Attention Deficit Disor... what?

March 15, 2005 8:37 PM

I've got a kid 'round here recently diagnosed as very likely ADD. What now?

Let's all assume that this is, indeed, a valid disorder and correct diagnosis, so that we can usefully relate experiences and solutions without getting in a sideline discussion.

I am interested in personal experiences, both from parents and from childhood memories. I am interested in any ameliorating habits or behaviours you developed. I am a interested in any changes in diet, activity, sleep, or whatnot helped you to have an effective life.

I am not much interested in drug therapies at this time. I am not interested at all whether you feel ADD falls within the range of normal human behaviour.

Thank you, especially to all for whom this is a very personal question!

posted by five fresh fish to health & fitness (22 comments total)

Get Driven To Distraction. There's a newer, updated version (Delivered from Distraction?), but it's still in hardback and apparently has a lot of the same info.

I am just now dealing with my ADD -- I wish more than anything that I'd been taught an organizational system. I'm calmer when I feel organized, but I don't know how to do it. It's been tough.

Oh, and exercise helps, too.
posted by sugarfish at 9:06 PM on March 15, 2005

May I ask "how old" the child is?

I'm the Poster Boy for Attention Deficit Disorder and had it long before it was a recognized "disorder". You may think that I am joking, but I think the thing that made a huge difference for me was learning to play chess at an early age (5) and playing it semi-seriously from 6th grade through High School. Chess rewards patience and planning and so (if you don't like to lose) encourages the sort of thinking that A.D.D. tends to discourage. I would love to see some long term studies of teaching chess to A.D.D. kids.

I believe that A.D.D. can be a blessing - in some regards. I think it is misnamed - as A.D.D. people can hyperfocus on things that interest them (to the exclusion of all other reality). I also think that A.D.D. people more readily make links between seemingly dissimilar things. This is how I can tell if someone I'm talking to has A.D.D. in a matter of minutes. You'll be talking about something and shortly you are leaps away on another subject. The new subject is not unrelated - it is just that the link exists within the A.D.D. "jumpers" mind although that link may not have been communicated. Thanks to this, A.D.D. people can be extremely imaginative and creative.

That being said, the impulsivity that comes with A.D.D. can reach debilitating levels. I am not "anti-medication" for A.D.D. kids (though some people are militantly so). I think that the ultimate help comes from more than medicine, however. As sugarfish says, learning organizational skills is one of the challenges.
posted by spock at 9:07 PM on March 15, 2005

I guess I should have made myself clearer -- I was diagnosed as an adult, not a child. However, I do still believe being organized would have made my childhood a lot easier.
posted by sugarfish at 9:19 PM on March 15, 2005

I applaud your desire to go without the drugs, but please be open to this avenue if other strategies do not work.

You should do a little research on sensory integration disorders. They frequently look like ADD, may be one type of ADD, may always be present in ADD to some degree, who knows. While they do often respond to drugs, they also respond to particular physical therapy regimens.

Some ADD cases may respond to diet changes, but don't count on it in any particular case. It is certainly worth a try, despite the drastic restrictions necessary to find out - you essentially cut out all possible offenders and processed foods and then gradually reintroduce them.

ADD is so many things, but the lack of concentration (on things not of interest) and the impulsivity have the most negative effects on a child. Teaching the child strategies to handle these issues will be necessary drugs or no, so start right away.

Since each case is different I would just buy out the bookstore's selection of relevant books and start reading. Everybody has a unique angle on this. Get Mel Levine's books to understand the mind, but not necessarily to fine tune the solution.

If you do go with drugs, consider a long acting one like Concerta. They don't have the mid-day peaks and valleys and you don't have to involve the school nurse. There is a new drug on the market which is not a stimulant which I would avoid until its safety has been established.
posted by caddis at 9:25 PM on March 15, 2005

Definitely speak to the child's teacher/s at school. My parents had a foster child who was diagnosed at around age 14, and they spoke to his teachers at high school who worked with him to come up with strategies for studying and working in class. From what little I know, he had a lot of frustration related to going for a long time undiagnosed, so it's possible that having someone to vent to would also help.

Teachers will, most likely, have some knowledge of how to work with ADD/ADHD children so it may be worth sitting down and talking to them even to get ideas to use at home.
posted by tracicle at 9:30 PM on March 15, 2005

As the (currently live-in) uncle of three ADHD kids, and in this case I won't omit the H for hyperactivity, there's probably one piece of advice that will help more than any other: Learn to see through the behavior. Especially if this is a kid who misbehaves, as opposed to just having a hard time learning in school. Superhuman reserves of patience will, at times, be necessary, and you should think of ways to maintain yourself so that you can draw on them when it's time.

As for the drug question, I'm not going to advocate for them, except to say that I'm not sure you'll be able to hold that position in the long run. Again, with misbehavior, you may find that the school system virtually ties your hands and forces you to accept a medication regime. Once on medication, prepare for changes every 6-9 months -- dosages, timing, pills.

In addition to patience, make sure you're proactive about attention. You'll want to think in advance about purchases, too, and discourage those which would not be good for an ADHD kid, such as lots of unrestricted video games. Nature therapy is also important; join Scouts or a friends-of-the-parks or something else, anything to get outside regularly. Try to maintain an ordered household with stable expectations, e.g. dinner at 6, time together in the living room till 7, Friday is always movie night, that sort of thing -- but don't under any circumstances put the kid on the spot about rules and schedules.

Just some thoughts, here, but I'm no expert by any means. Oh, school has been mentioned. As you may know under federal law today your diagnosed child must have an Individualized Education Plan. You will want to talk with the schools to find out what kinds of resources they are prepared to bring to meet the problem -- tutoring? in-class aides? special homework regimes? -- and you may even find yourself evaluating which school inside your district is the best for your child. There are also alternative schools which may have better resources available for LD/ED kids. Get to know his teachers, too (you will anyway, probably, but it helps to take the initiative).
posted by dhartung at 9:38 PM on March 15, 2005

First and foremost: PLEASE be aware, ADD kids "play with stuff on desk". It does NOT mean they're not paying attention! I have ADD, and as a kid in the 60's, got lots of trouble for 'misbehavior' that wasn't. I pay my best attention when I fiddle and doodle. Distractions are not always distractions, ya know?

ADD is real, but the name could use improvement. I vastly prefer the "hunter vs. farmer" paradigm formulated by Thomas Hartmann. His latest book "The Edison Gene" is said to be good but I've not yet read it (Links to author's website I listen to his radio show and have read other material). Hartmann became an expert when his own son was diagnosed, and hated the term 'disorder'.

Amongst other strategies for ADD'ers, a coach can be quite helpful at the right time.

And don't discount the issue of 'hyperfocus' expressed by Spock above. It can be truly awesome! Cultivate the strengths and use strategy on the weaknesses.

Consider this: Your child has no problem. The problem is the school system. It's designed to raise conformist drones. Please, advocate for your child.
posted by Goofyy at 10:22 PM on March 15, 2005

Turn the problem on its head. See this child as perfect, and society as flawed. He may move laterally when everyone else is on rails, so be prepared to go along for the ride. Make connections that nobody else makes, and laugh at your private jokes. Remind yourself that neatness, punctuality, and organization are over-rated virtues, and an incredibly rich, happy life can be lived largely ignoring them. Remember that love, patience, compassion, and nature are vital. Tell him he’s lucky. Tell him his teacher said that insects are not animals because teachers can be wrong. Buy matching cowboy hats. Visit the Armstrong Fair, Farmers’ Market and Caravan Theatre. Eat organic food. Turn off the TV and go for a walk in Kalamoir Park. Imitate the quail. Fly kites made from stalks of grass and tissue paper on spools of thread until they are out of sight. Take pictures without a camera. Tell him he’s your hero. Feel the earth turn when all others are watching the sunset. Hang this on your wall to remind you (he doesn’t need it because he’s perfect):

Much madness is divinest sense
To a discerning eye;
Much sense the starkest madness.
’T is the majority
In this, as all, prevails.
Assent, and you are sane;
Demur—you ’re straightway dangerous,
And handled with a chain.

Part One: Life. Dickinson, Emily 1924 Complete Poems
posted by weapons-grade pandemonium at 10:25 PM on March 15, 2005 [1 favorite has favorites]

Structure. Structure structure structure. Let the kid be a kid, but make sure "there's a place for everything and everything's in it's place", both with physical things and with scheduling schoolwork time.

I learned to organize and clean up my things at a relatively early age 'cause if anything gets messy all is lost. A Palm Pilot, also help tremendously since if I don't write things down immediately I'm liable to forget it.

But I never learned impulse control nor how to discipline myself, and am now paying for it. Don't leave all their time wide-open and expect them to get things done. Set aside one or two hours every night at the same time to do schoolwork. Even if they don't have any have them read a book or something. No TV, no video games, no computer unless it's supervised typing (though this depends on their level of self-control), not even music if it becomes distracting. Don't yell at 'em for fidgeting, but just make sure there's something there that's keeping them on track every day. Also, keep in close contact with teachers so you know what's going on in the class (though you could just check up on this during the scheduled schoolwork time).

But don't try to curb their impulsivity too much. Treat the ADD like any other personality quirk. Address the need for scheduling techniques and self-discipline training like the stuff above, but recognize what might be annoying during classtime can be wonderful among a good group of friends or when brainstorming ideas. I've got an ADHD friend who's always leading adventures 'cause his brain moves a mile-a-minute. It's pretty cool.
posted by schroedinger at 1:14 AM on March 16, 2005

I would have been diagnosed with this in seconds if the diagnosis existed when I was in school.

What helped me then - finding something I was interested in. There was very little of that in school.

What helps me now - finding an impossible task and finishing it. Also, I've found that my natural sleep cycle is 22 hours awake/9 hours asleep. I fall into this pattern whenever I don't have to conform to a schedule.

Also, if it makes a difference, I appear on the surface to be completely unorganized, but I can tell you where anything of mine is. This includes things I haven't seen in some time, like old pictures in a box in a closet somewhere. This only works when my things don't get moved by someone else. I see the same quirk in my two year old son. After a vacation, he came back home and went through every toy to find out where it was. Now he can find any of them whenever he likes.
posted by bh at 2:00 AM on March 16, 2005

Well, fff, I'm going through the same thing with my 11 yo son. We had him on Strattera for a few months, but he lost a ton of weight on it, so we took him off all meds for now. I'd like to see him back on them though. We are dealing with self-esteem issues. In a perfect world, i'd love to let him be free to be himself, but this is the world we live in. My only other option would be to homeschool him, and since I feel I have ADD as well, I don't think we would ever get anything done. My son is not really a discipline problem. He presents like this,
Time to start homework, spend 20 minutes setting up desk, call friend to ask what page of math to do, lose math workbook, look for it for 20 minutes, can;t find it, call friend to borrow book, not home, call other friend to borrow book, chat for a while, go to science, get a snack before he starts that, can't find pencil, finds it, decides to go downstairs to sharpen pencil, and on and on and on.
It usually takes him 3-4 hours to get 30 minutes of homework done. So there is no time left for friends to come over, etc. I don't mind medicating him if it would help him concentrate. I equate meds with glasses.
Anyway, I certainly don't have all the answers ( I really don't have any). So fff, I would love to hear later what you have discovered.
I love my son so much and see his potential. I hate to see him begin to stay so frustrated.
posted by davenportmom at 3:36 AM on March 16, 2005

"I equate meds with glasses."

I have to disagree very strongly with that. My only experience related to ADD has been taking ADD medication. Abusing it, you could say. I never considered myself ADD, and still don't. Ritalin and Adderall are both aphetamines, and produce drastic affects on subjects, whether they are ADD or not. Despite the people who say they have very different affects on people without or without this "disorder", I can tell you conclusively Adderall and other such drugs got me through high school and most of college. Be VERY careful before encouraging your child to rely on amphetamines to get their schoolwork done. It works, but there is a price to be paid in the long run.
posted by sophist at 4:12 AM on March 16, 2005

The more I read about it, the more I think I have ADD. Nothing to add; just wanted to say thanks for this post.
posted by Eideteker at 4:32 AM on March 16, 2005

ADD kids vary wildly. Some do well with structure, some do well without. Many kids with ADD are able to demonstrate intense attention to things they are interested in (i.e., spock). It always helps to listen to what kids want, to help them to pursue things they love and believe in. With ADD kids, it can be a lifeline. Sometimes, kids with ADD find an area where they can pay attention and stay focused and this helps them to achieve better focus in other areas.

It's a tricky thing though, as some kids will want to do all kinds of things, but only feel secure in complete structure. You're going to have to figure this one out based on the kid. Basically, look for scenarios that reduce the child's frustration and follow those. There are lots of resources and helpful folks out there who have been through this stuff, don't be afraid to look to other parents.

As others have mentioned, cues may seem a little bit off. Fidgeting may in fact keep a kid focused, where they won't pay attention to anything if you make them stop. When I was teaching, we gave our students silly putty for them to play with whenever they felt the need. Sometimes we'd have to make them put it away, but for the most part it really helped the kids. It would come out when they were bored, when they were stressed, when they were excited. It's amazing what a little ball of clay can do for a kid.
posted by spaghetti at 5:56 AM on March 16, 2005

fff, davenportmom,

I think you should search out a copy of an article publshed in the Journal of Marital and Family Therapy called Do No Harm: A Critical Risk/Benefit Analysis of Child Psychotropic Medications. Sparks and Duncan, the authors, do a good job of reexamining the studies that have made medication seem like a good idea for children. Their analysis of the Multimodal Treatment Study of Children with ADHD (MTA) shows quite clearly that of the four treatments studied, behavioral therapy was the most effective. Medication was only deemed more effective by teachers, who knew that the kids were taking active meds (in other words, the teachers were outside the blind of the study). Furthermore, the therapy was the only treatment that had residual effects once it was stopped. Kids learned things that kept symptoms from recurring, so even when therapy ended they were able to maintain functioning.

I think that reading the paper will be helpful for any parent thinking about how to treat a kid with a mental health diagnosis, not because it will necessarily convince you not to use medication, but because it will necessarily broaden the discussion and make the case for medication much less of a slam dunk than the pharmaceutical industry wants to present it. In addition, it will perhaps allow you to talk about whatever set of choices you do make with other people in the child's life.

I don't have a specific citation for the article because my copy is from pre-press, but I would be happy to send a copy along if you cannot find it. Email in profile.
posted by OmieWise at 6:01 AM on March 16, 2005

Gargantuan reserves of patience seconded. There's also a decent chance that squirmy, noisy behavior (which is certainly one of the ways I manifested my ADD as a kid) irritates other kids as well as teachers and other adults. Being the annoying kid can be hard on the self-esteem; I'm still working on feeling like people actually want to be around me.
I was medicated (ritalin) for about 2 years (4th and 5th grades) as a kid. I honestly don't recall if it helped. Let me echo Goofyy in saying that at least some of us can appear to be fidgeting and daydreaming, but still be listening and absorbing everything you (or our teachers) say.
After a certain age, be on the lookout for smoking; I have a (wholly anecdotal and unscientific) hypothesis that smoking is a pretty common (and, IMHO, effective) form of self-medication for ADHD (in short: there's at least one nicotine-derived ADHD medication, which suggests nicotine might help; taking smoke breaks breaks up long, focused tasks into a series of small ones; it gives you something to do with your hands; the act of smoking is not totally dissimilar from calming deep breathing; seriously every ADHD person I know either smokes or used to smoke); the catch is that it kills you and it's really hard to stop doing.
This may not help at the kid's current age, but a lot of 18-22 year-old ADHD kids I knew in college (including me) found some relief in being largely nocturnal; there just aren't as many distractions at night.
posted by willpie at 7:16 AM on March 16, 2005

The boy is aged 12ish. The only reason I don't want drug stories in this thread is that they cause dissension; already y'all are arguing about it.

I'm much more interested in adaptive behaviours that the boy himself can try.

WGP: you've freaked me out. You been doing a little data mining on me?
posted by five fresh fish at 8:04 AM on March 16, 2005

For my part, I was not trying to start an argument about drugs. I was actually just writing about effective treatment. Effective treatment happens to be behavioral therapy, which will teach the boy ways to handle himself.

My point about the article, and this might not make sense if you are just in the beginning of the treatment process, is that drugs have been (mis)represented as the only (or most) effective ADHD treatment. While you may feel right now that you can make whatever treatment choices you like, many many parents find that people who believe that meds are the best treatment also believe they have a stake in the treatment a particular child receives. It can be difficult to repond to those people if you've chosen a different treatment strategy when the preponderance of popular wisdom incorrectly credits medication with the premiere place.
posted by OmieWise at 8:33 AM on March 16, 2005

Strictly, strictly, anecdotal, your mileage may vary, observations:

(1) Forget about a neat bedroom, combed hair, and other superficialities. These are not the battles that need to be fought.

(2) Get the kid into a rigorous, highly aerobic, individual sport, amendable to a linear and minimal kinds of coaching, like swimming or cross country. Literally anyone can get into these sports at any starting point of fitness or athletic aptitude. Team sports or even intensively taught/coached sports like tennis or golf are not likely to be as helpful.

(3) Different strokes for different folks. Smart kids with ADHD need a different approach than average kids. Actively disobediant or destructive kids need a far different approach from those who do nothing worse than fail to do their homework or fidget when told to sit still.

(For smart ADHD kids, real, adult books books are an amazing alternative for learning. They are everything that scattershot 50 minute, 30-kid classes taught from water-downed bite-size-lesson textbooks are not. )
posted by MattD at 8:59 AM on March 16, 2005

I just worked with a bunch of kids like this last summer. It was an Experiential Education program (read: outdor education), we brought these kids out into the wilderness for 3 two week programs. (Canoeing, kayaking, mountain hiking). It was a group size of six kids two 2 educators.

Overall the program seems to do pretty well for ADD/HD kids. Lots of activity/structure and learning self reliance as well as group processes. As with any therapy there are those that respond better then others.

I'm not going to say run out and do this, but it may be of some benefit if there is a program in your area.
posted by edgeways at 11:07 AM on March 16, 2005

WGP: you've freaked me out. You been doing a little data mining on me?
No, just recall your mention of Kelowna in a comment you made.
Been there, done that.
posted by weapons-grade pandemonium at 12:04 PM on March 16, 2005

Read about the hunter/farmer theory about add. If anything it makes it less of a 'disorder'.

And as far as meds, ymmv and not everyone who uses them abuses them and they can do good if you're aware of what they can and can't do. That said, be very cautious of docs that try to treat everything with them.

Don't give up! If one doc, therapist, school, doesn't work, try another.

Oh and good luck.
posted by [this is good] at 10:41 PM on March 16, 2005