping children and parents living with the problems ADD presents. You can purchase his book by clicking on this link.

How do you promote the healing process in the ADD child then, Dr. Mate? Would it be to relieve the stressful environment that the child is in?

Dr. Mate: The brain research evidence very strongly suggests that the human brain, particularly the emotional self-regulating circuits, can develop not only in infancy, but also later on, even in the adult.

So the question is not simply how to treat symptoms, and all the behaviors of the ADD child are only symptoms. The question is, how to promote development. And for any living creature, the question of development has to do with the conditions in which that creature (plant, animal, human) must live. So the issue is, how do we best promote the development of our children, not just how we control their behaviors. Very often the things we do to change behaviors actually undermine development. So, my whole book is aimed at discussing and describing the conditions under which children and adults can experience new development.

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David: We have a few audience comments, Dr. Mate, that I'd like you to address, then we'll proceed on with how to help your child with these development issues.

motheroftacha: Most of us with ADHD children have spent years absolving ourselves of guilt, so we can help our children. This is hard to take, honestly. Secondly, many of us have been much more stressed as a result of living with ADHD. Life was a piece of cake before. Thirdly, it could also be speculated that ADHD adults, being more impulsive, produce more kids than non-ADHD adults (impulsivity), thereby "contributing" more children into this world.

Dr. Mate: I understand that parental guilt is a very negative quality. I am not trying to promote guilt, which I have felt myself, only understanding. The more we understand, the more active we can become in reversing the problems.

The point of view that ADD is some sort of genetic illness may help some people feel less guilty, perhaps, but it is essential pessimistic. After all, if something is genetic, we are kind of stuck with it, aren't we?

So, I am saying that it is not a question of an inherited diseases, but one of development. We can actually promote positive development in our children, if we understand what they are all about instead of just trying to change their behaviors. Furthermore, it's true that living with ADD children adds terrific stress to any parent's life (I have experienced that myself). However, we can reduce that stress if we really learn about what makes the child tick.

Finally, it is true that ADD runs in families, but from the scientific point of view the evidence for a genetic causation is extremely weak. The point its, that if a parent has ADD, as I do. then he/she can create the conditions in which his/her children's development will follow along similar lines.

David: I think it might be helpful, Dr. Mate, if you could list a few positive things that parents could do to encourage the kind of development you are talking about.

Dr. Mate: First, one has to put the long term ahead of the short term. For example: these children are all, by nature, I think this is genetic, highly sensitive. This means they are affected by the environment, physical and emotional, more than other kids. This includes most particularly how the parent relates to them.

These kids, being emotionally hypersensitive, are also very vulnerable. If say, I react to their behavior with anger and with some punishing technique like "time out," I am just reinforcing his insecurity, which is already deep. So, we have to be most loving and most understanding precisely when the child is acting out, because that is precisely when she/he is most hurt, defensive, and vulnerable. Yet most advice parents get is that they should become more controlling, more punitive at such times.

David: How would you suggest dealing with such things as inattention, and then hyperactivity?

Dr. Mate: It is well known that the inattention of ADD kids is highly "situational." In other words, it varies from one situation to another. It is also well known, that many of these children calm right down and can pay attention in the present of an emotionally calm, loving, and attentive adult. The point is that attention increases with emotional security.

In animal studies, it has also been shown that new brain circuits and new brain blood supply develop in animals given the appropriate emotional stimulation, even in adults. So the very first condition of long term development of attention and emotional self-regulation, is absolute emotional security. It is very hard to provide that, but if we work on it, and if we work on ourselves, we can do a lot. The results are quite amazing.

ericsmom: Does Dr. Mate believe in medication?

Dr. Mate: I take medication myself; it helps me. However, there are potential problems with medications, and I don't just mean side effects that can usually be managed. The chief problem is that 80% of the time a child is diagnosed with ADD, all he/she gets is a prescription. Medications can be helpful, but they don't by themselves promote development. So the danger is that if we medicate a child and she functions better, we think we have solved the problem, however we haven't.

David: One of the things you mention in your book is that ADD is being diagnosed a lot, but it's being diagnosed by the wrong people which, in itself, causes problems. What kind of professional should be diagnosing ADD?

Dr. Mate: Physicians-family doctors, pediatricians, psychiatrists, who understand ADD. Many don't, just as I knew very little about it until about six years ago. Also, well trained psychologists can diagnose, if they know about ADD, however, many do not.

HPC-Phyllis: Should a child with ADHD be in therapy?

Dr. Mate: It depends very much on the child. In most cases I feel it's not the child, but the parents who need counseling and advice. I spend much more time with the parents, than with the child. However, it does depend on the individual case. Some kids are quite ready for therapy. For example, if not talking therapy, then play, or art therapy.

nanabear: I have a daughter with ADD, now age sixteen, who is now a year behind in school. Specifically, how can I promote her development in our day to day lives? Can you give some examples?

Dr. Mate: I would have to know much more about the individual case. I have a whole chapter on teenagers in the book. In general, we have to let go of trying to control these kids at this age. You have to allow them to make their own decisions, and yes, their own mistakes. Above all, it is important that whatever we do, we don't exacerbate the resentment and oppositionality of the ADD teenager, and that we understand why they feel the way they do.

David: If you are looking for a lot of ADD information, here's the link to the HealthyPlace.com ADD/ADHD Community. 

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Carolina Girl: So how do we eliminate "stresses" from school, work, and even play in this busy world?

Dr. Mate: We can't eliminate all stresses. What we can try to do is that within the family, we begin with an understanding, open-minded, and compassionate attitude. Now, for example, being an ADD adult, I used to be quite a workaholic doctor. I still have those tendencies. However, I realize, given the sensitive nature of my children (we still have a twelve-year-old at home) that if I am to reduce the stress in her life, I have to say "no" to things and reduce the stress in mine. That's just one example.

DaveUSNret: My stepson was originally diagnosed with ADD. We later found that he had, in fact, a high IQ and was bored with school. Once he had an intellectual challenge, the problem resolved itself. How many kids get this wrong diagnoses?

Dr. Mate: I think many do. We tend to forget that kids have other reasons, besides ADD, why they may not be paying attention (i.e. rigid and boring school routines). They could also be too interested in their peers to pay attention to what adults want. It's not all ADD.

Krissy1870: I have such a difficult time with my own ADHD, that it makes having patience with my child, who also has ADHD, almost impossible sometimes.

Dr. Mate: I have a chapter called "Like Fish In The Sea." This means, as a psychologist once told me, that "kids swim in their parents unconscious like fish in the sea." ADD kids are highly sensitive to their parents' emotional states. There is no way to help them unless we first develop an attitude of compassionately seeking help for ourselves.

munsondj: Dr. Mate, how do you feel about using natural approaches to ADD as opposed to traditional medicines?

Dr. Mate: Truth to tell, I do not know much about them. I have had some parents tell me they have had success with various herbal remedies, etc., but for the most part, I have not been impressed. However, I have nothing against them, so long as they are not harmful, and most are not. Again, for me, the major issue is not what substances, medications, or otherwise, we wish to use, but how do we create the right conditions for our children to develop.

David: Some audience members would also like to know if you think there's a relationship between ADD and diet?

Dr. Mate: As I mentioned, these children are highly sensitive. I think that is what is genetic here. They certainly tend to have, on the average, more allergies, eczema, asthma, frequent ear infections, etc. This means they also are more sensitive to whatever they happen to ingest. Certainly, they tolerate low or high levels of blood sugar very poorly. However, I don't think diet by itself can either cause or cure, ADD.

ahowey: This doesn't seem to be helping at all. My child is now sixteen and was diagnosed at seven. No one has any answers for us that work. Schools and teachers are only supportive for so long, and then it is the same thing. They say he is lazy and won't do the work. How can I talk to schools that only seem to talk and think like the left-brained people?

Dr. Mate: Well, it's difficult for me to comment on individual cases, without knowing a lot of the particular details. Dealing with schools is extremely frustrating (that's another chapter in my book). Furthermore, I used to be a school teacher myself, so I know what schools are like, they want to assume that everyone has the same kind of brain, when the truth is that we don't. The best thing is for the parents to completely understand and accept their child, and this will fortify him to deal with the rest of the world. Some teachers are open and can be talked with, others are quite rigid and closed. I don't have an easy answer to your important question.

David: In our ADD community, click on "The Parent Advocate" site. There's a lot of good info there.

munsondj: Dr. Mate, how do you suggest we handle the behavior of these children?

KDG: How do you punish, you can't just ignore behavior that is hurtful to other children.

Dr. Mate: Punishments simply do not work. They do not teach anything, except they make the child feel more embittered. A child who is hurting other children needs to be removed from that environment, but not in a punitive fashion. If we emotionally connect with these kids, and they are desperately hungry for that, their anger and their hostility abates. The main thing is is to recognize that aggression, hostility are only symptoms of emotional insecurity and a sense of frustration and rejection: the behaviors are only the symptoms, not the underlying problem. We have to understand the emotional dynamics behind the "bad" behaviors and not be focused on changing the behaviors themselves. As the child heals emotionally, the "bad" behaviors automatically stop. They are only symptoms.

David: Just to clarify, you are saying most children with ADD act out, as do "normal" children, because the lack something, emotionally. Furthermore, you are suggesting it's important for the parent to give that child what it needs on an emotional basis?

Dr. Mate: Exactly. Look at that phrase "act out." What does it mean? It means precisely that the child cannot directly express his emotions in word, so he acts them out. If he is angry, instead of saying so, he will act it out in the form of hostile behavior. So, we need to respond not to the behavior, but to the emotionally hurting child who is sending us a message but acting out his emotions in ways he himself does not understand. It's our job to understand him. That's what I emphasize throughout "Scattered."

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David: So then, under your theory, what separates the ADD from the non-ADD child? I mean, both can be emotionally traumatized in life, and it is these traumatic life experiences creates identical behaviors.

Dr. Mate: Yes, many people are traumatized who don't have ADD, in fact, some are traumatized much more than the average ADD child. However, we do have to recognize that ADD children do suffer from emotional pain, that this pain happened to them not because they weren't loved, but because, perhaps, parents were themselves overstressed and didn't quite know how to relate to the child's extremely sensitive nature. If this stress occurred during the first few crucial years of brain development, it would have affected how the child's brain circuits, connections and chemistry,-developed. So now the question is, as I keep stressing, is how to promote healthy development.

Keatherwood: My son has ADHD, Tourettes, ODD and OCD. We've found that when they treated one thing, the medications make something else worse. He has been in therapy most of his life, but finally turned to drugs. Are these kids more prone to drug use. The treatment center he's in says that many of their kids are ADHD?

Dr. Mate: ADD individuals are more prone than average to engage in addictive behaviors. I have a chapter on that, in which, I discuss my own addictive tendencies. They are also more prone to become substance addicted, particularly to caffeine, nicotine, cannabis, and cocaine.

DaveUSNret: I can back up Keatherwood's comment, many of my own Drug/Alcohol clients were diagnosed as ADD.

KDG: There is still guilt even if ADHD is genetic. After all, I have clearly passed it along to my son.

motheroftacha: For what it is worth, I do not cop-out. I read and try to understand her. What touches me about Dr. Mate, is that what he says about how it feels to live like this, is frequently in my mind about her with love and caring. I get it that she doesn't have control over much of what she does, and we work to help that.

missypns: A more positive approach is simply looking at how the child is able to understand the information, rather than insisting that they take what is given just because it is the way it is done, it makes life a lot simpler for everyone involved.

kellie1961_ca: I find out the medications work very well. My son is doing great in school a year ago he was getting C's and D's in school, now he gets A's and B's.

Krissy1870: I am halfway through your book and it has already helped, but it is still hard dealing with both her ADHD and mine.

hrtfelt33: My child will not tell me when something is wrong and he does not act out, how can you get a child to talk to you when they won't?

Dr. Mate: The first question we have to ask is "why doesn't our child talk to us." After all, all infants are very vocal about letting us know when they are unhappy and uncomfortable. If a child then closes down as he/she gets older, it's because somehow, completely inadvertently, we have given the message that we have difficulty accepting what they are telling us, their anger, their unhappiness, etc.

So what we have to do is to rebuild that trusting relationship which existed when he/she screamed as an infant when they were uncomfortable, knowing that we would take care of them. We don't do that through words and promises. We do it by daily demonstrating to them that we fully accept them, regardless of what is happening. I can't say much more about that in this short space, but that's the idea. Unconditional love.

David: ADD children tend to be unmotivated. You say much of what parents are told about motivating children is self-defeating. What would you suggest as the best ways to motivate your child to improve him/herself in different aspects of their lives?

Dr. Mate: I have a chapter on motivation. Motivation cannot come from the outside, which is why rewards and punishments always backfire in the end. Motivation has to come from within, and human beings who feel good about themselves are naturally and intrinsically motivated. So the thing is, to build the child's self-love through how we love them. Then they will develop motivation on their own.

solo: My daughter is eighteen, and has only recently been diagnosed with ADD. Her school said she was lazy and they only tested her for her IQ (which was l46). The test did show that she had a learning disability. She is constantly frustrated and never follows-thru. She feels that I am the source of her problems, because I do keep on her constantly. How, or what, can I do to help her understand her disability?

Dr. Mate: It's very difficult to help an eighteen-year-old who basically, just wants us to leave her/him alone. My first advice to parents in such a situation is to back off, to take a deep breath, and not to inflict our anxiety on our nearly-adult child. I know it may sound self-serving, but I believe there is a lot in my book that would help you understand your daughter and help you to take a more constructive approach. Certainly, our judgments and unasked for advice only increases the resistance and oppositionality. 

ryansdad: Dr. Mate, my son is ADHD and bipolar and so far none of the medications have worked that good. I have an appointment to check with a new doctor, who does brain mapping. She say's that is 98% accurate. What do you know about this procedure?

Dr. Mate: It can be quite helpful, in pointing towards the right medication.

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missypns: What happens to our children that become adults with ADHD?

Dr. Mate: Well, they may become doctors and writers, like me. What can I say, it depends very much on many factors:

• the child's intelligence
• family support
• social and educational background
• the degree of ADD
• the kind of professional help available

However, we should never give in to pessimism. I treat many ADD adults, and yes they struggle, but then life is a struggle and suffering for many. Most people can cope and overcome problems, although they may have to go through difficulties. I think we all, speaker, moderators, guests, have likely experienced that one way or another.

motheroftacha: Yet, if there is an emotional "hypersensitivity" and often times our kids miss the societal feedback for behavior and academic performances. How can we nurture self-confidence? My child is loved by so many people, yet she rather misses that when she "chooses to." If the problem is not enough love and acceptance, then it is an error in interpretation. How do you help that?

Dr. Mate: These kids have often overdeveloped emotional defenses and our love sometimes just doesn't get through. When it does, it can work miracles. But it's very difficult. I think the issue is that the love has to get across precisely when it's most difficult for us. When our child is acting out and challenging us, we feel anxious and helpless. That's what we have to work on. I hope that answers your question, at least in part.

hrtfelt33: I am confused about what causes depression in ADHD children. Knowing that the social drawbacks are certainly part of it most likely, I would like to know if ADD medications, like Ritalin, themselves can cause depression?

Dr. Mate: Yes, it depends on the individual. When I took Ritalin, it certainly made me feel depressed, although it does not have that effect on everybody. Depression in the ADD child is a product of social rejection, but most fundamentally from a sense, unconscious usually, of being cut off from the parents. Again, the solution is to work on really connecting with the child. Sometimes antidepressant medications may be helpful, not as a long term solution, but as a temporary help.

David: So everyone knows we have a Conference Transcript homepage that includes various transcripts.

Thank you, Dr. Mate, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com.

Thank you again, Dr. Mate.

Dr. Mate: Thank you David, and to all participants. 

David: Good night, everyone.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Judy Bonnell, host of The Parent Advocate website, has 40 years of experience and knowledge to share when it comes to parenting and advocating for ADHD children. This conference is for parents of children with ADHD, ADD.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Advocating for your ADD, ADHD Child". Our guest is Judy Bonnell, owner of The Parent Advocate website here at HealthyPlace.com. If you haven't been to her site yet, I encourage you to do so. There's a lot of information there.

So everyone knows, Judy has over 40 years of experience parenting and advocating for her children with ADHD (Attention Deficit Hyperactivity Disorder) and helping other parents deal with the system and understanding their child's education rights. Over those years, she's picked up a lot of knowledge about how "the system" works and how you can make it work for you. You can read her story here.

Good Evening Judy, and welcome to HealthyPlace.com and thanks for being our guest this evening. I can't tell you how many emails I get from parents who are either frustrated or dejected and feel like they've run into a brick wall when it comes to getting help for their children. Why is it so darned hard to get the health system, the school system, and others to work with our ADD, ADHD children?

Judy Bonnell: Good evening. It is indeed a pleasure to be here. If I had an easy answer to your questions, we would indeed have healthy well-educated children. But I find politics and money are often the overriding factors in these services. It will be a fine day when a child's needs are most important.

David: If you had to summarize, what would you say are the one or two more important things parents should know when it comes to advocating for your child?

Judy Bonnell: Document, Document, Document. Write lots of letters of understanding. Explain what you want and what you have been told by school personnel. Be polite but thorough and keep copies of everything.

David: When it comes to school issues, would you say it's better to go through the chain of command, or would you go straight to the top to get your problems resolved?

Judy Bonnell: By the time parents realize they have a serious problem, the teachers and, usually, the principal are aware. If so, go to the special education director. Principals do not actually make special education decisions but are sometimes a member of the Individualized Education Plan (IEP) team and have input.

David: So, keeping well-documented files on your attempts to get help and what's been said to whom is very important. What about a parent's demeanor in dealing with the school personnel. Should a parent be tough or condescending, or what would you suggest?

Judy Bonnell: That is such a hard one! I was always Jell-O at my own son's Individualized Education Plan, IEP meetings. But if parents take a Parent Attachment and have their concerns on paper, it is much easier.

David: We have some audience questions, then we'll continue:

KK: Yale University Medical Center has strongly recommended that my 7 year old daughter have an aide in the classroom. We live in Florida and I was told "that is not how we do things down here." North, South, East or West should not make a difference. What is the criteria for obtaining an aide?

Judy Bonnell: The need actually. Anytime someone tells you something that sounds off the wall, ask them to please put their position in writing for you. Also, if it is district policy, it has to be in writing.

KK: They said that an aide is only used for short-term issues and since my daughter's need is long-term, she wouldn't qualify for an aide. Isn't an aide less restrictive than 2 hours in the resource room?

Judy Bonnell: I would ask for that position in writing! I bet you don't get the same response. Any aide is only as good as the support and training he or she gets. If utilized in regular education setting, then teachers need support and training also. You are entitled to ask for that.

David: So what you're saying is -- school officials, etc. can say anything they want, and they expect parents to take that as "gospel," but that doesn't mean it's so. So it's important to take the initiative and go through the written school district policy book and check it out yourself.

Judy Bonnell: The written word is your most important ally. Learn to use it all the time. You can afford to be polite but as firm as necessary when you make people accountable on paper for their words. Also Letters of Understanding give people the chance to correct any misunderstandings.

And yes, David, it is wise not only to get district policy but a copy of your state's regulations for special education.

teresat: How can parents obtain information such as written school district policy books?

Judy Bonnell: Such information is public record. I would ask for a copy of any policy that you regard as strange. Just ask for it in writing. They have to give it to you.

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David: What about the idea of bringing an advocate with you to school conferences and meetings with officials. Would you advise a parent to do that? And, if so, where does one find an advocate?

Judy Bonnell: It is always wise to bring family, a friend, and most especially an advocate. Every state has Parent Training and Information Centers that provide parents to assist parents, and also advocacy training. They are funded by the U.S. Department of Education and their services should be free. It was such a parent who originally assisted our family and who trained me.

David: And the function of the parent advocate, is it to "speak for the parent" or to act as a "witness" to what is being said and what's transpiring"?

Judy Bonnell: Ideally, the parent speaks for the parent. In real life, parents who have experienced only failure are often in extreme duress when I first get involved. So I assist only as much as the parent desires. Once they learn how to take everything in writing to the meeting, they start gaining self-confidence.

David: So, it's more of someone being there to show you the ropes until you feel comfortable doing it yourself. How do you find the Parent Training and Information Centers?

Judy Bonnell: The parent organization is PACER (Parent Advocacy Coalition for Educational Rights) and it is easy to find on the web. They will list all the sites. They are in every state and are there for the families.

David: My guess is you can also call your county and/or state board of education and they can point you in the right direction.

Judy Bonnell: Every State Department of Education is mandated to work with these centers. They should make available the information also. These are the people to ask for a copy of your state's special education regulations.

I cannot emphasize enough the importance of knowing the law that directs your child's education if he or she has special needs. Believe me, the local school administrators have the regulations practically memorized. You should be equally informed. The law was written to protect children, not written for the convenience of school districts. But often that information is not easily available to parents.

David: What kind of things should a parent expect the school district to do, to accommodate their ADD, (Attention Deficit Hyperactivity Disorder) ADHD child?

Judy Bonnell: First of all parents need to understand that not all children with ADD/ADHD qualify for assistance. If children just need minor help, such as shortened assignments, less homework, oral testing, etc. they can get that with a 504 plan. If they need big-time help with services they should qualify for IDEA which lets them have an individualized plan. IDEA means Individuals with Disabilities Education Act.

We are talking two different laws. 504 is a civil rights law. It says all children with disabilities will have access to the same things as children without disabilities.

David: Let's get to some more audience questions Judy:

chemcl: I have a son with adhd. For the past 5yrs of dealing with the school board and Individualized Education Plan - IEP teams, it took forever to get my son in the right setting. My son's self-esteem was in jeopardy also. After a long 5yrs of public schools (three different schools to be exact), I felt my son was not getting the education he so deserved. My question to you is, how beneficial are private schools for adhd children? My son will be attending this fall. This is a big cost factor, but after dealing with the public school, this was my only solution, to put him in a private school.

Judy Bonnell: It depends on the school. Some schools are geared to meet the needs of children with learning problems. Some schools are very conservative and the emphasis is on strict regimentation. So it depends on the individual child's needs. I would look for a school, public or private, where the emphasis is on a child's strengths.

teresat: What tips could you give to a parent who works with an advocate and school officials become intimidated, thus causing a defensive relationship instead of a working relationship?

Judy Bonnell: School officials who are easily intimidated are usually school officials who are either uninformed as to what they must do, or they are in personal ivory towers and have a great fear of losing control. A child in need cannot afford such an attitude. What must happen is to put aside other considerations and focus on the needs of the child and what teachers need to be successful with that child. When that eventually becomes the focus, and it will with effective advocacy, everyone ends up a winner and a smiler :-)

Special education is rapidly becoming a team effort. There is no room for people who are uncomfortable with that. Those people seem to be leaving the profession as it is too stressful for them. Ask for a full educational evaluation including executive functions and do it in writing. Then, if they still deny services, parents can ask the district to pay for an independent evaluation by a neutral party. But they must let the district test first. As always, request it in writing and they must meet a timeline to complete it. It varies state to state as to the timeline. When you make a request, always ask for a reply within say 10 or 12 working days.

David: Sometimes, it helps to be complimentary to the teacher or school officials when things are going right. Also, if you are educated yourself on what's going on and what the law is, you can then say "I came across this article, or whatever, and thought you may find it helpful". That way, you're educating the school officials without coming off as combative.

starLyon: How can you get help for a severe ADHD gifted child if the school says he's doing fine? Does a child have to be failing to get assistance?

Judy Bonnell: Again, ask for that evaluation and also testing for gifted. Being gifted does not let the district off the hook for services! In fact, doing just so-so is not good enough for a gifted child. Don't ever let them determine services just on an IQ score either.

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Pat B: What do you do when a special education coop continuously has a power struggle and forgets what the needs of the child is?

Judy Bonnell: You write that Letter of Understanding. State what you understand that is not happening, that should be happening. Ask for a meeting and state the expectation that district recommendations and denials of your requests be in writing as required by law.

Nadine: I was told my son has inattentive type ADD (Attention Deficit Disorder), however, he is at the top of his class and he has no behavior problems, so, therefore, the school will not step in and help. So it will cost me over a $1000 to have a full evaluation done here in Canada.

David: Is there anything she can do, Judy, to get the school district to help with the evaluation?

Judy Bonnell: Not all children with Attention Deficit Disorder, ADD, are going to need services. I don't know about Canada, but in the U.S., there must be problems in learning. As I say, I don't know Canadian law. She needs to get a copy of her law and see what it says about evaluations. Always learn what the law is that covers your child.

David: Even though some parents may like to, most can't afford to hire a lawyer and fight the system. When do you think it's time to throw in the towel and seek legal assistance in getting your child's special education needs met?

Judy Bonnell: The problem with due process and lawyers is that it can drag on for years. It can also irreparably damage relationships. In any case, parents should start building that all-powerful documentation because a lawyer will bless them for it!

I have found the Office for Civil Rights very helpful in many instances for ADHD. And they provide their own lawyers when necessary. That's how we won our class action suit for children in New Mexico.

David: Yes, I imagine that because of the slowness of the legal process, if you start with lawyers while your child is in 5 grade, by the time that issue is resolved, your child is a college graduate :)

Judy Bonnell: Not always. And we have some very fine, caring, advocacy lawyers. Just depends on the circumstances.

ikwit1: My husband and I spoke to a school psychologist to develop a 504 plan for my daughter. She had numerous educational testing. The problem is that the psychologist would not put certain interventions in the plan because she didn't know if the next school would follow through with the intervention. The psychologist wouldn't allow a few interventions that we wanted.

Judy Bonnell: I think the psychologist went far beyond her authority. Such decisions are team decisions and should be based only on a child's needs.

David: What should she do Judy?

Judy Bonnell: I think you would have a good issue for the Office for Civil Rights with that one. First I would get the psychologists position on paper, of course.

iglootoo1: I was told at annual review that my ADHD, Learning Disabled, Gifted 16 year old would not be entitled to accommodations in an honors history class according to the State (NJ). He has an IEP (Individualized Education Plan). Since he was only recently diagnosed and trying to come to grips I am considering an attachment to IEP sent to all his teachers. What do you think?

Judy Bonnell: I think I would write a letter of complaint to your special education director and tell him/her that you believe your son's civil rights are being violated by not making the necessary accommodations. I do recommend parents look ahead and see that such recommendations are in the IEP long before testing is due.

You might also ask them why the SAT is given with accommodations but a local class will not make accommodations?:-)

David: I want to thank Judy for being our guest tonight. We appreciate you sharing your knowledge and experience with us. And I want to thank everyone in the audience for coming and participating.

Judy Bonnell: It has been a pleasure David. Thank you for inviting me.

David: If you haven't visited Judy' site, The Parent Advocate, I encourage you to do so. There is a lot of very useful information, sample documents, and links to sites related to issues discussed above that you can use. You can also check other sites in the ADD/ADHD Community.

Good night everyone.

Click here for a list of conference transcripts about ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder) and other mental health topics.

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Alan R. Graham, and Bill Benninger, are our guest speakers. They have been working with with ADD, ADHD teens and their parents for over 20 years.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is for Parents of ADD, ADHD Teens.

We'll be covering school issues, social and peer relationships, what to do during the summer, driving issues, how you, as a parent, can help your child, and some good coping mechanisms for yourselves.

Our guests, psychologists Alan Graham and Bill Benninger have been working with children, adolescents and adults with Attention Deficit Disorder and their parents for over 20 years. Besides doing direct therapy, they work with individuals and groups over the phone on a conference call line and they publish the newsletter, ADDvisor.

Good Evening, Dr. Graham and Dr. Benninger and welcome to HealthyPlace.com. We appreciate you being here tonight. People in the audience may have different levels of understanding Dr. Graham, I'd like you to define ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder) and then we'll get into deeper issues.

Dr. Graham: ADHD is a disorder of the inability to inhibit behavior and impulses. It is marked by hyperactivity, impulsiveness and inattention. ADHD kids are fidgety, interrupt others, break into lines, always have to be first, daydream and are unfocused. ADD (attention deficit disorder) is all the above without the hyperactivity.)

David: For those in the audience, I'm assuming that most of you have, at least, a basic understanding of ADD, ADHD. However, if you have any question on this subject tonight, please feel free to send it in.

It's almost summertime now, Dr. Benninger, and I know parents are sitting around and wondering what they can do with their ADD teen. What are the issues that parents face during this time of year and what are the solutions?

Dr. Benninger: Supervision is a major summertime issue. It is very important that ADHD teens be closely supervised. Even though it can be difficult, even paying a "sitter" for older kids may be important. There are many camps that may also be a good resource.

David: What kinds of things should parents be concentrating on during the summer, in terms of working with their kids?

Dr. Graham: Structuring their kids time so that their environment predictability is a priority.

Dr. Benninger: I think behavior issues and responsibility are very important. These can be worked on by keeping them accountable. Daily reward systems, even for older kids, can be of significant help.

David: I think that's one of the issues that parents deal with all the time -- accountability. How would you suggest they help their teenager with that?

Dr. Graham: If you want, for example, to encourage your child to maintain a job during the summer, make attendance at the job, the criteria for using the car. Develop a set of incentives that the teenager is well aware of that encourages the responsible behavior you want to see in your child.

Dr. Benninger: Structured behavior modification systems work very well.

David: Can you explain that?

Dr. Benninger: Picking out 2 or 3 behaviors that you want your teen to work on, using the rewards that Alan is talking about on a daily basis. This is important because ADHD teens need much more structure and accountability than non-ADHD teens.

Dr. Graham: Financial incentives can work too. Your teen can earn money for desired behavior.

Dr. Benninger: It is important to let the teen help select a list or menu of rewards that help keep them interested. Money, movies, driving screen time, time with friends can all be incentives.

David: Here are some audience questions:

teresat: How can a parent help an add child retain what he or she has learned at school in the summer.

Dr. Benninger: Good question - They aren't going to have much more trouble than the average teen unless they have a learning disability. Adhd is a disorder of doing - not knowing. It is important to strike a balance as you don't want to burn out a teen that already dislikes school.

Dr. Graham: It also depends on your child's attitude toward school. Would they be interested in summer school? Would it have to be a fun course? Is a tutor a possibility?

Sunshine777: Dr Benninger you say there are many camps, but where would one go to find out where or who these camps are? I have looked in the ACA and there are maybe 1 or 2 and they are back east.

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Dr. Benninger: I would contact CHADD, the national organization for ADHD. They can probably help. Be prepared. ADHD specialty camps can be expensive.

Dr. Graham: In the Chicago area, the Sunday newspapers often advertise camps for ADD kids. Also, some camp specialists are around who can help. School counselors too. I would also look in the yellow pages under "camps" and see if any work with ADD (Attention Deficit Disorder) or learning disabled or special needs kids. Also, special education districts or programs may know as well.

David: Also Sunshine, how about contacting your local school district for some suggestions.

Noele: So, would you say that it is more important to focus on the more serious issues and let some of the small stuff slide? To work on a piece of the problem at a time, rather than to tackle this head-on? And if so, how do we get schools and teachers to see this?

Dr. Benninger: I would say yes to that Noele as well. Getting teachers to see this is sometimes difficult. First you must try to maintain a good relationship with the teacher despite differences that come up.

Dr. Graham: Certainly, you want to pick your battles with your child. You have to make an assessment if the power struggle is worth it. Remember that you do not have control over your child's actions. You only have control over your own actions. Make sure that any response you make is something you feel comfortable doing.

Gailstorm: My 15 year old son has frequent explosive, angry tantrums that can last for an hour or so. Then he settles down to a slow burn. What do you suggest outside of medication and therapy that I can do to help curb this type of behavior?

Dr. Benninger: In general, angry tantrums are not necessarily only ADHD (Attention Deficit Hyperactivity Disorder), especially as you describe. I would be sure your psychologist knows these details and completes a thorough evaluation.

Dr. Graham: When your child experiences a meltdown as you describe, rational thought is gone and trying to reason with him at that time is useless. Let your child know that you will wait until he is calm before you will talk to him and that you will walk away when he is in a meltdown. Tell him this at a calm moment, not when he is in a meltdown.

A good resource, Gailstorm is a book by Ross Greene, The Explosive Child.

Dr. Benninger: Excellent recommendation Alan.

David: I'm sure, Dr. Graham, that for parents dealing with explosive children, it must be emotionally and physically exhausting? How can a parent live with that day in and day out?

Dr. Graham: Again, pick your battles. Also, give yourself a break. I always tell parents that you could be "parents of the year" and still feel frustrated and angry much of the time, even if you are doing everything right.

Go to ADD support groups, stay in touch with other parents of ADHD teens. Go out with your spouse. Keep yourself replenished.

Dr. Benninger: It is important for the parent to take care of themselves to avoid becoming depressed. Try to get a regular night out by trading services with other parents of ADHD teens.

LisaHe: I have learned that ADD (Attention Deficit Disorder) can precipitate ODD, Oppositional Defiance Disorder in teens. What is your view on that?

Dr. Benninger: Oppositional Defiance Disorder (ODD) occurs in about 30% of ADHD teens, but it's a logical problem. You'd be frustrated too if you struggled like an ADHD child does. This may be due to the constant negative feedback they get throughout their life that they are "lazy", "underachieving", that they could "do it if they try". So they see themselves as losers and celebrate their "outcastness".

Dr. Graham: By being oppositional.

Dr. Benninger: How to handle this? Structure, rewards, consequences, consistency, persistence.

David: Another issue I want to touch on here, because like every teenager, an ADD teen wants to drive when he/she comes of age. But as we all know, impulsivity isn't one of the best traits for good driving skills. What should parents be aware of here and what are your suggestions for handling the issues that come up?

Dr. Benninger: Small steps, a lot of practice with an adult, a limited driving range, incentives for responsible behavior are all important. It could be that they will have to wait an extra year or so before they can drive independently.

Dr. Graham: First of all, ADHD is a developmental disorder of impaired behavioral inhibition. These kids are up to 30% delayed in their ability to control their impulses. Your 16-year-old who wants his/her license may have the control of an 11-year-old. In our last newsletter, we listed some guidelines for letting add kids drive.

Don't let them drive until you feel comfortable as a passenger in the car. Use the car as an incentive for responsible behavior.

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teresat: Are most ADHD teens immature for their ages?

Dr. Benninger: Yes they are, teresat. You can see it in behaviors, interests, socialization.

Dr. Graham: Yes, Teresat, but it is in the area of behavioral inhibition. They may be more mature in other areas.

David: On the average, emotionally speaking, how many years behind is an ADD child from a child without Attention Deficit Disorder?

Dr. Benninger: 30% so, get out your calculators!

David: So that's important to keep in mind when you are dealing with your ADD teen. He/she will be 3 or more years emotionally behind their age.

And here's an audience comment regarding letting your teen drive:

Sunshine777: Because we feel that driving or having your license is a privilege our son doesn't have his yet, but he sure manages to find the car keys and take the car out for a joy ride. Thank goodness there have been no accidents, but he couldn't understand why we were so upset to find out. "But Mom I'm a good driver, don't you trust me?" Then he goes into his negative feelings about himself. But someone suggested allowing them to take the lessons because of the liability issues.

Dr. Benninger: Sunshine - it's not that you don't trust him (that's a manipulation), you need to be sure he's safe and that he can follow the rules! I don't have any problems with lessons - that's supervised practice.

joan3: Nothing seems to work on my son in regards to him taking responsibility for things he does and it is "never his fault". What can I do to reach him?

Dr. Graham: Joan, whether you son takes responsibility for his actions or not, you remain consistent in your administration of appropriate consequences. Repetition is key. Eventually, hopefully, he'll get it. Many ADHD kids were very problematic as teens but grew up to be productive, happy adults.

Dr. Benninger: Alan is right - be consistent - try not to get worn down -continue to see the positive too.

David: Here are a few audience responses on successful parenting of teens:

antmont: I found that my son who takes taekwondo has learned to be more responsible for his actions. He has become a leader among his friends. I and my son worked on getting a car to work and he earned his money to pay for his insurance and car repairs, and then I let him get his driving license. He is a good and responsible driver.

Dr. Graham: I love to hear success stories. ADD kids are creative, bright, exciting and fun.

Dr. Benninger: I have found tae kwon do to be excellent for ADHD teens especially with a good instructor, even if I can't spell it!

Nadine: My son is 5 and his teacher thinks he has Attention Deficit Disorder. I was told a year ago that he was bright, gifted. Now he fidgets in class, interrupts, daydreams, he is totally unfocused, shifts from one uncompleted task to another, appears not to be listening to what is being said, has difficulty playing quietly. However, he is not hyperactive. What is your opinion?

Dr. Benninger: He could be ADHD, the inattentive type.

Dr. Graham: Yes Nadine, it may be that your son has ADHD primarily inattentive type. It may be worthwhile to get an evaluation to help determine if what you are seeing is ADD or something else.

Dr. Benninger: but you need to find a psychologist that specializes in ADHD for a evaluation. If medication is in the picture, this could be affecting things as well.

sms: A 15-year-old 9th grader wants to stay up late on school nights (11, 12, 1am+), and doesn't get up in the morning without big conflict. Then he gets to school just in time or late. Organization is an issue anyway, and it is being stressed further by this pattern. "Experts" suggest that we allow him the freedom of running more of his own life in this regard, and letting external sanctions shape his behavior (like feeling tired, and school detention for being late). We tested for 5 weeks, while this makes Mom nuts.

Dr. Graham: Dear sms, by letting your child have freedom that he is not capable of managing, you are setting up a disaster. True, only he controls his actions, but you can set up a series of incentives that can reward earlier bedtimes and more cooperative mornings.

Dr. Benninger: Natural consequences are not always the best if they create long term problems of their own.

teresat: What type of rewards would you suggest?

Dr. Benninger: Ask your teenager - they can help you set up a menu. And since ADHD teens shift their desires it will have to be flexible and fluid.

Dr. Graham: Rewards? $$$$, use of the car, anything that you truly have control over and your child wants.

David: I want to ask about that. Is money really an appropriate incentive for good behavior?

Dr. Benninger: Absolutely - if it is motivating.

Dr. Graham: I think so. Some people fear we are bribing our kids. But we work for pay. We get paid for what we do. Why not use it for kids if it is motivating.

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David: Here's an audience comment on that subject:

sms: Our fear is that he will never develop his own healthy self-control if we manage his life for him. For these issues, rewards didn't help for long (2 or 3 days).

Noele: If it works don't fix it with money, bribes are bribes, but not with the ADHD child.

Dr. Benninger: Bribing is incentives for illegal - undesirable behavior.

Dr. Graham: An ADHD child is externally motivated. If you wait for your child to develop internal motivation, you may be asking something that they are not capable of.

Dr. Benninger: Alan is exactly right. The nature of ADHD limits the amount of self-control that will be developed. You have to strike a balance.

Sunshine777: Dr. Benninger, I have a 16, soon to be 17 yr old who is having a very rough year in high school. Now he says he can't take the stress of being on campus and doesn't want to go to school anymore and doesn't care about not finishing school or graduating. Right now we just want him to finish the year with the credits and there are no incentives that he sees that are worth him going back to school. In fact, I have an IEP (Individualized Education Plan) meeting tomorrow to see if we will be allowed to do homeschooling. He is ADHD/ODDOCD.

Dr. Benninger: It really sounds like you have your hands full Sunshine - he may feel differently after a summer break and some adjustments in his schedule. But what about next year?

But this is a difficult problem for many parents with this complicated set of diagnoses. Homeschooling is okay but he misses the important socialization.

Dr. Graham: On the other hand, homeschooling may get him through the year as there are only a few weeks or days left.

David: Meanwhile, what would you suggest for Sunshine since she has an IEP meeting in the morning? What should she say at the meeting or ask for?

Dr. Benninger: At the IEP meeting - ask the school what they see as most enjoyable/motivating for him. Come up with as many positive programs/ideas as you can - a shortened school day may also be an option.

Dr. Graham: Ask for homeschooling for the remainder of the year and explore a smaller teacher-student ratio and less stressful atmosphere for next year.

David: Here are a couple of audience suggestions too, Sunshine:

antmont: Sunshine777, IEP may not be addressing all needs. Look for new evaluations and then seek out programs outside of school program. Another school may work. You have a right to look for other placements and the school district pays.

LisaHe: My son goes to a technical school and he is doing very well, I don't think college is for all children, it can just lower their self esteem and create chaos as to their goals in life.

Dr. Benninger: Good suggestions.

Noele: I think that she should ask the IEP team to ask for a summer evaluation to see if maybe they miss something in the diagnoses, as well as set up a proper set of so-called rules, realistic to her child's needs for the upcoming year. Ask that it be reviewed as early as 2 months into the school year and so on, or maybe extended school year. Just my thoughts.

jujubon: Could perhaps a mentorship in an area of his interests motivate him?

Noele: Dr. Graham, have you found that a lot of teens find that they have been treated for ADHD or ODD and then discover that they, in fact, had bipolar in addition, or instead of?

Dr. Graham: Noele, that occasionally occurs. Bipolar disorder is an inability to self regulate emotions which leads to a gyrating emotional roller coaster. It is very difficult to diagnose in children and teens.

Dr. Benninger: This is an emerging area, and one worth careful evaluation with someone who knows how to diagnose both disorders.

David: For the audience, here are the links to the HealthyPlace.com ADD-ADHD Community, and Bipolar Community. You can click on these links and sign up for the mailing lists at the top of the pages so you can keep up with events like this.

One of the sites in the ADD Community, for those of you concerned about school issues, is "The Parent Advocate". Judy Bonnell is the site master, who has a lot of experience in dealing with school-related issues, and she shares a lot of her knowledge on her site.

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LisaHe: Why has no one mentioned their self-esteem? When a child is proud of what he can do, and not focus on what he can't do, can make all the difference, can't it? And shouldn't you use those strengths that they have to build up their self-esteem, and concentrate on them?

teresat: LisaHe, exactly what I was thinking.

Dr. Graham: LisaHe, you are exactly right. We want to catch our kids being good. Work at finding the good and build on them.

Dr. Benninger: Self-esteem is very critical in the big picture - on our web site under newsletters - there is an old newsletter with the content called "The Game" read it, it can help.

David: Here are a few audience comments:

Noele:The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder, by Dimitri and Janice Papolos is a fascinating book!

jujubon: That is how community-based mentorships can help children with ADD and low self-esteem. They can even get credit for it.

LisaHe: Mood stabilizers have helped my child a great deal.

Gailstorm: I also have a son who is failing out of school but is very smart. He's being evaluated next week again.

LisaHe: I think waiting an extra year to drive sounds more like a punishment, why not be prepared for this a year ahead of time.

Dr. Benninger: LisaHe, sometimes you can't rush the maturation process - or the ADHD problem symptoms. Remember the 30% age rule? Disappointing to ADHD teens, yes, but safety is very important.

teresat: Can you explain more on the difference between attention deficit disorder and a learning disability? What is the specific difference?

Dr. Graham: Teresa, a learning disability is a discrepancy between a child's intellectual capability and achievement. This is caused by significant variability in processing either auditory or visual information. ADD is an impairment of behavioral inhibition. These kids may score high on achievement tests because they are learning but they fail in school because they are not producing.

David: Here again is Drs. Benninger and Graham's website address: www.ADDvisor.com.

Dr. Benninger: You can see our pictures - we are both very handsome.

Dr. Graham: Oh Bill, you are so modest.

Dr. Benninger: And for what it's worth, we are both parents of teenagers.

David: Also, for those of you interested in Bipolar in children, we had an excellent conference with Trudy Carlson.

Here's verification from one of our audience members:

Gailstorm: Went to the website, yep they're right: 2 very handsome gents ;-)

Dr. Graham: Aw shucks, Gail.

Noele: I want to thank you both, Dr. Benninger and Dr. Graham for all of your wisdom. I'm a parent with 3 kids. As mentioned above, want to beg the medical community to see if there is more children with Bipolar than meets the eye. I have two of the 3 with ADHD and Bipolar, and one just Attention Deficit Hyperactivity Disorder. It's imperative that we diagnose these kids earlier for their sake and ours, as parents. These kids often have both disorders. Please help me in my mission of knowledge on this!

Dr. Benninger: I agree Noele - but it's an emerging field with still lots to learn.

David: It's getting late. We'll call it a night. I appreciate our guests coming tonight and sharing their expertise with us. And for those of you in the audience, thank you for participating. I hope you found it helpful.

Dr. Benninger: Thanks for having us!!!!

Dr. Graham: Goodnight.

David: Good night everyone.

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Brandi Valentine is our guest. When it comes to ADHD (Attention Deficit Hyperactivity Disorder), Brandi Valentine, sitemaster of ADHD News, went through the school of hard knocks. She shares her home and school experiences of raising 2 ADHD children, so you don't have to learn everything the hard way.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Children with Attention Deficit Disorder". Our guest is Brandi Valentine of ADHD News and mother of 2 ADHD children.

Good evening Brandi. Welcome to HealthyPlace.com and thank you for being our guest tonight. You have one boy and one girl. How old are they now? And can you tell us a little about them in relation to them having Attention Deficit Hyperactivity Disorder?

Brandi Valentine: Hi everyone! I have one girl, now 15 who has ADD inattentive type, and one boy, age 12 who has ADHD

David: How would you characterize the level of severity of their ADHD symptoms?

Brandi Valentine: My daughter does not suffer from any problems with hyperactivity, but has lots of problems with focus and attention, organization, etc. Her ADD symptoms are rather mild in one respect, yet cause a lot of problems for her, on a day-to-day basis. This problem has caused a lot of issues with class work, projects due, etc., and it is causing some problems already in the high school setting.

My son, has severe ADHD and until this year, he's been in special education classes in a self-contained classroom. His behavior is okay 99 % of the time, but his issues lie with learning disabilities that interfere with his ability to process information and function as other children.

David: And are you married or are you a single parent?

Brandi Valentine: I have been a single parent until just recently. I married in May of this year. I am married to a great guy with ADHD.

David: Do you live in a large town, with a large school district? Or is it a medium or small-sized community?

Brandi Valentine: I lived in a large city with a large school district up until June of 98. I have now moved into a small foothill community with a much smaller school population for elementary and middle school children.

David: As I said earlier, we invited Brandi to be our guest because she has experienced it all and we thought it might be helpful for her to share her positive and not-so-positive experiences with others, so that you wouldn't have to learn everything the hard way.

So the first thing I'd like to address are school issues. Briefly, in general, how have school officials responded to your concerns regarding your children?

Brandi Valentine: In the beginning, they didn't respond well at all. Every problem my son was having was "my fault" and my responsibility to fix. Since I became educated on my rights and the school's responsibilities, I have very few problems with the schools in getting services for my children.

David: I'm assuming when your children were in elementary school, there wasn't much information out there about ADD-ADHD. How did you respond when the school administration came to you and said everything was your problem, your fault?

Brandi Valentine: You are correct, there was very little information on ADD/ADHD when James was diagnosed in 1993.

When they first told me my child was "psychotic", I was overwhelmed with guilt and, of course, in an effort to do everything I could for my child, I listened to everything the professionals had to say. I had no idea, at the time, that the "professionals" didn't have a clue. I feel very badly about some of the things I was a part of during my son's kindergarten year. I feel that they caused me to help contribute to the problem by not being informed professionals about ADD/ADHD.

I trusted them, went along with their demands and contributed to the problems. Foolishly, I felt that these people, who were trained in the handling of children and issues related to education, were giving me the best advice available.

At the time, James had not been diagnosed. They said James was psychotic. Having had an abusive relationship with his father, there was lot of guilt on my part as I felt I had caused these problems. So again, in an effort to do everything I could for my child, I listened to these people, took their "wisdom" and training to heart and went along with their ideas.

In looking back, I believe that a lot of the problems stemmed from their assumption that my son's problems were due to poor parenting. And the fact they didn't want to deal with his issues and needs and, instead, placed the problem at my feet to deal with.

David: So what would you recommend to parents who find themselves in a similar situation today?

Brandi Valentine: If I had the opportunity to do it over again, my advice would be this:

1. Find out WHY your child is having these problems. Do this by asking the school to do the testing that is available at their end and also have your pediatrician do whatever testing he/she recommends.

2. KNOW YOUR RIGHTS! AND THE SCHOOL'S RESPONSIBILITIES! I believe that school professionals rely on their "authority" as professionals to get parents to do as they ask without question. I have learned to question everything until I am satisfied that the professional talking to me is knowledgeable and working in the best interest of my child.

3. Be involved! I am in contact with my children's teachers on a regular basis. I don't usually wait for them to come to me with a problem. I stay in touch and make sure that they understand that I am available if there are any problems or concerns.

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David: When you say "know your rights and the school's responsibilities," where does one find that kind of information?

Brandi Valentine: Good question! In 7 years, I have NEVER had a school district, teacher or principal tell me what my rights were, or that I even had any. If it hadn't been for a very sad situation at my son's school, I never would have known there were rights for parents and children.

I found an excellent manual on my rights and the school's responsibilities through a legal organization that did advocacy work for disabled children. Today, you can find this information EVERYWHERE! I have a zipped copy of this manual available on my site here at healthyplace.com and you can find this information listed by state at the Wright's Special Education Law site.

David: So, to summarize this part of our discussion, the first thing you are saying is -- don't be intimidated by school officials; and secondly, if you know your rights and the school's responsibilities, you won't have to depend on what the administrators say and take that as gospel.

Brandi Valentine: Exactly! I have found that the school is much more responsive when they know that they are dealing with a parent that is knowledgeable about their rights.

David: Once you learned your rights and the school's responsibilities, was it a pushover? Did they say: "Well Brandi, we're not going to fool with you. How can we help?"

Brandi Valentine: I wish! No, but seriously, once they realized that I was aware of my rights and their responsibilities, I got a lot less of the "we'll wait and see" tactics. Instead, they were aware of the federal laws and guidelines they must abide by and they all knew that *I* was aware of the guidelines. It made it much harder for them to tell me there was nothing they could do, no services available, and took away a lot of the "delay" tactics I ran into.

David: When Pete Wright was here talking about special education law, he discussed the importance of documentation, documenting all conversations with teachers and school officials, doctors, everyone! Essentially, I came away with the impression that he was saying you really have to be your own advocate, your own lawyer in these matters. Do you find that's true?

Brandi Valentine: Very true. What is the school's incentive to be your child's advocate? They don't have any. YOU are the best advocate your child has. Documentation is very important.

David: Here's an audience question Brandi:

jill: Did the school district ever advise you that you had better put your children on medications or they wouldn't be allowed back in the building?

Brandi Valentine: Yes. In the beginning, they told me that I had to stay in school with my son in order for him to be taught. I quit my job to go to kindergarten with my son. Later, when I took my son off Ritalin for a one-year period, the principal told me that she was concerned for the safety of the other children and that I had to put him back on medication or attend school with him.

David: What did you do?

Brandi Valentine: I told the principal that there were children, without medical problems and not on medication, that were more of a threat to the other children than my son. My son has had a great deal of problems with bullies and taunting, both physical and verbal. It's pretty hard to maintain that my child is a danger to others when there are other children pounding on him who aren't on prescription medications.

I refused on both counts and the principal dropped the issue.

David: What's been your experience regarding medications and ADD-ADHD (Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder)?

Brandi Valentine: Medication has been a godsend for my son. Medication, in my opinion, is a personal choice and not one that should be forced upon a child or a parent.

I also believe that many teachers and professionals are under the impression that medication is a "magic bullet" approach to whatever problems they are having with a child. I have seen a lot of what goes on in classrooms. I have sat in classrooms that are so disruptive and disorganized that the school fired the teacher and brought in an ex-police officer to control the class.

Mix that with children who have different learning abilities, learning challenges that have been undiagnosed, and some teachers are looking for any way they can to make the job they have easier. So they look to medication as an answer rather than piling more work onto an already overloaded work schedule, that would allow them to treat children with more individuality.

David: Here's a question from the audience:

angie: Should I start keeping a record of things since my son will be starting in a couple of weeks or should I wait until kindergarten?

Brandi Valentine: Start now! Many parents do not realize that the school is responsible for helping your child from the day he/she is born.

I found out early on, while James was in preschool, that there were problems. 1 year of preschool and 2 years of kindergarten, and not once, did anyone tell me that there were solutions for the problems my son was having.

Once James entered a structured setting, such as preschool, his ADHD symptoms became more apparent. Teachers then told me there were problems, but failed to tell me that I had avenues to follow.

I would pay close attention to how my child does. Take notes, document, and ask that he/she be tested now for special education. Identify those issues as soon as you can. It will only help your child out down the road.

Joan: Even though I know my rights, I feel like every time I go in to talk to the teacher or the administration about my son, it's going to be a battle. Any suggestions?

Brandi Valentine: I take a support person with me to help keep me on track and help me remember that I need to do what is best for James and not fight with the school district. I make a list of all my issues and questions to help me out. And... I take my manual in with me to all meetings. It's one thing to know your rights, but when they KNOW you are well informed, it's hard to ignore you and/or beat around the issues when they can see with their own eyes that you have the facts in front of you.

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8360kev: Do you think diet is better then Ritalin?

David: Have you had any experience with that Brandi? Have you tried adjusting your children's diets?

Brandi Valentine: I can't say that it's better, but I do believe that it is overlooked as a possible solution or at least a benefit to the child.

I have tried several diets over the last couple of years that have made a difference. I can't begin to tell you how much certain things can interfere with your body such as glutens, wheat products etc. I believe that children, on-or-off medication, can benefit from a better diet.

On medication, many children have problems with appetite suppression. If they are not eating well, how can you expect them to be getting all the nutrition they need? I also believe that children with allergies have more problems with ADD, ADHD symptoms. If you can alleviate these through diet, I would certainly try it.

David: And definitely beware of sugar items, like sodas, snacks, ice cream, etc. That only adds to the hyperactivity.

Can you give us an example of two or three food items that you changed in your children's diet, and what was the difference that it made?

Brandi Valentine: I haven't changed any food items in their diets other than watching the amount of sugar that they eat. Not because of hyperactivity issues but because sugar can deplete the body of minerals. I do add an essential mineral and a multi-enzyme supplement to their diet. I do this because minerals are necessary for proper brain function, and enzymes are necessary in order for minerals to be effective. Enzymes also help with proper digestion and aid in the breakdown of foods.

My experiments with diet have been limited to just myself and my issues with pain and arthritis, etc.

Lesia: Just a week ago, we found that our son is possibly ADHD (Attention Deficit Hyperactivity Disorder) and the doctor has told us that he would like to put him on Ritalin 5mg twice a day. My husband and I have only heard bad things about this drug. We think that he is too young for this medication. What do we do? Please tell me that we have another road to take, other than medicating him.

Brandi Valentine: How old is your son?

Lesia: He is 3 yrs. old

Brandi Valentine: Please remember this is just my opinion and that I am not a medical professional.

My experience and opinion is this: even though my son was displaying what I now know to be ADD, ADHD symptoms at 3 years old, if I was given a diagnosis at that age, and was told to medicate him, I would ask myself these questions:

What drove me to seek a diagnosis? His behavior? Is he aggressive? Do I instinctively know that there is something wrong based on behavior and other issues? If so, even with the diagnosis, at 3 years old, I would try other methods simply because Ritalin can impact your child's life forever.

We know now that children who have been on Ritalin are not candidates for the military. If you have used Ritalin, it is much harder if not impossible to get a pilots license. Plus, the choice to medicate often comes with a large burden of guilt.

On one hand, you have professionals who are eager to see you "medicate first, ask questions later". On the other hand, you have others, who want to condemn you for placing your child on a class 2 substance simply because you can't effectively parent your child. Then, you have your own doubts as to whether or not you have done the right thing, about the long-term effects, etc.

I feel that if you try other alternatives first, and choose medication last, then, without guilt or doubt, you can say to yourself that you chose the best route for your child. 3 years is so young.

David: Also Lesia, if you are not comfortable with this doctor's opinion, I would certainly get a second and even a third opinion.

Brandi Valentine: May I ask what drove you to seek a medical diagnosis?

Lesia: We always said he was outgoing and left it at that, but he's in a school for the blind, and the school suggests that we get him checked. The school has been good, and they have been working with us very closely.

Brandi Valentine: You had the medical evaluation, have you had the academic evaluation? That would be just as important to me. They now know that many gifted and talented children are misdiagnosed as add/adhd due to the fact that going unchallenged leaves them bored and exhibiting symptoms similar to ADHD children. Also, a learning disability might be the cause too.

If this was my child, I'd be more inclined to be sure that there wasn't another way to address the problem. Perhaps an Individualized Educational Plan (IEP) would give him more individualized help. Help like that, might give him the ability to do what is being asked of him, without the aid of medication. 5mg of Ritalin is such a low dose, I would definitely try to address his issues without it as long as I could.

David: Brandi, since you introduced the subject of "parental guilt"-- earlier you said you felt very guilty when you found out your children had ADHD. Can you talk about that a bit? Your feelings and how they have changed over the years, if at all? Also, how you have coped with that guilt?

Brandi Valentine: I didn't feel guilty about the ADD ADHD diagnosis. That part was a big relief. Most of my guilt has come from the fact that, for so many years, I was told that my son's problems were a product of my inability to parent. I was told this by school professionals, medical doctors, family members, etc. The ADHD diagnosis lifted some of that guilt, by telling me that I was not responsible for what was happening to my son, but then, new guilt issues stepped in.

Many family members accuse me of making a "momma's boy" out of my son, using the ADD/ADHD as an "excuse." Knowing that your child takes a class 2 substance like Ritalin, with possible side-effects not yet known, adds some guilt, as well as what the label of special education has done to my child with regards to his future. And then too, the fact that I consented to have him committed to a psychiatric facility for 2 weeks.

I'd like to say that I handle the guilt well, but I can't. A lot of times, I am able to keep the guilt behind me, not let it affect me. But there are times, when no matter how much rationalization I do about the choices I've made, someone will say something that brings some of this guilt to the surface and I have to deal with it.

Hindsight is 20/20. I do feel that I would do some things differently, but for the most part, if I sit down and think about the choices I've made I have to say that I made each one with my son's best interest at heart. And each decision I made, at the time, was the best possible one to make.

I simply try my best not to put myself with people who do not understand or support my decisions. Unfortunately, some of these people are family members, but I do my best to either avoid the issue with them or avoid them. I can't function properly or have faith in my decisions if I let those that do not support me or understand me, undermine me with guilt.

David: And that's a great point Brandi. We, as parents, can only do what we think is best at the time. We are not experts in every field and so sometimes the choices may not be the best ones. But that comes with 20/20 hindsight.

I know it's getting late. Brandi, thank you for being our guest tonight and sharing the things you've learned and for being forthright about your feelings. We appreciate that. I also want to thank everyone in the audience for coming tonight. I hope you found it helpful. Visit Brandi Valentine's site, ADHD News, right here at HealthyPlace.com.

Brandi Valentine: Thank you for having me and thanks everyone for coming.

David: Good night everyone and thank you again for being here tonight.

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We frequently hold topical mental health chat conferences. The schedule for upcoming conferences, and transcripts from previous chats, are here.

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Thom Hartmann our guest, is an award winning best-selling author, lecturer and psychotherapist. The discussion centered around healing from the many childhood wounds caused by having ADD, like being told you're stupid and trying to fit in and be accepted by others. Mr. Hartmann addressed the impact that negative self-talk, poor self-esteem have on the ADD adult and different psychological tools that can be used to heal ADD, ADHD (Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder).

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Coping Skills for Adults with ADD, ADHD." Our guest is psychotherapist, lecturer and best-selling author, Thom Hartmann. You may recognize some of his book titles: Thom Hartmann's Complete Guide To ADD, ADD: A Different Perception, and Healing ADD.

Good evening, Thom and welcome to HealthyPlace.com. We appreciate you being our guest tonight. How did you get into writing about Attention Deficit Disorder?

Thom Hartmann: Thanks, David. I got into writing about this through the confluence of two situations. The first was that 22 years ago, for 5 years, I was the executive director of a residential treatment facility for severely abused children, and virtually all of them came in with labels like "minimal brain damage" and "hyperactive syndrome," which is how ADD and ADHD (Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder) were labeled back then. So I got curious and got into the research and Ben Feingold's book Why Your Child Is Hyperactive had just come out and Ted Kennedy was holding hearings on it all in Washington, D.C. I got to know Feingold and we did a clinical trial of his diet at our program, and so I wrote that up and in 1980 it was published in The Journal of Orthomolecular Psychiatry, one of the earlier references to this all.

But then it got "really real" for me about 10 years ago when our middle child was 12 and "hit the wall" in school. So we took Justin to be tested for learning disabilities and the fellow told him and us that he had a "brain disease" called ADD. So that's when I really dug into it, and out of that experience, I wrote a book to/for Justin, which became Attention Deficit Disorder: A Different Perception, in which I was trying to give him back some small part of his self-esteem, which that doc had totally ripped away from him.

David: We do many conferences here at HealthyPlace.com and the guests usually talk about the importance of medications and therapy. One of the things that struck me in your book, Healing ADD, was this sentence: "The challenge for most ADHD people isn't changing a person from one brain type to another (an impossibility), but, rather, to heal from the many, many woundings that ADHD people experience growing up." What kind of woundings are you referring to?

Thom Hartmann: The woundings of: not fitting in, of being told you're stupid when you know you're not, of not being able to perform things that others do easily. For children, the prime imperative in school is to "fit in" and "be accepted." So it's incredibly wounding for a child when they can't perform, and then, to make it even worse, we slap a label on them that has words in it like "disordered" and "deficient." Tell me, how many children do you know who would ever want to be deficient or disordered? My guess is none. Those are the primary woundings. Then kids try to recover or react to that by blustering their way through things, becoming the class clown or just intellectually dropping out, and then they're called "oppositional" and end up with other labels, and sometimes they commit suicide (the teen suicide rate has tripled in the past 30 years in the USA) and sometimes they seek out friends who will give them back some self-esteem but those are the "bad kids" and this whole spiral sets in that can be so destructive.

David: But, as adults, there are many who are "glad" to find out that there is a label that they can associate with their "difficulties." We get emails all the time from people who say they've been "walking about all these years wondering what was wrong."

Thom Hartmann: Yes - I had a similar response. But as an adult, I'm able to process things differently than children do. Adults know by the time they get at least into their 20s with Attention Deficit Disorder that they're "different" somehow, and many have concluded that their "difference" is that they're bad or morally deficient or cursed or something even worse. And for many, it's a sort of secret. So finding out that there's some rational explanation for it all makes up, in many ways, for the "disordered" and "deficient" label.

Also, adults live in a different world day-to-day from children. Imagine how different you may feel about the "relief of getting the diagnosis and knowing it's ADD, ADHD" if that meant that a couple of times a day your employer would call a meeting and in front of everybody bring you up to the front of the conference room to give you your medication. That's the experience of children. Adults can keep it private.

David: So, as adults, what you are saying is it's important to consider your childhood wounds caused by having ADD, so you can deal effectively with your adult life.

Thom Hartmann: Yes. Every ADD adult I've met carries wounds and pains and misunderstandings from their childhood, and often there's a LOT of negative self-talk around these, and so as adults one of the important things to do about that is to heal it, head on. That's what my book "Healing ADD" is all about. Of course, you can't "heal" ADD - the original title was "Healing from the Pain of Growing Up a Hunter in a Farmer's World," but the publisher said that was too long so I had to write a foreword telling the readers that I wasn't suggesting people could or even needed to be healed from ADD. Good grief. What are some of the other self-destructive patterns resulting from ADD and maybe you could briefly describe what an individual should consider in working towards "healing" them?

The single biggest issue that I almost always see in adults (and teenagers) is poor self-esteem. They had a rough time for years and years, and then to top it off somebody came along and tried to tell them that they have a deficient brain. There are all the social mistakes they've made, the academic problems, and very often, because they come from ADD/ADHD parents, problematic family situations. So the first step is to give them back their self-esteem.

This is done through a process called "reframing," which means seeing something in a new way, bringing a new understanding to it, and finding in it something positive and useful. In this instance, that's the "hunter in a farmer's world" metaphor, which I find personally very healing. There's not anything "wrong" with you, you are just wired differently than what we today choose to call "normal," but at another time and in other circumstances you would be "normal" or even "above normal." And anybody who's ever done a "hunter" job like sales or air traffic control or being in the Army's special forces or being an entrepreneur knows *exactly* what I mean.

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David: Let's get to a few audience questions, Thom, then we'll continue with our conversation.

drcale: From my childhood, I got to feel that I could not trust anything. So often, I got hit upside the head by unexpected censure, so now my Pavlovian response is to assume I probably have it wrong when I have been very enthusiastic, etc. How do you deal with that?

Thom Hartmann: There are several strategies you can use that are called "pattern interrupts" that will change that type of automatic response. You'll find them in my book "Healing ADD." (I don't mean this as a sales pitch - it's just that it would take way too long to try to teach them in a chat.)

There also is a concept of timeline repair that you may find useful. This involves first off figuring out where you keep your past and future. If I ask you right now what you'll be doing next week, notice where your eyes go to find the answer. Most likely it'll be somewhere out in front of you, probably up and to your right. And if I ask what you did last month, check out where you store those pictures/stories/experiences, too. They *should* be behind you and off to one side, down a bit. If they're out front, you may have the experience of being "haunted by your past." In our culture, we have an old expression that goes, "Put that behind you." The reason for this expression is that, literally, behind us is the best place for past memories. So there's a process that involves taking the past junk and moving it behind you, one by one. And if there are particularly painful or hot memories that you'd like to "defuse," you can also turn them from color into black and white, change their size, take out the sound or replace it with circus music, etc., etc. Lotsa things you can do to repair and recalibrate and thus re-experience and heal your past.

David: Here's drcale's comment, then the next question:

drcale: They are in front of me, up and left, and I feel like I relive them over and over.

Thom Hartmann: Drcale, try the timeline work tonight. You'll probably find it very useful. You *can* put the past behind you!

Forgetful me! How do I get my husband to accept the fact that my daughter and I both are ADD and although she is going through testing new week, I know from all the research that I have done, she is ADD. How do I get him to be okay with the time and efforts I put into educating myself so that I ,we, can manage our Attention Deficit Disorder? He is just the opposite, he is OCD (Obsessive-Compulsive Disorder).

Thom Hartmann: I'd suggest (and, not knowing him or you, this is a long shot) that the first step may be to make the concept of you and your daughter having ADD something that he can easily understand and that has some appeal or interest to him. If you frame it or position it or try to get him to see it as a disease, you may get the very common reaction of denial or avoidance or even embarrassment. But if you can put it in a comprehensible and less pathological model (I frankly prefer the hunter/farmer model ), he may find it palatable. Also, if he's OCD, notice the language he uses to refute or refuse your self-observation and figure out some way to agree with *those words* while, at the same time, making your point in a different way. Hope that helps. You may want to give him a real easy to read book on the topic as well. My first book, ADD: A Different Perception, is quite accessible and pretty short, and it reframes ADD in a pretty acceptable fashion (IMHO).

David: You have written many books on ADD, spoken to many people who have ADD, ADHD. Do you think that many of the ADD issues can be resolved through self-help, or is outside help (a therapist) necessary or more helpful?

Thom Hartmann: It depends entirely upon the person and upon the therapist. There are some (probably many) people who are sufficiently self-aware that they can do most of the repair work on themselves. On the other hand, having a competent professional to help really can ease the path. The big problem is that there are also, as in any profession from plumbers to surgeons, some folks out there who are simply incompetent or who don't understand ADD. They can end up doing more damage than good: I have seen a startling number of adults and children who've been more wounded by their therapy than by their lives. So look for professional help but also remember that you're a consumer of mental health care services and you can audition or choose the person to work with you just like you'd choose your hairdresser or dentist. If somebody hurts you, find somebody else. Shop around. And when you find somebody who can produce rapid, successful change in you, the way you want it, stick with him or her.

cellogirl: This is my first time in a chat room ever. I have never experienced all the trauma of ADD that Thom is talking about. I have been very successful in all areas of my life. I guess I had just enough OCD to keep me in line, doing what I was supposed to. After a few years on Prozac, my obsessions have eased up and now at 50. I find myself becoming more ADD and finding it hard to do what I'm supposed to do. I know I need to grade papers, but I don't want to. I know I should make lesson plans, but cellogirl isn't doing them. Any suggestions?

Thom Hartmann: Interesting. A few years ago, a friend of mine, a psychiatrist in Atlanta, made the offhand comment to me that, for a person with ADHD, a little bit of OCD is probably a good thing. This sounds to me more like a matter of finding the balance between the two, and that maybe our person here has tipped a little too far away from the "seat of control" that OCD-like things can bring. Of course, this is just a wild guess, as I don't know this person and am not her doc.

kimdyqzn: I have a son with ADHD (possibly both boys have it) and I was recently diagnosed with ADHD as well. I see a lot of educational products for helping children learn to "retrain" their brain and learn to pay more attention. Do you know of any computer software products like these for ADDults?

Thom Hartmann: Not personally, but I know they're out there.

My take on biofeedback and the related techniques is that they're just high-tech ways of teaching us to bring our attention back to something, over and over. The "old" biofeedback device was the rosary, for example. So it's nothing new, but the technology is new, and seems to work quite well for some people, and because it uses computers the feedback is so much faster than the old techniques that people learn to attend to things faster. So I'd suggest you explore that site and maybe www.eegspectrum.com site, which is probably the best on biofeedback, and make up your own mind.

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*Phatty*: I was known as ADHD when I was younger. Now at 17, I have mellowed out, but noticed I have lots of anxiety and I constantly shake my legs and can't stop with out really trying. Could this because I am ADHD or from the medicine (Effexor)?

Thom Hartmann: Common causes of anxiety reactions include caffeine drinks, stressful life changes (going to high school?) the family changes associated with growing up, and, of course, all medications have some side-effects.

David: Phatty, you may all want to check out the medications area of our website for the side-effects of Effexor and certainly, I'd let your doctor know what's going on.

suzeyque: I was diagnosed with ADHD this year at 40. I tried college, but quit after 4 months. I honestly can't handle "sitting" and paying attention all day! I've tried three different kinds of medication (ritalin, Wellbutrin, ionamine) but still couldn't pay attention! So again, I feel like a failure. Any suggestions for getting through college if I ever attempt it again? (my marks were great, had instructor who humiliated me and I gave up)

Thom Hartmann: Yes. Find a different college. I've seen an incredible number of "failure" kids do brilliantly when they get into different environments. There are very community-oriented colleges like Warren-Wilson in Asheville, NC, and there are online programs from most all the colleges and universities, and there are community colleges, and even same-gender colleges. The key seems to be either a high-stimulation, novelty-rich environment or small classrooms, or both. Shop around. Interview your prospective professors the term before you're considering attending and only take classes from those who are not boring. Get to know them in advance and build a relationship so you feel committed to the class. Sit in the front of the room where you're not easily distracted by the other students. Decide to have fun while learning, and for the terrible, boring, required classes, find the times or a community college where you can take them in smaller classes or from interesting profs. There's a bunch of this sort of stuff in ADD Success Stories, by the way.

David: One of the things that strikes me, and it's really not surprising, but it seems many adults with ADD also suffer from depression.

Thom Hartmann: Yes, and it's often a healthy response. When things aren't going well, it's entirely appropriate for us to have a negative reaction to things. We call this, in one of its may forms, depression. If a person hit a wall in life and *didn't* get depressed or upset, then that would be a real problem. The damage happens when people think that the depression itself is the "problem" and take antidepressives but stay in "not working" life situations. Of course, there are some people who have an actual disorder of depression, and for them the antidepressant drugs are life-savers (literally), so it's very, very important to see somebody who's competent and capable of sorting out: "Is this circumstance-caused depression that should be treated by changing their life's circumstances, or is this a biochemical problem that needs meds and nutritional changes?" It can be a tough call, because when we have circumstance-caused depression there *is* a change in neurology that happens...albeit temporary. So it takes somebody who knows what they're doing, and who understands how frustrating ADD can be, to differentiate between the two and make appropriate recommendations.

luckyfr: I have been diagnosed with ADD and depression instead of hyperactivity. Is this common?

Thom Hartmann:Yes. When I see this in people, it's most often people who've been very "beaten down" by life's experiences. I wrote about this at some length in "Healing ADD." People who primarily experience the world and life through their feelings (as opposed to those who are primarily visual or auditory) seem to have this sort of problem more frequently, too. My advice to such folks is to find somebody who's competent with one of the solution-based therapies, such as NLP, Core Transformation, or EMDR, and give that a try. And also to carefully examine their life's circumstances and situations for opportunities for change that may be interesting and exciting.

monoamine: You mentioned children diagnosed ADD or ADHD often coming from broken homes in your earlier practice or studies. Given the co-morbidities of ADD/ADHD, viz., Alcohol Abuse/Personality Disorders (among others), isn't it possible that a physiological effect is communicated through the progeny? In other words, isn't it possible that domestic trouble is merely another manifest of a valid physiological condition?

Thom Hartmann: Yes, I think it is. There's both nature and nurture, and reactive, impulsive children usually have reactive, impulsive parents (for example), or at least one parent like that, and so the kids get both the genes and bear the brunt of the behaviors, which they also learn, and then inflict on their own kids. That's why it's so important to intervene and break that spiral.

David: If I remember correctly, you also wrote a book called something like "ADD Success Stories," where people with ADD shared their strategies for coping with it. Am I right about that?

Thom Hartmann: Yes, ADD Success Stories is a book that I wrote because of all the mail I got after the publication of ADD: A Different Perception. Lots of people shared with me the strategies and techniques they'd used to be successful in home, work, and school situations, either in spite of their ADD or even using it as a tool, and so I took about 100 of the best of those stories, plus a bunch of my own, and compiled that into the book ADD Success Stories.

David: Could you share with us two or three of those strategies that proved successful?

Thom Hartmann: Well, the school answers I gave earlier are all in that book. The idea of figuring out what sort of neurology/person you are and then determining the best career for you based on that. Finding a partner who compliments you but isn't identical to you. (Hunters often do well when they marry farmers, for example, although that's by no means a hard and fast rule.) Learning how to learn. Geez - it's been about 6 years since I wrote the book and I haven't read it since then, so I'd have to go grab one and read the table of contents.

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blacksheep: I'm 35 years old. I have lived with Attention Deficit Disorer all of my life and one thing that I have found is that sometimes I can't understand why things happen to me.

Thom Hartmann: If that was the entire question, I can empathize. I'm still trying to figure out why some things happen to me. Seriously, though, this one of those things where I've found that spiritual practice, the idea of living one day at a time, of surrendering my will to Gods or the universe or higher power or whatever you call it, and learning to go with the flow, is the best coping mechanism. Keep repeating, "Everything works out in the end." And find that place in yourself where you know that's true.

cluelessnMN:Hyperfocusing. Good Thing? Too much of a Good Thing?

Thom Hartmann: Yes! Yes!!! The trick is learning to notice when you've switched it on and then deciding if it's useful in that circumstance, and then choosing to hang out in that mode or turn it off. That's a process of learning self-awareness that's very useful and that most people, surprisingly, have never really explored. Start noticing how you notice things, noticing your reactions and responses to things, and noticing the internal switches and levers that switch you on and off. From there to taking control of it all is actually a surprisingly short path.

twinmom: For those of us parents who are ADD and have trouble with follow thru and have ADHD kids, what one thing would you suggest that we focus on to improve quality of life for our kids?

Thom Hartmann: Forgiveness. It's so easy to think that we all have to have Beaver Cleaver lives and homes and all, and it's important to learn how to just be who you are and how you are and allow the same for your kids. Of course, we're always trying to improve things, but when it becomes a grind or painful, then the work is often more destructive than the results are beneficial.

David: Actually, Thom, what I've found in life that we all think our neighbors are living perfect lives, until one day it comes spilling out on the front lawn, and we find out they are no different than us. :) Here's the next question.

Thom Hartmann: Yep!

addcash: Hi. I'm 42 with an ADD son who is 3 1/2 and showing signs (eyes out of focus, angry outbursts, etc.) and want to start an ADD community center in Toronto, Canada. Any suggestions, Mr. Hartmann?

Thom Hartmann: I'm not sure. CHADD and other ADD groups seem to be on the decline, member-attendance-wise, and I think that's because people no longer need to go to meetings to get info, and most people don't need the level of help that, for example, alcoholics do with AA. There are so many books and all out there, magazine articles, the info is all over the place. On the other hand, if you can put together a community center or program of some sort that's truly useful for people and meets local needs (maybe not even calling it ADHD?) then you may be a real angel. But be sure you have a business plan and an exit strategy in place in advance for when it becomes boring to you.

luckyfr: I have had Attention Deficit Disorder since I was 4. I have learned to do all things in small bits! Is this a good way?

Thom Hartmann: Yes! One of my favorite pieces of advice from ADD Success Stories is: "Break big jobs into small pieces."

David: I know it's getting late. Thank you, Mr. Hartmann, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com. Thanks again, for coming Thom.

Thom Hartmann: Thank you, David, and thanks to everybody who showed up!

David: Good night, everyone. And I hope you have a good and peaceful weekend.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Dr. Joyce Nash, psychologist and author discusses adult ADD, ADHD diagnosis, along with treatment and ADDult work and relationship issues.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Adult Attention Deficit Disorder Issues." Psychologist, Joyce Nash, Ph.D. is our guest. Dr. Nash has a private practice in Menlo Park, California. She is the author of 7 self-help books, along with having a private practice. One of her specialties is treating Adults with ADD, ADHD (Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder).

We'll be starting with the Adult ADD diagnosis and treatment issues, then moving on into adult relationship and work issues. And, of course, Dr. Nash will be taking questions from the audience.

Good evening Dr. Nash. Welcome to HealthyPlace.com. Thank you for being our guest tonight. Most of the attention on ADD has been on children and adolescents. Still, many adults with ADD are being overlooked, misunderstood, undiagnosed, and untreated. Why is that? Is it difficult to diagnose ADD-ADHD in adults?

Dr. Nash: Good evening. For a long time, mental health professionals have believed that ADHD disappeared at about age 12. We now know that isn't true, although some people still doubt the diagnosis. Making the diagnosis of ADHD in adults is difficult. There are no definitive tests that say "yes, you've got it." What we do is a combination of things to decide "by the weight of the evidence" if ADHD or ADD is present.

Let me pause for a moment and say that there are now two subtypes of ADHD (Attention Deficit Hyperactivity Disorder) that are recognized. One is the primarily Inattentive type and the other is the primarily Hyperactive-Impulsive type. It is possible for a person to have either or a combination of both. The way we go about diagnosing is through a combination of:

1. a clinical interview that takes into account childhood history;

2. use of paper-and-pencil self-report measures, such as the Connors;

3. watching what the person does in the interview, i.e., observation; and

4. seeing what changes happen as the result of treatment, specifically, ADD medication treatment.

David: There are medications, private therapy, support groups available to help adults with ADD. Which do you recommend as the first line of treatment and why?

Dr. Nash: Probably the best bet is to find a psychologist who is trained to assess ADD (Attention Deficit Disorder) and start there. He or she should then be able to refer for a medication evaluation to a psychiatrist if that seems appropriate. Many people who do appear to have ADD don't want to start with medication, however. Therapy that does not use medication can focus on how to cope with ADD symptoms. Support groups are great, especially CHADD, which has chapters all over and a website. It is a good place to get initial information.

David: Because of the difficulty in obtaining an ADD, ADHD diagnosis, would you recommend that a person get a second opinion if they aren't satisfied with the first diagnosis?

Dr. Nash: Getting a second opinion is okay. A problem is that many people have read the popular literature on ADD and have memorized the ADD symptoms. They, then, rattle these off to the interviewer, who may take them on face value. It is important that whomever the person sees for diagnosis be trained and understand Attention Deficit Disorder in adults.

David: Here are some audience questions, Dr. Nash

val1: I have ADHD, so do all 4 of my children. How common is this?

Dr. Nash: It is believed that between 2 and 5% of children have ADHD, but estimates vary depending on the study and the criteria used. Often an adult "discovers" that he or she has ADD when the child has been diagnosed. ADD does tend to run in families.

David: Does ADD start in childhood and progress into adulthood? Or can it arise in adulthood without appearing in childhood?

Dr. Nash: ADD never arises in adulthood. Some symptoms of Attention Deficit Hyperactivity Disorder are always present in childhood, usually before age 7. The ADHD symptoms in childhood may be overlooked, however, and become a problem progressively. The key is to understand what is age-appropriate behavior and distinguish that from behavior that is "not normal."

David: Here's an audience comment, then more questions:

Starsdancing: I've shown ADHD symptoms all of the 40 years of my life, even before most doctors knew what it was. Only after looking at the 3 of 5 of my kids that have it, was I able to find a doctor who would consider me to have ADHD.

Stacie: Why are so many doctors hesitant to start an adult on Ritalin, even when the signs point to ADHD?

Dr. Nash: Ritalin is a stimulant drug and as such is closely monitored by the government. In addition, there are side-effects that can cause problems. Usually, the first intervention with adults with ADD is an antidepressant. This is generally a good idea because by the time an adult with ADD is "of age", they are often depressed as well. If the antidepressant doesn't help (usually an SSRI like Prozac), then the doctor may move to a stimulant.

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chilly: I have consulted a psychiatrist about the possibility of ADD, and after only 15 minutes he concluded that I "absolutely do not have it" because I made good grades in school; even though I have many other traits and ADD symptoms. How do you feel about eliminating the diagnosis based solely on this fact?

Dr. Nash: I think 15 minutes and one criterion--good grades--is not a good basis on which to decide a diagnosis. Many ADD adults compensate in various ways. Some have uniformly good grades. Some have high marks in some subjects and low marks in others--usually, the ones they aren't interested in or that are BORING.

add_orable: I had "known" for some time I had ADD because it was there in my school report. I found a specialist, took his name to my doctor and asked for the referral. He didn't believe me until my mind started to wander and my talking became rapid. I informed him that ADD in women can be very different than it appears in males.

Dr. Nash: It might be a good idea to take some handouts with you to the doctor's office before seeking diagnosis or treatment, especially if you are seeing an MD. CHADD has lots of terrific handouts that spell out in easy to understand language, the different "faces" of ADD.

David: I'd like you to address the differences between the appearance of ADD in women and men. Does ADD appear differently in women than it does in men -- symptom-wise, I mean?

Dr. Nash: Men with ADD tend to show more "active" symptoms, like aggression, anger, irritability. Women with ADD tend to be dreamers and "spacey." Of course, it can go either way.

netboy: Is it true that most ADD children can become Bipolar Adults? If so, how can you differentiate between whether an adult has Attention Deficit Disorder or Bipolar?

Dr. Nash: ADD can co-occur with a number of disorders, including depression, obsessive-compulsive disorder, anxiety disorders, etc. I haven't heard that ADD leads to, or causes, Bipolar.

Attention Deficit Disorder is believed to be a neurological problem--a difference in the way the brain functions, especially the frontal lobes or the "executive system". Bipolar results from an imbalance in the chemistry in the body and brain, usually in a deficit of lithium salts. I don't see how ADD could cause Bipolar, but I don't think they are mutually exclusive.

The symptoms of ADD and Bipolar are quite different. ADD symptoms are more or less constant and don't vary-- i.e., they are not: there sometimes, and not there other times.

Bipolar, which is also known as manic depression, involves an alteration (for most people) between a "high" state of mania or hypomania ("high but not that high") and depression.

David: Dr. Nash is a psychologist, not a psychiatrist, and as such isn't an expert in medication issues, but maybe you could answer this question:

tink2: I've been taking Adderall for two years, and I am concerned about possible addiction. My doctor says that it is no more addictive than caffeine.

Dr. Nash: Stimulant drugs can be addictive, which is why the government watches it so carefully. In addition, they cause side-effects such as insomnia. I'd talk to my doctor again or seek a second opinion.

David: Here are a few audience comments regarding adult ADD diagnosis and treatment. Then we'll address Adult ADD and relationship issues:

Starsdancing: There are still many docs who believe you outgrow ADHD.

tink2: Since I've been on Adderall, I can better help my own children to organize themselves.

Stacie: CHADD is great for the support and they have been great in helping me get through the diagnosis stage.

add_orable: I'm seeing one of the top ADD adult specialists in Australia. It has come from my father's side. My doctor believes me now and is getting quite interested!

Dr. Nash: More and more psychiatrists are willing to consider the diagnosis of ADD, now that the research evidence is accumulating.

David: On the relationships front: Living with ADD can easily feel like an emotional roller coaster, both for the adult with ADD and also for the spouse or partner of the adult with ADD. What does the partner need to understand that would help the relationship go smoother?

Dr. Nash: ADHD can wreak havoc on relationships, especially if the non-ADD partner doesn't understand what is going on. I often see couples that involve one ADD and one non-ADD person. It is so important for the non-ADD spouse to get educated about what ADD is. Otherwise, she (or he) may take the behavior as a personal affront. It is possible to teach the non-ADD person how to be supportive of the ADD spouse. It is also important for the non-ADD person to learn to understand and deal better with her frustration and anger that result from the behavior she sees but doesn't understand.

David: When you say "wreak havoc" on a relationship, what are you referring to, and what ADD symptoms cause that to occur?

Dr. Nash: The non-ADD spouse is likely to take it personally when the ADD person forgets appointments, loses things, etc. Often she will say, "Why can't he just think!" She gets angry, which in turn can make him feel criticized, misunderstood, and angry.

Sometimes, it is the ADD person with the anger problem. When he gets frustrated with himself, he can take it out at home. So the ADD person needs to learn how to cope better with his situation so that anger is less likely or more manageable.

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netboy: How can a spouse help the ADD mate structure their day?

Dr. Nash: Often, an ADD person marries a spouse who is highly organized and detail-oriented. This is terrific for the ADD person, but the non-ADD detail-oriented spouse can become frustrated. Both spouses need to learn how to work together. An ADD person usually does much better when there is a structured environment. The ADD person should learn to use some type of organizing system, but the key is that it must be SIMPLE. Some day organizers are just too overwhelming. Some ADD persons like the Palmcorders, others don't.

The non-ADD spouse can be helpful by providing reminders and playing back up. However, she must be willing to do so and understand why it is necessary, and he (the ADD person) must be willing for her to play this role.

In couple's therapy, these are some of the issues we address. In addition, she (the non-ADD person) can help out in managing his impulsivity, if that is a problem. For example, she can send him "silent signals" when he is interrupting or talking too much. My husband is ADD and we use a signal system in social situations where I gently tug on my earlobe, and that is his signal to slow down, take a breath, stop talking, start listening.

cBYcc: How can coping skills be learned for the angry, ADD male?

Dr. Nash: The first thing is to understand the emotion of anger and that it is the body's hard-wired alarm system. Once we understand that anger is inevitable, especially in the presence of frustration or fear, then we can focus on what to do with the anger. Anger is not a behavior; aggression (shouting, yelling, cursing, throwing things, etc.) is a behavior that is usually, but not always, driven by anger.

Next, we learn to understand what triggers his anger. What are the situations that are "high risk" for anger. Usually, they are being tired, hungry, in pain, overwhelmed, or otherwise distressed. The coping skills needed depend on the situation. It may be necessary to take time out, leave the arena, and "catch your breath." Go for a walk, but don't rehearse angry thoughts while you are doing so. Leaving an upsetting situation is a behavioral strategy.

Another type of coping skill involves thinking--talking oneself down, so to speak, from being angry. Trying to see or understand the situation another way.

Dobby: Any suggestions for explaining your Attention Deficit Disorder to your children?

Dr. Nash: Children are naturally full of energy, at least most of them. Use simple concrete language to explain your ADD to your children. (If they, too, are ADD, keep it really simple.) Say something like, "You know how you can get so excited sometimes that you forget things, well Daddy can get that way too." Try to help them understand that everyone is different, but that doesn't mean bad. It just means that each of us has to learn different ways to "be good."

David: Here are a couple of audience comments on Adult ADD and relationship issues, then we'll go onto ADD work issues:

cBYcc: My husband and daughter have ADD, and I feel I am constantly trying to "smooth" things for them!

add_orable: My better half says he exists to pick up after me and find my keys and glasses. He says "how do you do it? (laughing)" I say, "it is just a talent," and his life has meaning!

tink2: I've found that exercise improves my ADD symptoms.

Dr. Nash: Exercise releases endorphins and provides a calming effect. Some ADD people develop a substance abuse problem because they try to medicate away their symptoms that way. Exercise is a much better solution.

David: One of the most common problems adults with ADD experience in their jobs or careers, centers around time management -- getting things done on time. What do you suggest for dealing with that?

Dr. Nash: As to work-related issues, I believe it is really important to learn to PLAY TO YOUR STRENGTHS. I once worked with an attorney who graduated at the bottom of his class but was hired into a firm even so. Then, he was fired from that job. He was convinced that he shouldn't be an attorney because he couldn't remember trial dates, when to submit briefs, etc. But he loved constructing and arguing a case in court. I convinced him to start his own firm and hire someone to do the details--remind him of court appearances, etc. At first, he argued that he "should" be able to do these things. He did hire someone finally (part-time), and now he has his own successful law firm with several attorneys working for him. ADD people are often better being their own boss.

But even if you do work in an organization, learn to delegate, delegate, delegate. Say "no" to jobs that are too detail-oriented or repetitive. It just isn't an ADD person's strengths. An ADD person is usually creative and a "big picture" thinker. Let someone else do the details.

There is a saying I like repeating to my ADD clients: "It is easier to ride the horse in the direction it is going." Play to your strengths and don't try to be what you aren't. Build a support system around you. You may have to tinker a bit to find what works for you. Keep trying.

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David: One of the hallmarks of Attention Deficit Hyperactivity Disorder is forgetting, losing things, not being organized. What can adults do to help them remember and keep track of things?

Dr. Nash: We used to have the problem (more so than now) at our house. We developed a system that works for my ADD husband. We have an "in" drawer and "out" drawer in the chest in the foyer. Everything in his pockets goes into the in drawer each night and goes into his pockets in the morning. In the morning he also takes anything in the out drawer with him. Periodically, we coordinate calendars, and I play back up. He emails me copies of every communication that relates to both of us. (It used to be that he would agree to a social invitation and forget to tell me). Now, he just forwards emails to me or he emails me anything that comes to his mind. We have a saying here: "If it isn't written, it's not real."

These are just some of the ways that spouses can work together to deal with ADD.

David: That's a good system. Here's a good suggestion from one of our audience members:

add_orable: Turbonote.com has a wonderful little program that is like a post-it note for your computer. You can set it to alarm if you like too. It is wonderful!

David: Another work difficulty centers on "paperwork"-- trying to keep up with the details. Do you have any suggestions for handling that?

Dr. Nash: My husband also uses turbonote! Each ADD person has his or her own presentation of ADD or specific set of symptoms. Managing paperwork can be a problem. This is where Obsessive Compulsive Disorder and ADD can overlap. Some OCD people are hoarders. They can't make a decision about where to put something, or they can't bear to part with it, so they pile it. Filing is boring. ADD persons abhor boring tasks.

Here again, delegating is a good idea, or finding a simple system of managing paperwork. But if you have paperwork strewn all over the place, piled on the floor, etc., and you have trouble getting rid of paper, consider consulting a professional about the possibility of OCD complicating your ADD (God forbid).

add_orable: How do you deal with housework. None of us are really any good at it. Hubby does it every now and then. I am hopeless and never get it finished. I am sure I have lost a few friends as it is embarrassing for them to come over to an untidy house.

Dr. Nash: ADD people don't do well with boring or repetitive tasks. If you can afford it, hire someone to clean your house. Create a simple system for organizing things. As usual, the advice is to delegate and create a structure that supports you.

David: I know it's getting late. Thank you, Dr. Nash, for being our guest tonight and staying to answer everyone's questions. And thanks to everyone in the audience for coming and participating. I hope you found it helpful.

Dr. Nash: Thank you for the opportunity to be with you.

David: Good night everyone. and thank you again for being here tonight.

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We frequently hold topical mental health chat conferences. The schedule for upcoming conferences, and transcripts from previous chats, are here.

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Conference transcripts dealing with many aspects of ADHD in children and adults.

1. Adult ADHD Diagnosis - Conference Transcript
   Guest: Dr. Lenard Adler

2. Adult Attention Deficit Disorder Issues
   Guest: Dr. Joyce Nash

3. Advocating ADD/ADHD children
   Guest: Judy Bonnell

4. Alternative Thoughts About Attention Deficit Disorder
   Guest: Gabor Mate

5. Advice and Insights for Parents of Children with ADHD
   Guest: Brandi Valentine

6. Coaching, For Parents of ADD/ADHD Children
   Guest: Dr. Richfield

7. Coping Skills for Adults with ADD, ADHD
   Guest: Thom Hartmann

8. Mood Disorders in Children
   Guest: Trudy Carlson

9. Parenting Difficult Children
   Guest: Howard Glasser

10. Parents of ADHD Teens: School issues, social, and peer relationships
    Guests: Dr. Alan Graham, and Dr. Bill Benninger

11. Special Education Law
    Guests: Pete Wright and Pam Wright.