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THE hyperactivity

VIEWS: 69 PAGES: 83

									                                   THE
                      ATTENTION DEFICIT DISORDER,
                ATTENTION DEFICIT HYPERACTIVITY DISORDER
                        AND RELATED DISABILITIES
                                  eBOOK

                              THE ADD, ADHD eBOOK

                            HOW TO USE THIS eBOOK

        Welcome to the ADD, ADHD and Related Learning Disabilities eBook. Simply
scroll down (or print this document out) to browse through the book in its entirety or
click on the subject in the table of contents below to be taken to the appropriate
section.

       The intention of this book is to educate you about the character, symptoms
and different treatment options for ADD and the sub-types of ADHD. It can also help
you distinguish the subtle differences between these disorders and the related
medical and psychological disorders that often go hand-in-hand with ADD.

        Chances are if you are reading this ebook that you already have some
concerns that a member of your family or even yourself. He or she may be exhibiting
distressing behaviors or symptoms that you suspect might be attention deficit
disorder. Although this book is not meant as a substitute for a diagnosis from a
qualified medical professional, it is the sincere hope of the publishers that the
information contained within this ebook will help demystify the nature of ADD and
ADHD. We have also tried to suggest tried and true routes to receiving a definitive
diagnosis and proper treatment.

      In the last chapter, we have also included a comprehensive list of frequently
asked questions that have been posed to us by individuals who are coping with ADD
and ADHD. Hopefully, by addressing their concerns, we will also have shed light on
your own.
                          TABLE OF CONTENTS

I.   CHAPTER ONE

     I.     INTRODUCTION TO ADD ADHD and LEARNING DISABILITIES

                 i) Why you may be drawn to reading this book
                 ii) Familiar Scenarios
                 iii) Effects on the Family
                 iv) The Search for a Definitive Diagnosis

     II.    DEFINITIONS

            I. ADD and ADHD

                 i) What's the difference?
                 ii) Behavioral Factors
                 iii) Biological Factors
                 iv) Environmental Factors


     III.   LEARNING DISABILITIES

                 i) Types of Learning Disabilities

                       i) Developmental Articulation Disorder
                       ii) Developmental Expressive Language Disorder
                       iii) Developmental Receptive Language Disorder
                       iv) Dyslexia
                       v) Developmental Writing Disorder
                       vi) Developmental Arithmetic Disorder


.    VI.    SIMILAR SYNDROMES

                 I. A Misdiagnosis?

                       i) Tests
                       ii) Self Testing
                       ii) Things to Watch For

                 II. Similar Conditions

                       I. Similar Medical Disorders

                              i) Thyroid Disorders




                                                                        2
                            ii) Hypoglycemia
                            iii) Allergies
                            iv) Epilepsy
                            v) Brain Tumor

                     II. Similar Psychological and Behavioral Disorders

                            i) Mood Disorders

                                     i) Depression
                                     ii) Manic Depression
                                     iii) Schizo-Affective Disorder
                                     iv) Asperger's Syndrome

                     III. Comorbid Conditions

                            i) Anxiety
                            ii) Oppositional Defiant Disorder
                            ii) Tourette's Syndrome
                            iii) ADD related Depression
                            iv) Substance Abuse
                            v) Bed Wetting

II. CHAPTER TWO DIAGNOSIS


          I. ADD IN CHILDREN

               i) Common Symptoms

               ii) Physiological
                      i) Loss of Coordination
                      ii) Loss of Balance
                      iii) Loss of Motor Control
                      iv) Sleep Disorders
                      v) Bedwetting
                      vi) Prone to Injuries

               iii) Behavioral

                     i) Distractibility
                     ii) Impulsivity
                     iii) Hyperactivity

               iv) Gifted Children




                                                                          3
          II. ADD IN ADULTS

                i) Common Symptoms

                      ii) Physiological
                             i) Loss of Coordination
                             ii) Loss of Balance
                             iii) Loss of Motor Control
                             iv) Sleep Disorders
                             v) Prone to Injuries

                      iii) Behavioral

                            i) Distractibility
                            ii) Impulsivity
                            iii) Hyperactivity


III. CHAPTER THREE TREATMENTS FOR ADD and ADHD

    I. Common Treatments

          i) Types of Testing For ADD and ADHD

    II. Medications

          I. Stimulant Medications

                i) How Stimulant Drugs Work
                ii) Rapid Acting Stimulants
                iii) Long Duration Stimulants
                iv) Are Stimulant Medications Addictive
                v) Side Effects of Stimulant Medication
                vi) The Right Medication at the Right Time
                vii) Stimulant Medications and Drug Abuse

          II. Non Stimulant Medications

                i) Types of Non Stimulant Drugs

                      i) Tri cyclic Anti-depressants
                      ii) Bupoprion (Wellbutrin)
                      iii) Blood Pressure Medications
                      iv) Mood Stabilizers
                      v) Selective Serontonin Uptake Inhibitors




                                                                  4
                      vi) Strattera (Atomexteine)
                      vii) Newer and Unconventional Medications
                      viii) Medication for Adults

          III. What If the Medication is not working?

          IV. Therapies

                I. Types of Therapy

                      i) Behavioral Therapy
                      ii) Cognitivie Therapy

          V. Controversial Treatments

                      i) Nutritional
                      ii) Elimination of Food Additives
                      iii) Allergy Tests
                      iv) Herbs
                      v) Homeopathy


IV. CHAPTER FOUR

     I. COPING STRATEGIES

          I. Accepting the Diagnosis

                i) Cooperating with Professionals
                ii) Coping With Medication
                iii) Community and Extended Family Support

          II. COPING WITH CHILDREN

                i) Behaviors of Toddlers and Infants
                ii) Behaviors of Older Children
                iii) Behavioral Planning
                iv) Childproofing
                v) Coping with Medical Personnel
                vi) Coping with Medication
                vii) The Reactions of Siblings
                vii) Coping with Stigma
                viii) Educational Needs
                ix) Homework
                x) Assertive Technology
                xi) Self Esteem Issues




                                                                  5
         III. COPING WITH ADULTS

              I. How to recognize ADD in Adults

              II. The Impact of ADD on Adult Life

              III. How To recognize Your Own ADD - A Self Test


V. CHAPTER FIVE ANSWERS AND RESOURCES

    I. FREQUENTLY ASKED QUESTIONS

    II. RESOURCES

         i) Associations
         ii) Helpful Web -Sites
         iii) Books
         iv) Books for Children
         v) Magazines




                                                                 6
I.     CHAPTER ONE

I.     INTRODUCTION TO ADD ADHD and LEARNING DISABILITIES

      If Attention Deficit Disorder were a mythic beast, it would have three heads.
One head would constantly be distracted and non-self-aware, another would be
impulsive and apparently self-destructive and the third would be hyperactive and
apparently manic.

      Distraction, impulsivity and hyperactivity are the three faces of this common
disorder. Unfortunately these symptoms mimic other behavioral, psychological and
physical disorders that menace our peace of mind. These include developmental
reading disorder, developmental writing disorder, developmental arithmetic disorder,
hypoglycemia, allergies, epilepsy, brain tumors, bipolar disorder, schizophrenia and
autism.

        To complicate matters more, most parents of children with this ADD mistake
the nature of the beast as simply just being a bad case of "willful disobedience."
Many adults with the disorder are often treated by both their doctors and employers
as sociopaths (individual who have an inability to learn) or obsessive-compulsives.
The chaos that can reign as a result of not achieving a diagnosis of ADD can
psychologically damage the sufferer for years as they resort to compulsive and
addictive behaviors to cope with other people's reactions to the misunderstandings
caused by this affliction.

       Attention Deficit Disorder is a general term that describes all conditions that
involve the three pronged symptoms of distraction, impulsivity and hyperactivity.
ADHD is a clinical term that is used to describe three subsets of the disorder:
Combined Type, Predominantly Inattentive Type, and Predominantly Hyperactive-
Impulsive Type.

        Many people use the term ADD as a generic term for all types of ADHD. The
term ADD has gained popularity among the general public, in the media, and is even
commonly used among professionals. Whether we call it ADD or ADHD, however, we
are all basically referring to the same thing.

      The idea here is to understand the nature of the beast, so you can tame it with
medication, behavioral therapy, counseling and other treatments.


       i) Why You May Be Drawn To Reading This Book

       If you are reading this book, you probably suspect that a child, a spouse, a
friend or a colleague may be suffering from ADD. Usually it is because you are
exasperated by someone's behavior.




                                                                                         7
        For instance, your child who you know is quite intelligent might keep coming
home with failing grades even though he thoroughly passed a home oral examination
with flying colors the night before. Your spouse may repeatedly bouncing checks or
forgetting to pay bills even after you have resorted to leaving reminders printed in
bold letters taped to the refrigerator. You might be concerned about a friend, who
keeps storing her purse in the refrigerator and the milk in the medicine cabinet.

       Another common scenario is the co-worker who starts several projects and
never finishes them, leaving you to pick up the pieces. You might even be reading
this book because you suspect that ADD is why you constantly receive bad
performance reviews on the job.

        Another indication that you are reading the right page is if you are becoming
sick of your own behavior. In order to cope with the person with ADD, you may have
become a codependent or a caretaker who lives in a state of perpetual resentment,
This is because you always have to clean up, cover up or fix the perpetrator's
mistakes. This resentment is also always accompanied by a feeling of guilt, as you
may feel so baffled, frustrated and weary of your loved one's antics that homicide is
becoming one of your favorite fantasies.

        As the nature of ADD is essentially cunning baffling and confusing, the first
thing you need to do is realize that you are feeling the resonance of this disease. You
are in the same pickle that partners of alcoholics or manic-depressives are as you
can't help but react to mysterious and hurtful behaviors that seem to be "on-purpose."
If you are trying to cope with ADD by mirroring the sufferer's own behavior back to
them - stop. An individual with ADD almost never learns by example. Put your energy
into understanding the disease and learning not to take it personally. The most
important thing you can tell yourself is "This is not about me."

       As with most behavioral or psychological disorders, the symptoms of ADD are
engaged according to the degree of severity. Everybody at one time or another
displays at least one of the major traits of an ADD sufferer. We all get distracted,
impulsive and restless. The difference between a so-called normal individual and an
ADD sufferer is the frequency, duration and length of these symptoms,

        If you are living every day expecting the unexpected then you are possibly
living with someone who suffers from ADD. ADD sufferers baffle others because they
are consistently inconsistent. You have probably already learned that it is not easy to
trust an individual with ADD. The disorder causes them to behave in an erratic,
incompetent manner.

       Typically, sufferers with ADD have problems with paying attention and
following through with instructions. They often seem not to be listening, make
inappropriate remarks, and tend to be disorganized. They have difficulty breaking
down a task into individual components. They have terrible short-term memories, but
can describe often-irrelevant details from the past in great deal. In addition some




                                                                                        8
individuals with ADD can be impatient, verbally impulsive and unable to wait their
turn. However, it is important to remember that not all people with ADD demonstrate
all of these symptoms all of the time.

       ADD is not classified as a learning disability although ADD sufferers can
develop disabilities as reaction to the pressure that they feel they are under. Although
ADD obviously effects the academic performance of a person, it will also affects other
areas of life, which can include relationships with others, running a home, keeping
track of finances, organizing, planning, and managing a business.

       ii) Familiar Scenarios

       Your five year old is a champion when it comes to playing complex video-
games for hours, but seems incapable of remembering how to flush the toilet, put his
things away or tie his shoelaces. His moods vary from sullen acquiescence to a literal
running around in circles. When you discipline him for his misbehaviors, the
confusion on his face breaks your heart. You have become so weary of him taking off
on you in the mall that you have actually resorted to harnessing him to a leash before
you can leave the house.

       You love your wife dearly but she is absolutely hopeless when it comes to
behaving like a responsible adult. Every day you come home to a complete mess -
undone dishes, laundry everywhere and the television on with no one watching it.
When you first met her you loved her mercurial and creative mind but not you are
having second thoughts. Strewn everywhere are your r wife's incomplete arts and
crafts projects. That dress she started sewing over five months ago is still draped
over the dining room table. Your tools are scattered in the back yard along with
recycled items that were initially meant to construct a hummingbird feeder. You open
the refrigerator to get a drink and see a selection of non-perishable canned goods in
there. Sighing, you start to clean up the mess, all the while suppressing your anger
and wondering you thought marrying such as "space cadet" was a good idea at the
time.

        You adore your next door neighbor, but you are starting to wonder if she has a
drinking or drug problem. When you ask her to return that money you leant her two
days to buy groceries, she claims to have no memory of it. You know it can be hard
to be a single mom, so you do little things for her like gather her laundry for her when
it has been sitting out on the line for five days. However, recently, you have started
avoiding even saying hi to her over the back fence. It seems that even the simplest of
greetings leads to her reminiscing in great detail about her ex. It seems that she
would rather talk about the past than attend that important doctor's appointment or
necessary job interview. You can't understand why she is always broke and why you
have to be her therapist for free. You can only help a person so much before they
have to help themselves.




                                                                                       9
       Everybody at work calls your employee "the absent-minded professor."
However lately you are not finding that phrase as funny as it used to be, especially
since he accidentally placed your document in a shredder instead of the photocopy
machine. His habit of jumping up out of his chair and pacing back and forth while
ruminating about projects out loud is also becoming very disconcerting for the other
employees. In fact his erratic behavior has caused three valued secretaries to leave
their positions. You pull out his resume again and look at the string of Ph.D's and
M.A.'s attached to his name. How on earth did this person even make it through
school? You consider firing him but something stops you. You have a feeling there is
more to this situation than meets the eye.

         You feel so lost and alone. You have attended every twelve-step meeting in
existence, spent years talking to a therapist and explored every New Age therapy
known to man. Still you can't seem to get your act together. Doctors have diagnosed
you with everything from chronic fatigue to manic depression, but so far no
medication on earth has been able to get rid of that restless feeling or improve your
ability to concentrate on matters at hand. Furthermore, every one of your loved ones
seems to have walked away from you with bitter recriminations and mistrust. They
often accuse you of having no moral standards or being on drugs. The one phrase
you are sick of hearing every day is "I know you know better so why did you do
that?" In fact, you know you are supposed to call someone up today and apologize
for something you did, but you can't remember who it is. Maybe you can meet
someone new if you join an Internet chat room. Also redecorating the bathroom might
be good project to start today or maybe visiting a psychic ...here comes that panicky
feeling again. Maybe you will just rest today and watch T.V. or head down to the
local bar for a drink...

       If any of the above situations are familiar to you, you may indeed be dealing
with a case of ADD.

      iii) Effects on the Family

       Family members who have been diagnosed with ADD can be disruptive to say
the least. Parents are often tempted to use corporal punishment because they feel
that nothing less will get a child's attention. Spouses with ADD affected partners will
try everything from emotional black mail to ignoring the problem to care taking in
order to try and manage the situation.

       Unfortunately, individuals with ADD do not respond well to any kind of
punishment, whether it is corporeal or emotional. In the case of children, attempting
to discipline them with violent acts only teaches them that violence is the best way to
resolve conflicts. You cannot teach an individual with ADD to be accountable for their
actions. All you can really do is minimize the heart-rending guilt that they feel when
they do commit a misdeed.




                                                                                       10
        Many parents of ADHD children are still waiting for their child's case of the
"terrible twos" to be over even after the child has reached adolescence. These
impulsive and hyperactive children are often unable to "look before they leap" and
cause serious safety threats to the entire family. As children with ADHD are also
usually very creative and intelligent, it is difficult to quell their curiosity. They are
always getting into medicine cabinets, trying to cook supper on their own and seeing
how high they can climb up a tree. To make things worse some ADHD children have
perceptual, coordination and balance disorders that affects their judgement when it
comes to determining whether or not they are about to put themselves in a
precarious position. This also leads to a lot of spills, breakage and loss of valuable
property.

        Individuals with ADD or ADHD can also cause serious emotional rifts between
yourself and other members of your family. For instance, siblings of a child with ADD
can act up because they feel they deserve the same kind of attention and focus that
is given to the child who is misbehaving all the time. They may also resent the child
and shun them from their social circle because they are embarrassed by his or her
behavior. Physical and emotional injuries are frequent as conflicts break out between
frustrated siblings and baffled sufferers of ADD.

       Parents and spouses of ADD afflicted individuals may also find themselves
taking a lot of heat for the behavior of their loved ones. Parents may be admonished
by grand parents and friends and advised to discipline the child more often. Some
parents may suffer from low self-esteem as the result of repeated accusations of not
knowing how to raise a child. Some ADD children scream and act out so much that
the neighbors and teachers suspect the parents of abuse. Teachers may also
suspect a negligent or abusive family life is behind the child's disturbed behavior.

        The family unit often does become toxic as family members adopt unhealthy
behaviors to cover up, prevent or compensate for the ADD victim's behavior. They
may indulge that person a little more, tiptoe around them so as not to cause some
kind an episode or become like emotional pressure cookers waiting to explode with
hostility and resentment towards the troublemaker.

       Adults with ADD might feel guilty, withdrawn or depressed as they realize that
they are incapable of providing structure and organization for the rest of the family
members. They may have difficulty handling their tempers if children misbehave and
then suffer guilt afterwards. The roles of parent and spouse add new dimensions of
complexity to daily life. A woman with difficulty maintaining divided attention may
blow up when her children start asking for things while she is trying to do write a
Things To Do list.

      ADD can strain a marriage. The non-ADD spouse may misinterpret the
partner’s disorganization and procrastination as deliberate. If the ADD afflicted
spouse decides to go on impulsive spending spree, it may damage family finances.
The urge for exciting and new situations, as well as the guilt and disapproval they feel




                                                                                       11
from their partners can also lead individuals with ADD and ADHD into repeated job
changes or extramarital affairs.

        Everyone in the family s should have a thorough understanding of the
psychiatric diagnoses of ADD or ADHD and how the behaviors associated with the
diagnoses affect all of them. This can help minimize the damage caused by "knee-
jerk" reactions to the unfortunate occurrences that seem to follow in the wake of an
ADD sufferer's daily activities.


       iv) The Search for a Definitive Diagnosis


      Many families go through a period of confusion during the time leading up to
an eventual positive diagnosis. A diagnosis of ADD or ADHD can either feel like a
Godsend or like a death sentence.

        Those who do not feel relieved that a name has been found for the disorder
may experience a sense of loss. They may go through a period of grieving for the
child's lost potential. The classic stages of mourning, denial, anger, grief and finally
acceptance of the situation.

      Fortunately medical professionals are trained to be patient with the relatives of
a person with ADD. Despite all the convincing in the world, parents of a child with
ADD might still feel that the disorder is all their fault and experience guilt. Parents
should comfort themselves by realizing that s studies have shown that environment
has very little to do with ADD and that the causes are usually genetic.

       Community support is important during and after the time of the initial
diagnosis. It is easy for a family to become overwhelmed by the prospect of living
with an individual with ADD for life. Embarrassment and shame may cause family
members to isolate themselves just when they need to outreach to teachers,
professionals and other family members the most.



II. DEFINITIONS


I. ADD and ADHD


      Many people use the term ADD as a generic term for all types of ADHD. The
term ADD has gained popularity among the general public, the media, educators and
medical professionals. Whether we call it ADD or ADHD, however, we are all
basically referring to the same disorder.




                                                                                           12
       ADD or ADHD is a diagnosis applied to children and adults who consistently
and frequently display certain behavioral characteristic behaviors over a period of
time. The three most common characteristics are:

      distractibility (poor sustained attention to tasks)
      impulsivity (impaired impulse control and delay of gratification)
      hyperactivity (excessive activity and physical restlessness)

In order to reach a definitive diagnosis, these behaviors must be long-term, excessive
and pervasive. Doctors will only diagnosis ADD if these three behaviors are disabling
the individual in at least two major areas of his or her life. These can include
disruptions to academic career, employment and family relationships. In order to
meet diagnostic criteria, these behaviors must appear before age seven, and be
consistent for at least six months.


       i) What's the difference?

       ADD is a term that embraces all forms of ADHD. ADHD is broken down into
three different subtypes: Combined Type, Predominantly Inattentive Type, and
Predominantly Hyperactive-Impulsive Type.

       The Combined Type of ADHD refers to an individual who suffers from
distractibility, impassivity and hyperactivity.

      The Predominantly Inattentive Type will experience distractibility as an
overwhelming symptom with less extreme impulsivity and hyperactivity.

      Excessive activity and extreme physical restlessness characterize the
Hyperactive-Impulsive Type. These symptoms predominate over distractibility.

       ii) Behavioral factors

       Some generalized common symptoms of ADHD include:

          a failure to pay close attention to details
          making careless mistakes
          an appearance of not listening when spoken to
          difficulty concentrating
          losing things
          forgetting important things
          feelings of restlessness
          fidgeting
          running or climbing excessively
          talking incessantly




                                                                                      13
          blurting out inappropriate remarks
          impatience


      Keep in mind that the exact nature and severity of ADHD symptoms varies
from person to person. Approximately one-third of people do not have the
hyperactive or overactive behavioral component of ADHD.

       iii) Biological Factors

       ADHD is thought to have a genetic basis. It is very likely caused by biological
factors that influence neurotransmitter activity in certain parts of the brain.

       Researchers at the National Institute of Mental Health have concluded that
sufferers of ADD tend to have less brain activity than other individuals. Using
technology that measures the amount of glucose used the brain researchers have
found that the brains of ADD sufferers do not uptake glucose. Glucose is the fuel for
the brain and the areas that control concentration and attention span in the ADD
sufferer seem to be dormant or "sleeping." Low levels of activity in certain parts of the
brain might be responsible for some of the lazy, distracted and inattentive looking
behaviors associated with ADD.

        Studies have also shown that the disorder runs in families. If one person in a
family is diagnosed with ADHD, there is a 25% to 35% probability that any other
family member also has ADHD This is compared to a 4% to 6% probability for
someone who has no family history of the disease.

       iv) Environmental Factors

       According to researchers, ADHD is not caused by poor parenting, divorce,
flaws in the educational system, too much television, food allergies, or excess sugar.

        For many years ADHD was called "minimal brain damage" or "minimal brain
dysfunction." One theory that is still believed today is that minor head injuries or
damage to the brain causes attention disorders. At one time, there was a folk-belief
that such disorders were perhaps caused by being dropped on one's head as an
infant. Researchers and doctors now doubt this theory, as the vast majority of people
with ADD have no history of head injury or brain damage.

        Another long-held belief that was all the rage in the seventies is that refined
sugar and food additives create hyperactive and inattentive behaviors in children.
Scientists at the National Institutes of Health state this may apply to only about 5
percent of children with ADHD, most of them with blood sugar disorders and h\ food
allergies.




                                                                                         14
IV.    LEARNING DISABILITIES

I. Types of Learning Disabilities

              Learning disabilities can often result as a consequence of having ADD
or they can occur as a separate incident that is the result of other factors. In the case
of ADD or ADHD the person may simply be too distracted or blank out when it comes
to speaking, reading or learning information. Frustration and fear may also affect the
person's perception of events causing them to display any number of academic
related disabilities.

       Many aspects of speaking, listening, reading, writing, and arithmetic are
dependent on the same brain capabilities. So, it's not surprising that people can be
diagnosed as having more than one area of learning disability if they also have ADD.
For example, the ability to read involves an excellent short-term memory. Children
with ADD simply forget the information as soon as they absorb it. Writing involves
excellent hand and eye coordination. This is simply a skill that most people with ADD
do not have because of disruptions to their balance.

        Individuals with ADD or ADHD may demonstrate many gaps in their brain
activity including a lack of coordination, an inability to retain information and an
inability to perceive complex concepts. Unfortunately just a single gap in the brain's
operation can cause any of the disorders described below.


i) Developmental Articulation Disorder

       Children with this disorder have trouble controlling their rate of speech. They
may be delayed or thwarted in their attempts to vocalize consonants and vowels.
This disorder which often appears before the age of eight is often outgrown or
successfully treated with speech therapy.


ii) Developmental Expressive Language Disorder

       This speech disorder makes it difficult for the child to create phrases that are
longer than two or three words. The child may also blank out when asked a question
even though he or she is articulate at other times. This disorder also shows up before
the age of eight.

iii) Developmental Receptive Language Disorder

       Some individuals have trouble making sense of speech. They simply cannot
distinguish one word from another. Some researchers think that this is also a




                                                                                         15
disassociative disorder. For instance, if you ask a person with developmental
receptive language disorder to hand you a ball, they might hand you a bell. They also
have trouble putting words into context. For instance, they might not catch the
nuance in a phrase such as "passing the buck" and wonder if you mean handing
them a male deer.

iv) Dyslexia

       Individuals afflicted with Dyslexia have an inability to control their eye
movements so they can focus their attention on the printed marks on the page. They
are also unsuccessful at grasping the concept of phonetics (recognizing the sounds
that are associated with each letter.)

       Sufferers of dyslexia may also demonstrate a limited vocabulary and poor
grammar in their speech. They often perceive letters, graphics and all kinds of
images as upside down or as their mirror opposite. They will often objectify words
into symbols as opposed to reading them. For instance they will see a teepee when
the look at the capital A rather than interpret it as being the letter A. Dyslexics also
have difficulties retaining information as well as relating one abstract concept to
another.

        Scientists found that a significant number of people with dyslexia share an
inability to distinguish or separate the sounds in spoken words. Some children have
problems sounding out words, while others have trouble with rhyming games, such
as rhyming "cat" with "hat." However skills fundamental to learning to read.
Fortunately, remedial reading specialists have developed techniques that can help
many children with dyslexia acquire these skills.

        If the brain is unable to form images or relate new ideas to those stored in
memory, the reader can't understand or remember new concepts. Many children can
"fake it until they make it" until they reach the upper grades when the focus of reading
skills shifts from word identification to comprehension.

v) Developmental Writing Disorder

         Writing involves several areas of the brain, including the ones that coordinate
vocabulary, grammar, hand movement and memory. ADD may affect a person's
ability to print, practice calligraphy or even construct simple words on paper. Many
reverse letters as they have difficulties distinguishing a mirror image from a normal
image. Individuals with this disorder find it almost impossible to compose complete,
grammatical sentences. They may think in full sentences but their brains can make
the relationship from thought to reproduction on a piece of paper.




                                                                                       16
vi) Developmental Arithmetic Disorder

       Developmental Arithmetic Disorder is also referred to as dyscalculia. As
arithmetic involves the ability to remember numbers and symbols and comprehend
abstract concepts such as number alignment and fractions, ADD sufferers often have
great difficulty performing the simplest of mathematical calculations.


IV. Similar Syndromes

        When it comes to symptoms, ADD can be a bit of a chameleon. It is often
misdiagnosed as other diseases such as hypoglycemia, allergies or a mood disorder
before a conclusion is reached that ADD may actually be the culprit. For instance,
children who wet the bed may be suspected of having a bladder problem when in
reality ADD is at the core of the malaise. An adult may be diagnosed as a manic-
depressive, when really what others perceive as mania is actually hyperactivity
caused by a case of ADD that has been left undiagnosed since childhood.

       Arriving at a true diagnosis becomes even more complicated once you realize
that ADD can cause other conditions such as alcoholism, depression, dyslexia, mood
disorders and codependency.

I. A Misdiagnosis?

If your child or relative has been diagnosed with one disease and does not seem to
be responding to treatment and medication than it might be time to suspect ADD. For
instance if you have been told that allergies are causing your child's headaches and
inability to concentrate but allergy tests do not turn up a reaction, then you might
want to look into other causes for your child's problem.

       Conversely, if your loved one has been prescribed a medication for ADD and
his or her symptoms seem to worsen, then you might want to get a second medical
opinion. An example of this would be the adult who suffers from manic depression
that suffers a psychotic episode as a result of taking Ritalin to manage ADD.

       Common conditions that often co-exist with AD/HD are:

      Oppositional Defiant Disorder (and Conduct Disorder)
      Learning and communication differences
      Anxious state
      Obsessive Compulsive Disorder
      Depression
      'Bedwetting (Enuresis
      Drug abuse
      Bipolar Disorder
      Sleep Disorders




                                                                                  17
      Tourette's Syndrome
      Pervasive Developmental Disorder
      Physical illnesses such as asthma
      Accidental Injury


       i) Tests

       Before your doctor diagnoses you or your relative with ADD, he or she will
most likely do a barrage of medical tests to make sure that the problem does not
have a physical cause such as a encephalitis, epilepsy or a brain tumor. If your
doctor refuses you these tests and you are not certain that ADD or ADHD is the
cause of your loved one's symptoms and misbehavior, then get a second opinion.
Sometimes an examination from a neurologist or a psychiatrist is in order.

       Unfortunately, ADD is so complex that there is no single test or battery of tests
for diagnosing it. However, it is usually sufficient to complete a standard
psychoeducational array of tests. These kinds of tests create a psychological and
behavioral profile of your child. Some educational systems also provide computerized
test that rate a child's attention span and concentration.

       ii) Self Testing

      There are many sites on the Internet that offer self-testing for ADD and ADHD.
Type ADD test into a popular search engine such as Google and you will be led to
hundreds of sites that allow you to diagnose conditions online.

       We have also included an example of a self-test in the Adult ADD section of
this book.

       Self-tests should not be used for diagnostic purposes or replace evaluation by
a doctor; however, they can be used to help determine if further testing might be
beneficial.

      Some of the more popular and reputable sites recommended for self-testing
for ADD are

The Amen Clinic Adult ADD Test. This test uses a rating scale to help determine if
you should seek professional evaluation. www.amenclinic.com

The Amen Clinic ADD Subtypes Checklist. This takes the testing one step further by
posing questions to see if you might have a sub-type of ADHD. www.amenclinic.com

Testing Your Child's Attention. This is a downloadable test that you can use to test
your child's attention span. Requires Registration. www.attention.com




                                                                                       18
Jasper/Goldberg Adult ADD Screening. An adult screening questionnaire for ADHD.
www.enteract.com

 Internet Mental Health. This is an adult questionnaire based on the clinical
experience of Edward Hallowell and Dr. John J. Ratey. www.mentalhealth.com

7 Brief Rating Scale for Parents. This is a 12 question screening form to provide
information on whether further evaluation would be beneficial. www.the-add-
clinic.com


      iii) Things to Watch For

      A diagnosis of ADD or ADHD does not usually include any of the following
symptoms, which are characteristic of much more serious disorders such as
encephalitis or a brain tumor

         Convulsions
         Seizures
         Bleeding from the eyes, nose or ears
         Severe persistent headaches
         Lactation
         Fainting
         Loss of breath
         Rapid Heart Beat
         Unconsciousness

II. Similar Conditions

       There are some medical, psychological conditions that do cause behaviors
similar to those suffered by those who are afflicted with ADD and ADHD. This section
includes descriptions of these disorders as well as an explanation as to why they are
often mistaken for ADD and vice versa.

      I. Similar Medical Disorders

      Most medical disorders that are confused with ADD and ADHD can be
diagnosed with simple blood tests, urinary tests and cat scans.

      i) Thyroid Disorders

       The thyroid is a small gland in the neck, just under the Adam's apple. It
creates hormones that help to regulate the body's metabolism (how the body uses
and stores energy from foods eaten) and organ functions. When the thyroid is not
working properly, it can affect your body weight, energy level, muscle strength, skin
health, menstrual cycle, memory, heart rate, and cholesterol level.




                                                                                        19
       When the thyroid gland is underactive it is also called hypothyroidism. When
the thyroid is more active than it should be it is called hyperthyroidism.

       The symptoms that ADD has in common with hypothyroidism are forgetfulness
and mood swings. However hypothyroidism is usually accompanied by other
symptoms as wells such as fatigue, weight gain, hoarse voice, intolerance to cold,
and increased cholesterol.

       ADD has much more in common with hyperthyroidism. Both ADD and
hyperthyroidism share irritability, nervousness and trouble sleeping as symptoms.
However people with hyperthyroidism will also have frequent bowel movements,
vision problems, intolerance to heat and heart palpitations.


       Thyroid disorders are much more common in women than in men. About one
out of every eight American women will develop a thyroid disorder. Fortunately
underactive or overactive thyroid can be diagnosed with a simple blood test called a
thyroid stimulating hormone or TSH test. This disorder is often treated with
medication, surgery or radioactive iodine.

       ii) Hypoglycemia

       Hypoglycemia or "low blood sugar" as it is casually called is due to a state
called state of hyperinsulinism. This is a defect in the body's ability to metabolize
carbohydrates. The most common cause of this blood sugar disorder, which is the
opposite blood sugar condition identified with diabetes, is an excessive intake of
refined sugars, caffeine and emotional stress

        Hypoglycemics often suffer from symptoms that are also associated with ADD
such as confusion, anxiety, irritability, fear and headaches. However flushing or
pallor, sweating, weakness and fainting also characterize hypoglycemic conditions.

       ADD and hypoglycemia are easily confused because hypoglycemia has a
history of aggravating any symptom in any part of the body. This includes the
neurological system, which governs concentration and hyperactivity.

       iii) Allergies

       Allergies to moulds, food, dust and pollution are have symptoms that mimic
those of ADD. In fact, some alternative doctors and researchers believe that
environmental allergies might be a cause of ADD.

       Individuals suffering from environmental allergies have such symptoms as
mood swings, impatience, headaches, hyperactivity, an inability to concentrate and
low brain activity. As these symptoms are also common with ADD sufferers, it is no




                                                                                        20
wonder that many parents suspect that their child's ADD might be triggered by an
unknown allergen.

       iv) Epilepsy

       Epileptics have many symptoms in common with ADD including short periods
of blanking out, an inability to read, an inability to concentrate, confusion, memory
loss, making inappropriate remarks, a dazed look, compulsive movements and
explosive emotional reactions to stimuli.

       Epilepsy however is almost always accompanied by Grande-mal, petite-mal or
Jacksonian seizures that are definitely measurable by an EEG. Just before a seizure,
a sufferer of epilepsy may also report smelling strange smells or tasting metal in their
mouth.

       v) Brain Tumor

       Some of the most common symptoms of a brain tumor are headaches that
wake you up in the morning, seizures in a person who does not have a history of
seizures, nausea, lactation and vision problems.

      Speech disturbances, an inability to read or concentrate and memory loss are
the symptoms that characterize both the presence of a brain tumor and ADD.


       II. Similar Psychological and Behavioral Disorders

       Many psychological disorders, such as a mood disorder, can be temporary.
Many of them can also be treated with therapies that do not require medication such
as biofeedback and cognitive therapy. Other disorders, such as manic-depression
and schizophrenia can be worsened by medications prescribed for ADD sufferers
This is why it is important to try and distinguish whether or not your loved one is
experiencing f a temporary emotional disorder or a permanent condition such as
ADD.

       i) Mood Disorders

         Moods are part of the rich fabric of human experience. Without them we would
lose part of what it is to be an individual. However, a mood can so intense or fixed
that it can ruin our quality of life.

       . Mood disorders also often co-exist with other problems such as anxiety or
attention deficit disorder. Accurate diagnosis is important because psychotherapy,
medication and other treatments for specific types of mood problems can be tailored
to also accommodate the special needs of the ADD sufferer.




                                                                                      21
              i) Depression

       Confusion, irritability, forgetfulness, insomnia and an inability to concentrate
often accompany the following types of depression. However unlike ADD many of
these disorders are triggered by trauma. ADD sufferers can be more prone to these
kinds of depression as many of them do not have the emotional skills to cope with
upsetting events

Adjustment Disorder with Depressed Mood: This is mild to moderate depression that
develops within 3 months of a significant life trauma such as a divorce or death.

Bereavement: Although this may resemble depression, it is generally not classified as
a mental disorder. Sometimes, though, it may develop into a major depressive
disorder.

Major Depressive Disorder: This is characterized by at least two weeks of depressed
mood. Changes in sleep, appetite and energy are common. Guilt, impaired
concentration, and suicidal thoughts may also be present.

Dysthymic Disorder: Sometimes referred to as "Double Depression", this disorder is
characterized by milder but more chronic depressive symptoms. It must be present
for at least two years in an adult or one year in a child or adolescent before a
diagnosis is even considered.

Seasonal Affective Disorder: This describes a recurrent depression or bipolar
disorder associated with specific times of the year. The sufferer is thought to be
affected by the dimming levels of light that are associated with seasonal changes.

Cyclothymic Disorder: Repeated periods of hyperactivity that consistently alternate
with episodes of mild depression.

Substance-Induced Mood Disorder: Withdrawal from alcohol, prescription drugs or
recreational drugs can cause depression, memory loss, sleep disorders and
hypomania.

Mood Disorder Due to a Medical Condition: Many individuals develop changes in
mood and activity after being diagnosed with a fatal condition such as pancreatic,
brain or liver cancer.

              ii) Bipolar Disorder

        The hyperactivity associated with ADD is often confused with the mania that
identifies bipolar disorders.

       Mania is usually characterized by hyperactivity accompanied by an abnormally
elevated, irritable or grandiose mood. The individual may experience insomnia, rapid




                                                                                      22
speech and racing thoughts as well as emotional and physical agitation. They are
also easily distracted and can't concentrate just like ADD sufferers.

       There are two basic kinds of bipolar disorders, Bipolar I Disorder which means
the individual has experienced at least one episode of true mania and Bipolar II
Disorder which means the individual has experienced multiple periods of mania
followed by depression (also known as manic-depression.)


              iii) Schizoaffective Disorder

       This feature combines some features of schizophrenia with a mood disorders.
Psychotic thoughts, hallucinations, delusions and inappropriate and intense emotions
often accompany this condition.

       People with schizoaffective disorder may appear apathetic, distracted and like
they are not listening to you. Like ADD sufferers they experience confused thinking,
and can be "blank" or emotionally unresponsive. They often perplex others with their
strange behavior and inappropriate remarks and actions

       Sadly, this disorder is considered to be comorbid with ADD sufferers who
might finally 'crack" under the pressure of being so misunderstood all the time.

              iv) Asperger's Syndrome

      Asperger's syndrome is a form of autism that affects social interactions,
communication, creative skills, and responses to sensory input. This syndrome
occurs in about one in 500 children.

        Symptoms of Asperger's syndrome vary, but often include: difficulty
understanding how to play or interact, poor eye contact, poor ability to look at faces
to get emotional information, anger at being bumped by accident, impaired ability to
point and extreme shyness. Like ADD sufferers they sometimes extreme bright but
very eccentric. They often talk excessively and have special interests that dominate
social interactions and conversations.

        Like those afflicted with ADD they also display a remarkable memory for
irrelevant facts accompanied by a poor short-term memory. They also demonstrate
hyperactivity, abnormal response to sensory input, and often perceived by others as
odd, spoiled, or obnoxious. A common misdiagnosis of Asperger's Syndrome is
ADHD and vice-versa.




                                                                                     23
       III. Comorbid Conditions


       Does the individual have ADHD plus another condition or it is just another
condition masquerading as ADHD? This can be a difficult call. A comorbid condition
is one disorder that exists in conjunction with another disorder such as ADD. The
presence of two, three or even more coexisting conditions leads to what is called a
differential diagnosis.

      Many individuals with ADD end up with a comorbid condition. This means
ADD is existing in conjunction with another disorder such as obsessive compulsive
disorder or drug addiction.

        Anxiety or OCD can look like ADHD. Drug abuse can also make an individual
appear inattentive and impulsive. It may be wise to perform a drug screen on some
adults and adolescents who present with symptoms of inattention, irritability and
impulsivity.

      ADHD generally begins before age seven. However, a bright child, especially
one who is not hyperactive, may escape notice until later when the demands of
academia or of life exceed the individual's coping mechanisms. They may develop a
secondary disorder that is related to, but not the same as ADD.

       Here are some common disorders and a discussion of their relationship to
ADD.

       i) Anxiety

       The anxiety suffered by ADD sufferers is usually situational. Usually it is
triggered by the fact the sufferer is finding it difficult to succeed academically,
vocationally or socially. Treating the ADD may reduce the anxiety.

       However sometimes the anxiety is a separate entity from the ADD and maybe
even the result of taking long-term ADD medication such as Ritalin. To avoid
distressing drug interactions where an already over-anxious individual might be made
even more nervous by stimulating ADD medications, doctors sometimes prescribe
cognitive techniques to help control the anxiety.

       ii) Oppositional Defiant and Conduct Disorder

        Both of these conditions are commonly associated with AD/HD. This is the
willful disobedience that starts cropping up in the behavior of ADD sufferers as young
as two years old. Often this behavior is the result of a need to vent frustration and
anger.




                                                                                      24
        These individuals enjoy defying the rules that they feel have oppressed them
al of their lives and, in some cases, engage in violent behavior. This type of behavior
is usually treated with individual and family counseling.

       Recreational drugs or drinking can also provoke defiance and strange conduct
as these substances interact with medication used for treating the ADD.

      iii) Tourette's Syndrome:

       This disorder involves the repeated uttering of multiple vocal noises such as
throat clearing or the compulsive use of certain words and motor tics. These tics
manifest as twitching or jerking. The development of tics is often preceded by
symptoms of inattention and hyperactivity.

       Tics tend to peak in adolescence and be milder in adulthood. There has been
a controversy about the use of stimulants ADD medications in individuals with tics.
When treating Tourettes, it is important to determine which symptoms are the most
troublesome: The tics, the ADD or other behavioral problems. Often the tics are not
the main thing that bothers the individual.

      iv) ADD Related Depression

        Individuals with both ADHD and depression may be at increased risk of
impulsive acts such as harming themselves or suicide. Some doctors feel that
inattentive, less hyperactive individuals are more likely to develop co-morbid
depression at some point in their lives.

        Boys are more likely to suffer from ADD related depression before puberty
and girls are more likely to experience it after puberty. Children who demonstrate
ADD-related depression at an early age are thought to have a higher chance of
developing bipolar disorder later in life.

        Sometimes the depression seems to occur only during the fall and winter. If
the depression is seasonal, one must determine whether the depression is related to
the change of the seasons or the frustrations caused by coping with ADD. A clear
indication that the depression is seasonal is if symptoms of depression only crop up
during the winter months.

      v) Substance Abuse

      Individuals with AD/HD have several characteristics that make them more
vulnerable to substance abuse

       First of all, an individual with ADD may be attempting to self-medicate
themselves with alcohol or recreational drugs to quell feelings of hyperactivity or
panic. Secondly, if they are not dong well academically they will consort with other




                                                                                       25
individuals who are also more likely to do addictive substances. This is an attempt to
"belong", boost self-esteem and escape reality.

       vi) Bed Wetting

      As there seems to be a statistical correlation between children who wet the
bed (enuresis) and ADD, chronic bed-wetting is one reason to suspect your child
might have ADD.

        A child who wets the bed should always be subjected to a complete physical
exam before any other conclusions are arrived at. It is important to always ask an
adult individual with ADHD about current and past bedwetting problems. Teens with
ADHD also wet the bed, but in this case you might have to do some detective work,
as many are ashamed of the accidents they have at night.

       As ADD and ADHD sufferers are more likely to have sleep disorders, many of
them have difficulty waking up to go to the bathroom when their bladder is full. Their
brains which register low activity even while awake, just don't send their conscious
minds the appropriate signals. They are just not aroused to visit the washroom.

      Bedwetting is usually treated with behavioral interventions and sometimes
medication.

       vii) Frequent Physical Injury

       Children with ADD and ADHD are often rambunctious, curious and very
careless people who run past tablecloths carrying the place settings with them, put
anything colorful inside their mouths and fall out of trees. They are also more likely to
have violent altercations with other children.

      Personnel in emergency rooms call children with ADD "frequent fliers"
because of their frequent trips to the hospital. It is advised that parents of children
with ADD take out adequate medical insurance to cover the high cost of keeping
them healthy.




                                                                                          26
Chapter II. DIAGNOSIS

I. ADD In Children

       The National Mental Health Institute estimates that there are about two million
children in the United States afflicted with ADD or one of the three sub-types of
ADHD (discussed in an earlier chapter.)

i) Common Symptoms

      To be diagnosed with ADD, a child must display one of the three key
symptoms, distractibility, impulsivity and hyperactivity, for more than six months.

      Male children are more likely to develop ADD with their odds of being
diagnosed at 4:1 while girls are 9:1. These figures are possibly not that accurate as in
many children are misdiagnosed or not diagnosed at all.

       Girls are more difficult to diagnose than boys. Excessive talkativeness,
socializing and risk-taking are signs of ADD in girls. On the other hand some girls
may become shy and inattentive, have few friends and seem to suffer from
depression. The latter group usually defies diagnosis until adult-hood. Often these
females are over-achievers who have become expert at concealing their anxiety and
confusion. As a result, girls with ADD are at higher risk for anxiety, depression, drug
abuse and unplanned pregnancy. This makes treatment more complicated for them,
especially later in life.

      Below are subsections that identify the major physiological and behavioral
symptoms of ADD and ADHD in children.


ii) Physiological

       Some of the symptoms described below are a direct result of ADD and others
are a consequence of being afflicted with the syndrome.

       i) Loss of Coordination

       Some children with ADD may display awkward or clumsy behavior. This often
results in hasty or nervous looking behavior that causes them to have many
accidents, break things and suffer from frequent falls. This is because the part of their
brain that controls coordination and perception is considered to be underactive or
"sleeping".




                                                                                      27
       ii) Loss of Balance

        Some children with ADD seem to have difficulties to do with visual depth
perception and balance. Therefore you are advised to supervise them during
gymnastics and keep them away from precarious or risky places, such as roof tops or
tall trees.

       iii) Loss of Motor Control

      Many children with ADD have trouble with the movements of their eyes, which
causes them to be unable to read. Their eyes lack the ability to focus on and track
the marks on the paper.

       The part of their brain that controls other functions such as walking, running,
turning, writing and performing other simple tasks may also be underactive. The child
with ADD frequently drops things, misjudges distances, walks into walls and
expresses frustration when it comes to homework.

       iv) Sleep Disorders

       Children who have a dominance of hyperactivity, may suffer from disturbed
biorhythms and insomnia. Other children may have difficulty waking to perform such
functions as getting up in the middle of the night to go to the bathroom.

       Disturbed brain activity might also cause them to have frequent nightmares.

       v) Bedwetting

         As many children with ADD do suffer from sleep disorders, it is common for
them to suffer from bed-wetting, also known as enurosis. Some of them sleep very
deeply and may have difficulty waking up to go to the bathroom when their bladder is
full. As most children with ADHD have difficulty with discipline and organization in the
first place they may be less responsive to behavioral interventions.

       Children who suffer from ADD, feel ashamed for many reasons in the first
place. This is the result of constant criticism and rejection from their peers. Some of
them just may accept the bed-wetting as one more thing in their life that cannot be
changed or controlled and not make the effort to change the situation.

       Enuresis is classified into four categories:

          Primary enuresis refers to wetting in a person who has never been dry for
           at least 6 months.
          Secondary enuresis refers to bedwetting that begins after at least six
           month of dryness.




                                                                                      28
         Nocturnal enuresis, also called night time incontinence, refers to
          bedwetting that occurs while one is a sleep
         Diurnal enuresis or day time incontinence which refers to wetting while one
          is awake

      Bedwetting is thought to be more common in boys than girls. At age five
bedwetting affects 7% of boys and 3% of girls. By age ten, it affects 3% of boys and
2% of girls. By adolescence, 1% of ADD sufferers still suffer from bed-wetting

        Doctors do not know an exact cause of nighttime enuresis in ADD afflicted
children, except that the area of the brain that controls impulses seems to be under
active.

       Enuresis may occur on its own in normal and ADD afflicted children because
of slow neurological development, a small bladder and a tendency to produce too
much urine at night. It has also been attributed to anxiety, a sudden change in routine
and emotional trauma.

       A very small percentage of children might experience bed-wetting as the result
of such physical problems as bladder infections, kidney infections, chronic nephritis,
diabetes mellitus, lower spinal cord problems and congenital malformations of the
urinary tract. Bedwetting is also associated with enlarged tonsils or adenoids.

      vi) Prone to Injuries.

        According to the American Medical Association children with ADD are more
likely to need medical attention as they experience higher rates of accidents and
illness than children without ADD do. They are more likely to end up in an emergency
room as a result of bone-fractures, car-accidents and chronic medical conditions.
Studies also indicate that they suffer more frequently from infections, asthma and
personal problems than children without ADD.

       These statistics indicate the parents and teachers should be alert for situations
that might put an ADD child at risk. This includes child proofing and such safety
measures as making your ADD child wear a helmet while riding a bike and kneepads
before skateboarding. Children with ADD also usually require more supervision in
the playground and gymnasium than normal children.

        Families affected by AD/HD must have access to insurance and adequate
medical care. Those who are unable get insurance should get documentation of the
child’s medical and psychiatric conditions and talk to their doctor about whether the
child might qualify for an insurance program that is tailored to their needs.




                                                                                       29
iii) Behavioral

       Some of the most common behavioral symptoms can be characterized by the
three main components that identify ADD - distractibility, impulsivity and hyperactivity.

      Keep in mind that the exact nature and severity of ADHD symptoms varies
from person to person. Approximately one-third of people do not have the
hyperactive or overactive behavioral component of ADHD.


i) Distractibility

       Children with ADD seem to lack the ability to pay close attention in class. They
also often lack the ability to pay close attention to details. Their eyes glaze over
when presented with a list of instructions that involves more than one phrase.

      These children also appear thoughtless and careless to others as they try to
speed through projects or chores that they find boring. The handiwork of a child with
ADD is often strewn with what looks like careless or stupid mistakes.

        Often called "daydreamers" or "absent-minded professors" these children also
appear to have their heads in the clouds. Instead of directly responding to a question
they will often respond by stating what is on their mind. As many of them are very
intelligent and creative, their responses can seem completely self-absorbed or "off-
topic."

       Their imaginations and excellent long-term memories also easily distract them.
Few of them seem to have a very strong grasp of what a schedule is and even
though carefully and repeatedly instructed, they often forget what they are supposed
to be doing in the next five minutes.

       As children with ADD can't focus they also develop many learning disorders
because they can't pay attention in class. Their inability to put matters in context also
leads to many misunderstandings and confusing conversations. This often causes
the child with ADD to feel very alone and very misunderstood by others, which almost
always affects their confidence and self-esteem. This feeling of being misunderstood
by others to the point of feeling like an alien encourages the trait of distractibility to
develop to an even worse extent.

       Depression is often the result of a desire to escape the world that becomes
pathologically alien in nature. The child may become sullen, incommunicative and
display little emotion or enthusiasm. He or she may also suffer from insomnia, a lack
or increase in appetite, shame-based behavior and nightmares.




                                                                                       30
ii) Impulsivity

        Children with ADD often suffer from acute feelings of restlessness that cause
them to experience an almost unbearable feeling of malcontent. They display little
patience with any situation and their most hated phrase is "wait your turn." An ADD's
child impatience often suddenly explodes in an outburst of temper.

        ADD sufferers also have a hard time being tactful and rarely think before they
speak. This is part of their self-absorption. They are well known for blurting out
inappropriate remarks at the wrong time, interrupting people or making unkind
observations. This is not so much because they want to be rude, but more because
they are so excited by their thought that they can't wait their turn to express what they
want to say. Many ADD sufferers also suffer from a secret panic that they will forget
their thought before they have a chance to express it out loud as many of them
experience speeding or fleeting thoughts.

        Children who suffer from a predominance of impulsivity may also develop what
is called Oppositional Defiance Disorder. This causes them to object to or do the
opposite of what they are told to do, even if they don't want to. To these children, "no"
means "yes" and "yes" means no" matter what you do. Psychologists say this
defiance is an angry reaction to being constantly disciplined and criticized for their
behavior.

        Anxiety is also a state or a trait that is displayed by children with ADD. They
may appear impulsive as they become more and more neurotic and need to escape
situations that may be triggered by upsetting visual stimuli and "trigger" words. This
might include such frequently made comments such as "I know you can do better
than that" and "Look at me when I'm talking to you."

        Very anxious ADD sufferers may develop obsessive compulsive disorder that
requires them to perform a ritual, such as washing their hands repeatedly several
times a day. This is also an associative disorder that might have been triggered by a
remark or situation that they wish to avoid. The belief is that the acting out of the
ritual somehow defers the situation from occurring again. The person suffering from
OCD may not even be aware of what the trigger is and merely driven by compulsions
from the sub-conscious mind. Sufferers of obsessive compulsive disorder are also
continually plagued by repetitive and unwanted thoughts with their minds continually
seeming to "go round in circles."

       Some children who suffer from ADD might start to display addictive behaviors
quite early in life. In later years these habits might translate to alcohol and
recreational drug abuse, workaholicism and eating disorders such as anorexia and
bulimia. Young girls who have ADD should be carefully watched for a tendency to
over-eat or starve themselves as such habits fall into the category of obsessive
compulsive disorders.




                                                                                      31
       Children with ADD are considered to be more prone to addiction simply
because they tend to feel more angry and lonely than other individuals. They may
start smoking tobacco, drinking and doing drugs at an early age in attempt to self-
medicate feelings of panic, anxiety, hostility and frustration.

        Children who are over-eaters are said to be resorting to ancient carnivorous
drives as the stuffing of food in the mouth also represents the stuffing down of anger.
It also appeases feelings of deprivation that arise as a result of being denied
approval, compliments or affection. Children with ADD are often deprived of approval
simply because others have nothing but criticism for their common behavioral traits.

        Young bulimics and anorexics may feel that their life is out of control and that
the only thing that they can control is their in-take of food. The desire to become tinier
is also related to a desire to be seen as more helpless so that one is treated with
more kindness and compassion. There is a sub-conscious belief that it is a good idea
to become "too small and attractive for others to hurt."

       Tourette's Syndrome, which manifests as tics or compulsive, repetitive jerking
movements and blurting out inappropriate remarks or curses, is the impulsive
quotient of ADD taken to its most manic extent. Tourette's is a hyperactivity disorder
taken to its worst extreme. Depending on the extent of the damage to the person's
psyche, Tourette's Syndrome can be outgrown or last until the end of a person's life.


iii) Hyperactivity

       Children with ADD never seem to sit still. They are constantly fidgeting, picking
at things, drumming their fingers, jerking their legs and tapping their feet. When
allowed to roam free they will often run or feel the urge to climb something such as a
tree or a fence.

       Some sufferers talk incessantly without giving the other person room to get a
word in edge-wise. Sometimes this can be attributed to social insecurity, but in ADD
sufferers it is part of the hyperactive component of the disorder.

       Another facet of hyperactivity is the ability to over -focus, also known as hyper-
focusivity. Some children with ADD have no problem paying attention to something
that they find of great interest or highly stimulating. This is why some children with
ADD seem to able to pay attention while working one-on-one with someone or doing
something they enjoy such as playing electronic games or watching TV for hours on
end.

       Children with a history of bipolar disease in their family might also be prone to
periods of mania. These periods are usually followed by an episode of depression
and are cyclic in nature. Talking excessively, starting many projects at once, acting
wild, boasting, bragging, refusing to take a bath or shower, sleeplessness and




                                                                                       32
demonstrating an overblown confidence in one's obviously limited abilities are all
symptoms of a bipolar disorder.

       Children with ADD usually suffer from some kind of sleep disorder, whether it
is nightmares, bed-wetting or just a refusal to go to bed. Wearing out sleepy parents
by staying up all night is a common behavior of children who display a dominance of
the hyperactive component in ADD.

       iv) Gifted Children with ADD

       "Gifted" has been defined in a variety of ways. In the past, individuals were
defined as gifted by a score on an IQ test. More recently, professionals have been
interested in looking at different types of talents instead of a number that is compared
to national or global averages.

       The term gifted is often used to refer to students with academic gifts in
language or mathematics. More recently, individuals with specific gifts in the areas of
art, music or athletic performance are referred to as talented.

        A gifted child with ADD often displays many of the same characteristics as a
gifted child without the ailment. Ordinary gifted children also become bored, restless
and rebellious if they don't find a curriculum to be challenging. Some teachers may
not appreciate a gifted child’s creative contributions to the class environment.

        Some studies have suggested that gifted children may be more active and
sleep less than normal children. This is a conclusion that corresponds with the
patterns of many children with ADD

        However, unlike children with ADD, gifted children usually pay attention quite
well when placed in accelerated classes. An exception is the small group of
profoundly gifted children whose abilities are so divergent that regular programs for
the gifted cannot serve them. In this small group, there may be an increased
incidence of educational and emotional problems whether or not ADD is present.

        A gifted student with ADD may be very understood by teachers and educators.
If the task is repetitive or below the student’s achievement level, he or she tends to
glaze over or "tune out." However, usually the same student will perform brilliantly if
engaged or awed by a topic or project. The danger is that many teachers may
interpret poor performance as laziness or willful disobedience. When a student is
gifted and also has ADHD, it is common for his homework and class work may be
poor but exam grades to be excellent.

        A gifted student with ADD may be placed in a slower curriculum because the
school may clump many types of special needs students together. This often
happens for economic reasons or because the school is overcrowded. Often the
gifted student with ADD perceives this as a set back and acts up even more. This




                                                                                     33
creates a vicious cycle as he or she is disciplined or sometimes set back in even
more remedial classes.

        The gifted ADD child's anger can create an uncomfortable dilemma for
parents. While, they may feel that an unchallenging curriculum is exacerbating the
child’s inattention or impulsivity, the school, on the other hand, may resist placing the
student into an accelerated class until he can show improved performance.

If you suspect your child is gifted, a proper evaluation of your child's abilities and
limitations is essential. The comprehensive assessment should include a careful
psychiatric evaluation to diagnose the ADD. The psychiatrist should also look closely
for signs of depression, anxiety and other conditions that can co-exist with ADD.
Psychological and educational testing are crucial parts the evaluation as well.

        Psychiatrists and psychologists also often use continuous performance tests
to help assess the degree of sub-type of ADD. The most popular test for this is the
TOVA, which stands for Tests of Variables of Attention. OVA can help educators and
doctors determine where the gaps between intellectual ability and actual performance
are in the subject. Each gap that is found is suspected of being a learning disability. .

        Proper evaluation is beneficial even if the ADD student doing exceptionally
well in school. Many gifted adults are not diagnosed with ADD until they are much
older. As children, they used their superior intellectual and creative abilities to
develop their own learning strategies to fake it through the academic system.
Sometimes, this compensation for a lack of academic attention produces a creative
and talented adult. Often, though, they suffer emotional and self-esteem problems as
a result of feeling ashamed of their low achievement levels.

       Treatment for gifted students is usually similar as those recommended for
individuals of average intelligence. These can include medication, behavioral
programming and therapy. For some students, this may decrease or even eliminate
the need for educational accommodation.

       If the gifted student with ADD does not respond to medication, one may need
to enroll the student in another school setting. They may be enrolled in either public
or private schools. In the public schools, parents and staff can arrange educational
modifications through what are called 504 plans or IEP's (Individual Education
Plans). In other cases, adjustments to the gifted student's curriculum are arranged
on an informal basis with the principal or the teacher.

          Unfortunately a student with an IQ of 154 who maintains passing grades only
is still considered to be educationally handicapped. In most states, giftedness is
specifically recognized as a special education condition. In some other states, it may
be more difficult to get special education services for highly gifted students who are
only performing at grade level. It may difficult to explain that they are performing




                                                                                       34
below par because they are bored. Some gifted ADD students can benefit from
being moved into more accelerated classes with special accommodations.

       Certain private schools work well for ADD Gifted Children because they offer
small classes, tutoring on site and a proactive approach to involving parents in the
educational process. However, most private schools are expensive, and have long
waiting lists.

      In the past decade, admission to traditional private schools has become much
more competitive. This has made it more difficult for bright students with even mild
ADD to secure admission to some schools.

II. ADD IN ADULTS

      . In order for an adult to meet criteria for a positive diagnosis of ADD, he or
she must have evidence of distractibility, impulsivity and hyperactivity dating back to
age seven.

         Diagnosis is often complicated the fact that many older individuals find it
difficult to give an accurate, unbiased history of their early childhood. Often it is
useful to get corroboration from a parent or a sibling about the person's childhood
behavior.

       Diagnosis of adult ADD is also complicated because adults with ADD and
ADHD also tend to have a high incidence of comoribid disorders. One study found
that only 12% of adults referred to their clinic had pure AD/HD without any other
major psychiatric diagnoses such as alcoholism, manic-depression and shizoaffective
disorder.

        In the past, Attention Deficit Disorder was believed to be a condition that only
affected children and adolescents. This is because most people thought ADD was
outgrown by the age of sixteen. During the past two decades, it has been recognized
that attention deficit disorder in older adolescents and adults is more common than
previously thought.

      As a child with ADD moves from adolescence to adulthood, the predominant
symptoms of AD/HD tend to shift from external, obvious ones (such as physical
hyperactivity) to disturbances in the internal emotional landscape.

         Although an adult may not meet the full criteria for ADD longer, he or she may
still experience significant impairment in certain aspects of life due to the negative
"fall-out" of experiencing it as a child. Depending on the person's professional or
domestic situation, the adult may need to deal with more complex, abstract issues in
order to deal with his her complicated reactions to stimuli.




                                                                                        35
         Many adults were never correctly diagnosed, even when they were children.
Sometimes this was because their main symptoms were inattention and impulsivity
as opposed to the physical hyperactivity that marked the diagnosis of the disease in
the fifties and sixties. In other cases, the individual used his or her high intelligence or
great determination to mask the symptoms from others and "beat the system."

       Unfortunately this attempt to hide the disease often incurred great emotional
cost. Even though many adult sufferers of ADD are highly functional, their
compulsive natures make them feel less than perfect. Many of them suffer from low
self-esteem as a result of constantly being shamed and criticized as children. These
neuroses may be layered with typical ADD symptoms such as impulsivity. For
instance, the woman who suffers from a combination of low-self esteem plus the
impulsive component of ADD may feel the urge to shoplift to try and quell feelings of
deprivation.

i) Common Symptoms

       The distractibility component of ADD causes afflicted adults to be bored by
tedious, repetitive tasks. They often initiate many projects and then don't finish any of
them. Throughout their lives many of them become Jack or Jills of all trades - a
master at everything and expert at nothing.

       The impulsivity component often leads to procrastination, frequent job
changes, troubled romances, infidelity and financial troubles. They might also have
trouble staying focussed on an academic career. The fact that they always seem to
be off doing their own thing causes others to perceive them as selfish, unreliable,
irresponsible and immature.

      Often they have reputations as blowhards, braggarts or hot heads. As few of
them are cognizant of the effects of their actions and words on others, they often
disgust or hurt the feelings of others. Sometimes the hyperactive component of ADD
manifests itself as bullying or pushy behavior, excess chatting, being stuck in the past
and excessive self-absorption.

      Below is a compendium of the most common physiological and behavioral
symptom experiences by adult sufferers of ADD.


ii) Physiological

       Some of the symptoms described below are a direct result of ADD and others
are a consequence of being afflicted with the syndrome.

       i) Loss of Co-ordination




                                                                                         36
       Some adults with ADD may display awkward or clumsy behaviors. This often
causes them to have many accidents, break things and suffer from frequent falls.
This is because the part of their brain that controls coordination and perception is
considered to be dormant or "sleeping".

       Adults with ADD should avoid heights, extreme sports and driving in
dangerous conditions. As many of them are terrible drivers, they should also avoid
multi-tasking (talking on the phone or putting on make up) while in the car.

       Adults with ADD should also take extra care to make sure that their home is
safe. For example, throw rugs and exposed wires that can be tripped over are not the
furnishing s of choice for ADD sufferers who often slip and fall in their haste to
remember what they should be doing next.
'
       ii) Loss of Balance

       Some Adults with ADD seem to have difficulties to do with visual depth
perception and balance. They should stay away from extreme sports, driving in
dangerous conditions and attending disorienting rides at amusement and theme
parks.

      As some of them experience a sudden loss of balance, putting safety rails and
a rubber bath mat in the bathtub is also a good idea.

      iii) Loss of Motor Control

       Many adults with ADD have trouble with the movements of their eyes, which
causes them to be unable to read. Their eyes lack the ability to focus on and track
the marks on the paper. Some of them will also have problems watching certain kinds
of computer animations or coping with darkness or strobes. Many are often two-
fingered or inefficient typists.

       The adult with ADD frequently drops things, misjudges distances and walks
into walls. They react very badly to hangovers and other conditions that involve
dehydration and loss of equilibrium.

      iv) Sleep Disorders

       Adults with ADD may suffer from disturbed biorhythms and insomnia.
Disturbed brain activity might also cause them to have frequent nightmares.

      v) Prone to Injuries

       Adults with ADD are more likely to need medical attention as they experience
higher rates of accidents and illness than adults without ADD. They are more likely
to end up in an emergency room as a result of bone-fractures, car accidents and




                                                                                     37
chronic medical conditions. Studies also indicated that they suffered from more
frequent infections, addictions and personal problems than normal individuals.

      Adults affected by ADD must make sure that they have access to insurance
and adequate medical care to cover the high cost of their accident-prone natures.


iii) Behavioral

       Some of the most common behavioral symptoms can be characterized by the
three main components that identify ADD - distractibility, impulsivity and hyperactivity.

      Keep in mind that the exact nature and severity of ADHD symptoms varies
from person to person. Approximately one-third of people do not have the
hyperactive or overactive behavioral component of ADHD.

       i) Distractibility

       Adults with ADD seem to lack the ability to pay close attention a to details.
Their eyes glaze over when presented with a list of instructions, especially if they are
presented in a verbal manner. They are also constantly losing their keys, daybooks,
wallets and other essential objects.

      These adults also appear thoughtless and careless to others as they try to
speed through projects or chores that they find boring. The writing and paperwork of
an adult with ADD is often strewn with what looks like careless or stupid mistakes.

        These adults also often appear to be space cadets. Instead of directly
responding to a question they will often respond by stating what is on their mind. As
many of them are very intelligent and creative, their responses can seem completely
self-absorbed or "off-topic." However, even when not paying attention, they will often
insist that they are or blame the communication lapse on you.

       Few of them seem to have a very strong grasp of what a schedule is and even
though carefully and repeatedly instructed, they often forget what they are supposed
to be doing in the next five minutes.

      Many of them also have distorted priorities. They are more likely to be swept
away by nostalgia, a creative idea or a train of thought than most people. Many of will
make a "to do" list and then forget to look at it.

      As children they may have developed many learning disorders that they
conceal in adult hood. They may mask illiteracy by throwing out "red herrings" in
conversation to appear intelligent.




                                                                                      38
       Their inability to put matters in context also leads to many misunderstandings
and confusing conversations. This often causes the adult with ADD to feel very alone
and very misunderstood by others, which almost always affects their confidence and
self-esteem. This feeling of being misunderstood by others often develops to the
extent that the adult will feel beaten up and broken in spirit by life events.

        Many adults with ADD also develop depression. He or she may become
sullen, incommunicative and display little emotion or enthusiasm. He or she may also
suffer from insomnia, a lack or increase in appetite, shame-based feelings or
behavior and nightmares. Many accomplished sufferers of ADD cultivate depression
and collect disability as it is one way of escaping the cruelty of their outside reality.

       ii) Impulsivity

      Adults with ADD often suffer from acute feelings of restlessness that cause
them to experience an almost unbearable feeling of malcontent. This may manifest
as manic bursts of behavior, such as cleaning the house from top to bottom in just a
few hours, or indulging in an excess of risk-taking athletic activities.

       Adult sufferers of ADD rarely make it to appointments at the bank or the
doctor's simply because they hate waiting in lines. They are also very intolerant of
slow service in any situation, including restaurants and clothing stores. Their erratic
and rude behavior make them into very unpleasant dates. As they have very little
control over their temper, one never knows what will cause them to cry or express
inappropriate anger.

        Adult ADD sufferers often don't know the meaning of the word "subtle" and
rarely think before they speak. This is part of their self-absorption. They are well
known for blurting out inappropriate remarks at the wrong time, interrupting people or
making unkind observations. This is not so much because they want to be rude, but
more because they are so excited by their thought that they can't wait their turn to
express what they want to say. Many ADD sufferers also suffer from a secret panic
that they will forget their thought before they have a chance to express it out loud as
many of them experience "speeding brains."

        Adults who suffer from a predominance of impulsivity may also develop what
is called Oppositional Defiance Disorder. They resent authority and consider
themselves to be loners, rebels and saviors.

        These adults always play Devil's Advocate in any situation. They like to
debate and take conversations to a difficult, irrational extreme. Psychologists say this
defiance is an angry reaction to being constantly disciplined and criticized for their
behavior in life.




                                                                                          39
      As they suffer from low esteem, they always have to come first or win an
argument. Some also think that their rapid-fire speech and overwhelming
personalities seem brilliant, unique or precocious to others.

       Adults with ADD may also develop what is called Antisocial Personality
Disorder This is a personality style characterized by a tendency to violate the rights of
others, to flout societal rules, and to lack remorse for crimes. About 18 to 25% of
ADD sufferers are thought to have this disorder.

        Anxiety is also a state or a trait that is displayed by adults with ADD. They may
appear impulsive as they become more and more neurotic and need to escape
situations that may be triggered by upsetting visual stimuli and "trigger" words. This
might include such frequently made comments such as "Why do you always let us
down?" and "Why don't you listen?"

        Very anxious ADD sufferers may develop obsessive compulsive disorder that
requires them to perform a ritual, such as washing their hands repeatedly several
times a day. This is also an associative disorder that might have been triggered by a
remark or situation that they wish to avoid. The belief is that the acting out of the
ritual somehow defers the situation from occurring again. The person suffering from
OCD may not even be aware of what the trigger is and merely driven by compulsions
from the sub-conscious mind. Sufferers of obsessive compulsive disorder are also
continually plagued by repetitive and unwanted thoughts with their minds continually
seeming to "go around in circles."

        Often obsessive compulsive disorder manifests in adults as a tendency to go
on and on about the past or repeatedly talk about an ex-boyfriend or girl friend.
Alternatively they may repeatedly describe a rosy future that seems very detached
from the logistics of their current reality. ADD sufferers often lose friends because of
their inability to keep promises and to live in the present.

        Individuals with AD/HD have several characteristics that make them more
vulnerable to substance abuse: Adult attention deficit disorder seems to be related to
earlier onset of substance abuse, a longer period of active abuse, and a lower rate of
recovery.

       . It is possible that adults have the higher rate of substance abuse because
their ADD might not have been treated when they were children. A recent study in
Pediatrics showed that AD/HD children and adolescents treated with stimulant
medication were less likely to develop problems with drugs or alcohol in later years.

         Adults afflicted with ADD might start to display addictive behaviors quite early
in life. In later years these habits might translate to alcohol and recreational drug
abuse, workaholicism and eating disorders such as anorexia and bulimia. Women
with ADD are vulnerable to obsessive compulsive disorders such as bulimia and
anorexia.




                                                                                        40
        Adults with ADD tend to feel more angry and lonely than other individuals.
They may start smoking tobacco, drinking and doing drugs at an early age in attempt
to self-medicate feelings of panic, anxiety, hostility and frustration.

        Obese adults with ADD over eat because it appeases feelings of deprivation
that arise as a result of being deprived of compliments or affection. This is usually
because others have nothing but criticism for their behavioral traits. Eating also
squelches feelings of fear and anger.

       Women with ADD should be carefully watched for a tendency to over-eat or
starve themselves. Such habits fall into the category of obsessive compulsive
disorders and include bulimia and anorexia.

       Bulimics and anorexics may feel that their life is out of control and that the only
thing that they can control is their in-take of food. The desire to become tinier is also
related to a desire to be seen as more helpless so that one is treated with more
kindness and compassion. There is a sub-conscious belief that it is a good idea to
become "too small and attractive " for others to hurt.

       Tourette's Syndrome, which manifests as tics or compulsive, repetitive jerking
movements and blurting out inappropriate remarks or curses, is the impulsive
quotient of ADD taken to its most manic extent. Tourette's is a hyperactivity disorder
taken to its worst extreme.


       iii) Hyperactivity

        Adults with ADD are constantly doodling, fidgeting, picking at things,
drumming their fingers, jerking their legs and tapping their feet.    Some sufferers
talk incessantly without giving the other person room to get a word in edge-wise.
Sometimes this can be attributed to social insecurity, but in ADD sufferers it is part of
the hyperactive component of the disorder.

       Another facet of hyperactivity is the ability to over -focus, also known as hyper-
focusivity. Usually they are over-focused on analyzing the self or ancient history.
They also develop focusivity when they are over-stimulated. This is why some adults
with ADD become addicted to gambling or surfing the Internet.

       Adults with a history of bipolar disease in their family might also experience
periods of mania in conjunction with the hyperactivity identified with ADD. These
periods are usually followed by an episode of depression and are cyclic in nature.
Talking excessively, starting many projects at once, acting wild, boasting, bragging,
refusing to take a bath or shower, sleeplessness and demonstrating an overblown
confidence in one's obviously limited abilities are all symptoms of a bipolar disorder.




                                                                                        41
       Adults with ADD also usually suffer from some kind of sleep disorder as a
result of their hyperactivity, usually insomnia.

       iv) Common Personality Traits

         Adults with ADD also display certain kinds of personality traits that identify the
affliction. These are usually defense mechanisms created by the personality so that
they can cope with every day life.

       Some sufferers may become overly rigid and ritualized in their routines. As
they are aware of their own impulsivity this is a way of preventing themselves from
allowing that trait from taking over their lives. They set up elaborate structures to
prevent any accidents or chance incidents that might interfere with their train of
thought. This might include such behaviors as parking the car in the same place
every time or arranging canned goods in alphabetical order in the cupboard. This
type of ADD sufferer becomes very annoyed and upset at the slightest change to his
or her routine, often reacting to any change with anger, anxiety and panic.

       Some adults with ADD give up the fight to win and just sort of let fate take
them to wherever it is they are supposed to be in life. This kind of listless,
irresponsible behavior is the result of being afraid to make decisions, possibly
because they have been criticized relentlessly for having bad judgement. This type of
ADD victim believes that if he or she doesn't take accountability for their own actions
and leaves it up to God or fate, that they can't be blamed or shamed any more.
However, this attitude often complicates their lives further as it makes them seem
irresponsible, unreliable and immature to others.

       Other adults with ADD retreat from others and refuse to do anything more than
they have to do in a day. The reason they think this is a good idea is because they
know that the less they do, the less there is a chance for them to make a mistake or
be tempted to do something impulsive and destructive. These ADD sufferers truncate
their own potential in order to please others. Many of them spend their lives
ruminating about guilt and trying to make up for it by pleasing others as well.

       Some adults with ADD use their imagination, creativity and hyperactivity to
take short cuts in life that often cost them later. As they think fast on their feet, this
type often survives by behaving a con-artist that manipulates others. As they cannot
survive in a normal working environment and also often suffer from a personality
disorder or addiction, preying on others is the only way they have found to survive in
life.




                                                                                         42
III. TREATMENTS FOR AD AND ADHD

       ADHD is recognized as a disability under federal legislation (the Rehabilitation
Act of 1973; the Americans With Disabilities Act; and the Individuals With Disabilities
Education Act). Appropriate and reasonable accommodations are sometimes made
at school for children with ADHD, and in the workplace for adults/

        Clinical experience has shown that the most effective treatment for ADHD is a
combination of medication (when necessary), therapy or counseling to learn coping
skills and adaptive behaviors, and ADD coaching for adults.

I. Common Treatments


        Medication, as prescribed by a physician, is often used to help normalize brain
activity. Stimulant medications (Ritalin, Dexedrine, Adderall) are commonly used
because they have been shown to be most effective for most people with ADHD.
However, many other medications may also be used at the discretion of the
physician.

        Behavior therapy and cognitive therapy are often helpful to modify certain
habits and to deal with the emotional fall out of ADHD. Many adults also benefit from
working with an ADHD coach to help manage problem behaviors and develop coping
skills as organization and estimation.

       i) Types of Testing For ADD and ADHD

       Some children are identified with ADD or ADHD after problems at school bring
attention to the matter. In other families, the parents bring the child because of
disruptions in the home, social life or community.

       Usually a child is subjected to a general pediatric screening to rule out any
physical causes for the symptoms. An adult will be also be subjected to a full
physical. Vision and hearing tests may also be recommended to rule out organic
defects as being the cause of inattention.

       Clinicians will also interview the parents of a child or the relatives of an adult to
determine the duration and severity of the difficulties. If family consents,
communication between a psychiatrist and the child's school is sometimes
recommended as the first step to modifying the child's curriculum. Adults may be
referred to an ADD coach or counselor.

      Children may also be rated according to their behavior. Connors Scales and
the Devereux Scales of Mental Development are tests common used to determine
whether or not a child has ADD or ADHD.




                                                                                         43
       Independent psychological testing can be expensive but useful for individuals
that wish to gage the extent or severity of any learning disabilities, mood disorders or
emotional problems that might be caused by the ADD or ADHD.


II. Medications

       Medications used to treat ADD and ADHD fall into three basic categories:
stimulant medications, non-stimulant medications and mood stabilizers.

       I. Stimulant Medications

      Stimulating medications are among the most popular and oldest medicines
used to treat ADD and ADHD. The most common stimulants are from the following
two pharmaceutical families.

Methylphenidate: includes the brand names Ritalin, Concerta and Metadate-ER

Amphetamine: includes Dexedrine, Dexedrine Spansules and Adderal.

Methamphetamine: includes Desoxyn

Pemoline: includes Cylert

       Despite some damaging reports from the media, these stimulants have a fairly
good track record when it comes to managing the symptoms of ADD. Drugs in the
methlypheidates and amphetamine families o are by far the most commonly
prescribed drugs for sufferers of ADD.

       There have been many studies showing the effectiveness of stimulants in
children, adolescents and adults. Statistics show that stimulants effectively decrease
inattention, distractibility, over activity and impulsivity in three-quarters of individuals
with ADHD.

        Stimulant medications work by increasing the release or blocking the
reabsorption of dopamine and norepinephrine, two brain neurotransmitters in the
brain. This increases the transmission between certain neurons. This has the effect
of waking up the dormant or inactive parts of the brain that cause the inattention
symptom in ADD sufferers.

       i) How Stimulant Drugs Work

       Each stimulant performs these effects on the brain in slightly different ways.
This is why each different type may vary in their effects on any given individual. For
instance, methylphenidate elevates levels of serotonin, and that this may account for
why it calms ADD individuals.




                                                                                          44
        The brain's relationship with attention is a complex matter. First of all, there
are many different types of attention including g selective attention, sustained
attention, strategy development, flexibility and response inhibition. Researchers are
just at the beginning of their attempts to understand how different types of attention
correlate with brain anatomy and drugs.

        However, research has shown some differences between the brain functioning
of individuals with ADD and that of normal subjects. For instance, individuals with
brain injury to the frontal lobes of the brain may show attention problems similar to
those of ADD adults.

.       It is believed that the transmission of dopamine and norepinephrine in the
circuits between the frontal cortex and deeper brain structures play an important role
in ADHD. Stimulants might help to regulate and correct this process in certain
individuals.

       Stimulants are best known for their use in treating ADD and ADHD. However,
they are also used to treat several other common conditions such as narcolepsy,
obesity, depression and apathy in severely ill patients.


        ii) Rapid Acting Stimulants

       Methylphenidate (Ritalin) is the most commonly prescribed stimulant. It is
approved for use in individuals ages six and older. It usually starts to work about 15
to 30 minutes after it is taken. It peak effectiveness occurs at an average of 90-120
minutes after it is taken. This efficacy of this medication can vary from one individual
to another. A dose can take anywhere from 2.5 to 4 hours to take complete effect.

       Amphetamine (Dexedrine) is approved for ages 3 and older. It is also short
acting but usually lasts an hour or so longer than methylphenidate.

      It is important to remember that these medications have a short duration.
Many individuals take a morning dose of methylphenidate at 6:30 in the morning and
a second dose at noon.

        A draw back of using these medications is that it is easier to miss taking a
dose.

        iii) Long Duration Stimulants:

      Metadate-ER, manufactured by Celltech, releases the active component,
methylphenidate, is in a wax-like matrix that releases the drug over a period of
several hours.




                                                                                           45
      Celltech more recently released Metadate CD, which uses a different delivery
system. Its peak effect is generally around 5 hours and its effect lasts 8 hours.
Metadate CD encapsulates the methylphenidate in two types of beads. About 30% of
the medication is released immediately. The remainder is released over time through
beads with a release-control membrane.

        Concerta (Alza Pharmaceuticals) markets a form of Methylphenidate that
uses an osmotic system to deliver methylphenidate in a pulsed pattern. This allows a
12 hour response from a single daily dose. It may prove to be more reliable than
Ritalin or amphetamines. This pulse system, also known as the osmotic "oros"
system has been used successfully for several years in diabetes and bladder control
medications.

       With Concerta, the methylphenidate level does not rise as fast as it would with
Metadate CD, but the Concerta lasts longer than Metadate CD or Ritalin SR. Drug
studies suggest that its duration of action is 12 hours.

      . Novartis, the manufacturer of brand name Ritalin, has recently released a
long-acting form of methylphenidate, called Focalin. Other forms of methylphenidate
such as Concerta and Metadate are mixtures of methylphenidate .

      Dexedrine Spansules, a long-acting form of d-amphetamine, has been on the
market for years. It has a peak effect in 1-4 hours and lasts 6-10 hours. It tends to
have a more gradual tapering and thus may have less of a "downer" effect as the
drug wears off.

       Adderall is a mixture of four salts of d-amphetamine combined with a smaller
amount of the less active r-amphetamine. In November 2001, Shire, the
manufacturer of Adderall, released Adderall XR. In this formulation, the Adderall is
encapsulated in coated beads inside of a capsule. Half of the beads dissolve
immediately, and the other half dissolve about 4-6 hours later. There are, as yet, no
published studies comparing Adderall XR to the less expensive Dexedrine
Spansules.

     Adderall XR is useful for patients who cannot swallow pills. The capsule is
opened and the beads are sprinkled on pudding or applesauce.

       Pemoline (Cylert) is approved for ages 6 and older. It takes about one or two
hours to take effect and lasts up to eight hours. Permoline may take days to build up
enough to have an effect. It should be given seven days a week. There have been 15
deaths due to liver failure associated with Pemoline. As a result this medicine, which
once looked promising, is now a second-line medication for treating ADHD.
Individuals who are taking Peomline are advised to have periodic blood tests to
check for liver dysfunction.




                                                                                    46
        Methamphetamine (Desoxyn) may be effective in some individuals who do not
respond to the other stimulants. It comes in a rapid acting form and a slow release
form. It is considered to be extremely addictive and as has a higher potential for
abuse than the other stimulants. Used carefully in selected patients, it can be an
effective treatment for ADHD.

      iv) Are Stimulant Medications Addictive?

       The Food and Drug Administration (FDA) has classified all stimulants, except
for Cylert, as Schedule II which means that they are addictive and have a higher
potential for abuse than most medications.

       . This means that the physician cannot write prescriptions that automatically
repeat. You must visit the doctor to get the prescription refilled. Pharmaceutical
companies claim that if individuals take their medication as prescribed, the potential
for addiction to methylphenidate or amphetamine is fairly low. Methylphenidate is
absorbed into the brain much more slowly than a compound like cocaine.

       . A study published in Pediatrics magazine in 1999, (showed that individuals
with ADD who were treated with stimulant medication had a lower risk of drug abuse
than individuals who had not taken medication. Still, doctors are usually cautious
about prescribing stimulants to individuals who have a history of drug abuse. Injecting
these ADD stimulants intravenously, inhaling them or mixing them with illegal drugs
can lead to further addictive behavior as well as hideous withdrawal symptoms.

      v) Side effects of Stimulant Medications


        When a medication gives you a symptom that you not want, it is called a side
effect. Many individuals take stimulants for ADD with few side effects. Others
experience mild problems. Some simply possess a body chemistry that is unable to
tolerate stimulants.

       Instead of stopping your medication, consult with your physician to find a way
to reduce side effects. Often annoying side effects can be handled so the individual
can continue to take the stimulant.

Common side effects of stimulant medications include.

Reduced appetite: This effect may be quite pronounced in children and cause an
alarming amount of weight loss. This condition is supposed to improve after several
weeks or months of using the drug. If the condition does not improve, a physician
may recommend reducing the dosage or recommend a short-acting stimulant so that
the person feels hungry again just before meal times. .




                                                                                     47
Rebound Reactions: Some people who take short acting methylphenidate or
amphetamine experience irritability or depression for an hour as the stimulant wears
off. Sometimes this feels worse than the individual's original symptoms before the
medication was started. One can avoid "crashing" by spacing the doses closer
together, giving a smaller dose after the final larger dose, or by switching to a longer
acting stimulant.

Headache: If this does not improve with time, doctors may reduce the dose or switch
to another stimulant. Sometimes restricting caffeine intake helps get rid of stimulant-
borne headaches.

Jittery feeling: Doctors advise eliminate caffeine, including tea, coffee, chocolate and
Coke to manage the bad case of "nerves" that sometimes is a side effect of stimulant
medications. A small dose of a beta-blocker (a type of blood pressure medication) is
sometimes prescribed to reduce tremors and jitters.

Gastrointestinal upset: To prevent an upset stomach, doctors advise taking the
medication with meals or eat smaller, more frequent meals throughout the day.

Sleep difficulty: Insomnia is most common with his longer-acting stimulants (such as
Dexedrine Spansules.) However, sometimes the sleep problem is due to the ADHD
not the medication. If the sleep problem does seem to be due to medication, give the
last dose earlier in the day. Sometimes blood pressure medications such as clonidine
or guanfacine may be prescribed to calm the person before bedtime.

Irritability: Sometimes irritability may be due to the ADD or another psychiatric
disorder. If the irritability is truly due to the stimulant, a doctor may reduce the
stimulant dose, switch to a different stimulant, add clonidine or guanfacine to the
prescription or use another class of medications to treat the AD/HD.

Depression: This may be a delayed effect of long-term use of stimulant medications.
It may be more common with the long-acting stimulants. Screening for a history of
depression, and treating co-existing depression can minimize the dangers of this. If
the depression truly is related to the medication, one may switch to another class of
medications such the tricyclic antidepressants or bupropion (Wellbutrin.)

Anxiety: If an individual is anxious, the stimulants can exaggerate the symptoms. The
treatment for this side effect is similar to that of depression.

Blood glucose changes: Individuals with diabetes mellitus or borderline glucose
tolerance may experience a rise in blood sugar. Such individuals can often take
stimulants but may need closer monitoring of their blood sugar over the course of a
day.

Increased blood pressure: Stimulants may cause increases in blood pressure or
racing pulse. Individuals on very high doses of stimulants or individuals at risk for




                                                                                        48
blood pressure problems should be monitored more closely. Some adults may opt to
continue the stimulant and add a blood pressure medication to their prescriptions to
control this side effect.

Psychosis or paranoia: These rarer side effects usually occur in an individual who is
already predisposed to a bipolar disorder or another psychotic disorder. Psychosis
may also occur when someone takes an overdose of stimulants. It is important to
screen for and treat certain other psychiatric disorders prior to starting a stimulant.

Tics and repetitive movements: In the past, doctors rarely gave stimulants to
individuals with tics because we believed that the stimulant would make the tics
worse. Recent data seems to indicate that low to moderate doses of amphetamine or
methylphenidate do not exacerbate tics. If an individual develops tics or compulsive
movements while on a stimulant, the side effect should definitely be discussed with
the prescribing physician.

       vi) The Right Medication at the Right Time

        . Attention deficit disorder affects individuals differently depending on the type
of activity, and the severity and type of the AD/HD. Some people have mild ADHD or
have learned to compensate for their lack of abilities in most situations. Such an
individual might take a short acting stimulant only to cover school or difficult work
situations.

      Other individuals benefit from broader stimulant coverage. Impulsivity can be
problem for children. Children and adolescents may need to take a stimulant in order
concentrate on doing their homework in the evenings or on weekends. Sometimes
doctors prescribe a longer acting stimulant twice a day. Those who truly need
coverage 24 hours per day may need to be prescribed antidepressants.

       Doctors often start a patient out with a single dose of methylphenidate. This
allows the individual to compare the way he feels on and off the medication. The
dose is gradually increased over time until the patient achieves a satisfactory
response or experiences negative side effects.

       . Even people without ADD have trouble remembering to take medication.
Forgetful individuals might be prescribed a longer acting stimulant such as Adderall
or Dexedrine Spansules. As time goes on, doctors “fine tune” the size and frequency
of the medication doses. Some people take the same dose every day. Others may
take a lower dose on weekends.

      Some adults with ADHD may need to use a pillbox or other reminders to help
them remember to take their medication. Children and adolescents should ALWAYS
have their medication supervised and dispensed by an adult.




                                                                                        49
       vii) Stimulant Medications and Drug Abuse

       Adolescents and adults with ADD and ADHD are at increased risk for
substance abuse. Methylphenidate can be sold as recreational street drug. It is
usually crushed and snorted.

       When an individual has both ADHD and a drug problem, treatment becomes
more complex. Reducing the person’s impulsivity may make it easier for him to make
safe choices. However, doctors do not want this person combining stimulants with
alcohol or illegal substances. Thus, doctors often avoid prescribing methylphenidate
and the other Schedule II medications in individuals who are active substance
abusers. Instead, they may try to treat ADHD with an antidepressant.

        If antidepressants are not effective, doctors are left with a dilemma. If the
patient makes a commitment to stay clean and agrees to constant monitoring than
doctors will cautiously prescribe stimulants.



       II. Non Stimulant Medications

        Although between sixty and eight percent of youths and adults do achieve
significant relief from the use of stimulant drugs used to treat ADD, there are some
individuals who can't tolerate them or simply achieve no results from "speed.'

         There are several good reasons why you might want to choose a non-
stimulating medication over a stimulating one. First of all stimulants do not provide
symptomatic relief and may even excaberate existing symptoms such as anxiety or
nervousness. Stimulants can also have many side effects including but not limited to
tics, tremors, headaches and insomnia.

       i) Types of Non Stimulant Drugs

        There are five main types of non-stimulating drugs that are used to treat ADD.
They include tricyclic antidepressants, antidepressants, blood pressure medications,
mood stabilizers, serontonin uptake inhibitors and selective noradrenergic reuptake
inhibitors.

              i) Tri-cyclic Antidepressants

         Non stimulant drugs include tricyclic antidepressants, such as desipramine
(Norpramine) imipramine (Tofranil) and nortryptiline (Pamelor). These drugs can
provide a 24-hour blanketing of symptoms. They are not associated with the sleep
difficulties often created by the use of stimulants. ,




                                                                                        50
       However, tricyclic depressants do cause other symptoms such as dry mouth,
blurred vision, constipation, dizziness and sedation. Some tricyclic medications,
especially desipramine, can cause changes in cardiac conduction. Children are more
sensitive to this effect than are adults. Children taking tryicylic medications may need
frequent blood tests and EKGs to test their heart rhythms

              ii) Bupropion

       The antidepressant Bupropion, also commonly known as Bupropion is also
considered to be an effective treatment for ADHD. Like trycyclic medications
Wellbrutin provides a 24-hour coverage of symptoms. The chemical structure of
Buproprion also resembles that of an amphetamine, except it is not addictive. Its
main two side effects are jitteriness and insomnia. It is not prescribed to individuals
with a history of seizures.
       \
               iii) Blood Pressure Medication

       Clonidine and Gunafacine are two blood pressure medications that are given
at night to produce sedation at night or during the day in smaller doses to cause an
ADD afflicted individual to become calm.

        Since both of these drugs affect blood pressure, it is necessary to have it
consistently monitored and get regular EKGs to check the heart rhythm. These
medications can help all of the symptoms of ADHD but they may have a weaker
effect on sub-types where in attention is a problem. In some cases, they are
combined with a stimulant if the stimulant does not have enough effect with regards
to reducing irritability and impulsivity.

              iv) Mood Stabilizers

      The mood stabilizers are traditionally used for Bipolar Disorder. (Manic
Depressive Disorder)

      These medications include Lithium and several anticonvulsant (seizure)
medications such as valproate (Depakote) carbamazepine (Tegretol) and others.

      There is debate among child psychiatrists about the percentage of ADHD
youth who have comorbid Bipolar Disorder Some see mood swings as a part of the
AD/HD. Others see it as a sign of a second separate disorder. In either case, the
mood stabilizers may be useful to help modulate irritability and rapid mood shifts.

      These medications require closer medical monitoring. Blood tests and
sometimes an EKG are required when taking this medication.




                                                                                          51
              v) Selective Serotonin Reuptake Inhibitors

        The Selective Serotonin Reuptake Inhibitors (SSRIs) include paroxetine (Paxil)
sertraline (Zoloft) fluvoxamine (Luvox) and others. They probably do not treat the
core symptoms of ADHD but may be helpful for irritability, anxiety or depression
accompanying the syndrome. These medications tend to have fewer side effects than
the tricyclic antidepressants, and do not require as much medical monitoring.

        This class of antidepressants occasionally causes jitteriness, headache,
stomachache, appetite changes, sedation, apathy or irritability. They can interact with
other types of medication, so it is necessary to inform your physician of any other
medications or herbal remedies being taken. Any of the antidepressants, tricyclics,
bupropion, or the SSRIs has the potential to precipitate a mania in individuals with
undiagnosed Bipolar Disorder.

       vi) Strattera

        Eli Lilly manufactures Atomoxetine, also known as Strattera (formerly called
tomoxetine). Released in 2002 , it is called a selective noradrenergic reuptake
inhibitor.

       Common side effects of Strattera are headache, abdominal pain, nausea,
vomiting, weight loss anxiety, sleepiness and insomnia. Studies show that it to cause
less insomnia and appetite suppression than Ritalin. However it may cause a higher
incidence of sleepiness and vomiting than Ritalin.

       Strattera is most commonly administered once a day in the morning. Although
the compound has a short half-life, the clinical effect appears to last all day and even
into the next morning. It can be quite helpful to those who cannot tolerate stimulants
due to irritability or weight loss.

       vii) Newer and Unconventional Medications

        The antipsychotics (haloperidol, risperidone and others) are not usually used
to treat ADD. They may be useful for other disorders that may also be present as a
result of ADHD. Such disorders include Bipolar Disorder, Pervasive Developmental
Disorder, and Tourette Disorder.

      Some, such Lithium and Depakote (valproate) Tegretol (carbamazepine) are
used to treat ADD.

        There is debate among psychiatrists about the percentage of AD/HD
individuals who also have Bipolar Disorder. Some see the mood swings as part of the
AD/HD. Others see it as a sign of a separate, co-existing disorder. In either case, the
mood stabilizers may be useful to help modulate irritability and rapid mood shifts.




                                                                                       52
        If an adult appears to have both ADHD and Bipolar Disorder, the physician
often treats the Bipolar Disorder first and then treats the ADHD. Individuals with both
conditions have a significantly increased incidence of substance abuse. Since illegal
drugs can have dangerous interactions with some prescribed medications, drug
screens may be advisable.

         Modafinil (Provigil) has been approved for treatment of narcolepsy in adults. It
is chemically unrelated to methylphenidate or amphetamine. When compared to
methylphenidate and amphetamine, it seems less likely to cause irritability and
jitteriness. It appears to act on the frontal cortex and is more selective in its area of
action than the traditional stimulants. Cephalon is a company that is doing studies to
assess the efficacy of modafinil in children with ADHD.


       Some women report that their AD/HD symptoms worsen in the premenstrual
period and during the peri-menopausal years. Low or fluctuating levels of estrogen
might lead to the excaberation of ADD or ADHD symptoms. Some women with ADD
have reported improvement in memory and attention span after estrogen
supplementation. A woman who has hormone-related ADD might benefit from taking
a stimulant drug such as Ritalin.

       Nicotinic Analogues are medications that act on some of the same brain
receptors as nicotine. Much of the work on the neurological basis for ADHD has
focused on the regulation of dopamine and noradrenergic neurotransmitters in the
brain. Nicotine enhances neurotransmission of these transmitters.

       This may explain why individuals with ADHD are often so addicted to cigarette
smoking. They may be trying to self-medicate'. A small study involving transdermal
nicotine patches improved AD/HD symptoms in ADHD adults.

              viii) Medication for Adults

        Over the past 10-15 years, it has become easier and less controversial to
diagnose and treat adult AD/HD. Not so long ago, doctors had to get special
permission from drug enforcement agencies to prescribe stimulant medications to
adults.

       Since then, medication options have expanded, but stimulant medications,
usually methylphenidate (Ritalin) and dextroamphetamine compounds (Dextrostat,
Dexedrine Spansules and Adderall) are still a frequent starting place in the
pharmacological treatment of AD/HD.

      Although there is still more information on pediatric ADHD, there is an
emerging body of knowledge specific to medication for adult ADHD. Many of the
medications used to treat children are also used to treat adults.




                                                                                       53
       However, as adults are generally larger, their liver and kidney function may not
be as robust as children. Thus an adult may need less of a particular medication per
pound of body weight.

       Medication may also hang around longer in the adult’s system as they do not
eliminate chemicals as easily as children and are more prone to storing chemicals in
fat.

        Adults are also more complicated to prescribe for as they are more likely to be
taking medications for other medical conditions such as high blood pressure or
diabetes. There is more of a risk that some of these medications may interact with
the ADHD medication Conversely, some of these other medications may have side-
effects such as inattention and thus cause the adult to display symptoms that mimic
those of ADHD leading to a potentially faulty diagnosis.

       Adult ADHD by itself often requires more than one medication to control all of
the symptoms. If the individual has another disorder, such as depression, one may
need to medicate this too. When done carefully and systematically, polypharmacy
can bring relief to individuals who have experienced distressing symptoms. However,
if done in a quick or haphazard fashion, it can lead to serious side effects, or make
the symptoms of ADD even worse.

The stimulants, including methylphenidate (Ritalin) and amphetamine (Dexedrine and
others) along with some tricyclics (such as Desipramine), have demonstrated efficacy
in the treatment of adult and childhood AD/HD.. However, some adult individuals
respond partially or not at all. Others develop uncomfortable side effects.

      III. What If the Medication is not working?

       There has been controversy about the use of medications to treat both
children and adults with Attention Deficit Disorder. Not all medications work for
everyone. Sometimes a medication is not taken in the right dose or at the right time.
The three things to take into consideration are the kind of medication, the dosage and
the timing of the medication.

     Medication can be quite helpful if prescribed in the right context. Small
changes in timing and size of doses can make a surprisingly big difference a swell.

       Although Ritalin is the best known medication for ADHD, there are a number
of other useful medications available as well. For individuals who have an incomplete
response to one medication, the doctor can often work with the patient to find another
medication or combination of medications that does work to control his or her
symptoms.

      Sometimes the failure of medication to work is due to lack of communication
between patient and doctor. The doctor, patient and family should be clear about




                                                                                      54
exactly which symptoms the medication is expected to treat. For instance, a
medication primarily used to treat hyperactivity may not necessarily treat impulsivity.
They should also inform the doctor of side effects or if the medication does not seem
to be working.

      If after many adjustments, the medication is s not working as expected, it may
be time to re-evaluate the diagnosis. Individuals with ADHD may also have other
disorders at the same time. Anxiety and depression may superficially resemble
ADHD. Occasionally a medical illness may masquerade as a psychiatric condition.

       Medication can only take the individual part of the way to recovery. Therapy,
community support, coaching and the individuals own determination are important
parts of treatment.


       IV. Therapies

       I. Types of Therapy

        Cognitive and behavioral therapy (and sometimes a combination of the two
that is referred to as cognitive behavioral therapy) are clinically proven treatment for
many kinds of problems including those associated with ADD such as depression,
mood swings, social anxiety, obsessive compulsive disorder, worry, eating disorders,
relationship problems, stress, low self esteem, inadequate coping skills, passivity,
temper tantrums, substance abuse, guilt, shame and over-excitement.

        Doctors and clinicians will not only recommend these therapies for the ADD
afflicted individual but also for parents, spouses and other care-takers who may feel
like they are at the end of their rope while trying to manage living with an individual
with ADD or ADHD.

              i) Behavioral Therapy

       Behavioral therapy helps troubled individuals control their reactions to
troublesome situations. It helps you develop the ability to choose your habitual
responses and feelings, such as fear, depression or rage, to negative stimuli.

       Behavioral therapists teach individuals how to calm their mind and bodies so
that they can, feel better, think more clearly, and make better decisions.


              ii) Cognitive Therapy

       Cognitive therapy teaches individuals to retrain their thinking patterns so that
these negative thoughts no longer cause distressing emotional, mental and
physiological symptoms.




                                                                                       55
       Cognitive therapists attempt to show individuals how emotions can distort
one's inner picture of reality. The connection between provocative stimuli and your
subconscious mind is explained. Triggers for self-destructive or damaging behaviors
are brought into awareness so that they no longer have power over the individual.


      V. Controversial Treatments

     In less educated circles ADD has thought to be caused by everything from
demon possession to the child being dropped on its head at birth.

        Here are some saner theories that have been put forth in the past thirty years
that consistently teeter on the verge of being miraculous alternative solutions or
totally debunked as a fad.

      i) Nutritional

With the release of such books as "The Sugar Blues" and " Dr. Mindell's Vitamin
Bible" in the sixties and seventies, people became much more conscious of the
phrase "you are what you eat."

       For many years, hypoglycemia or high blood sugar spikes were thought to be
the culprit behind the symptoms of ADD. It was thought that depriving an individual of
sugar would calm them down and enhance their powers of concentration. Many
individuals who tried to control their ADD in this manner still display symptoms of the
disorder.

      Hyperactivity was also thought to be caused by a deficiency of certain vitamins
such as the B family and E. These vitamins are responsible for fueling the body's
motor-control functions.

Although eating right, taking your vitamins and exercising every day is a good idea,
definitive symptomatic relief of ADD symptoms has not been found in a food or a
vitamin.

       As far as foods are concerned, there’s no hard evidence that a dietary
approach helps in all cases. A1993 Cornell University study found that eliminating
dairy products, wheat, corn, yeast, soy, citrus, eggs, chocolate, peanuts, artificial
colors and preservatives seemed to decrease ADHD symptoms. An even earlier
study showed that a low-allergen diet supplemented with calcium, magnesium, zinc
and vitamins also produced favorable results.

       Researchers have also discovered, that eliminating caffeine from the diet can
help eliminate the hyperactive component in sufferers of ADHD.




                                                                                        56
       According to Dr. Andrew Weil, omega-3 fatty acids are recommended
supplements for all children with ADHD. Apparently omega-3s in the plasma and red
blood cells of children with ADHD are lower than in normal children. These fatty acids
assist with brain activity and function.

      According to Dr. Zoltan Rona, past president of the Canadian Holistic Medical
Association, some dietary suggestions that are found to be helpful are:

  1. Provide essential fatty acid (EFA) supplements (as in fish oil, flaxseed oil, DHA /
EFA supplements, primrose oil).
  2. Adjust the types of fats your family eats (good fats are olive oil, fish oil, canola oil
and flaxseed oil; reduce all others). These are also helpful for the cardiovascular
system, and can reduce the risk of cancer.
  3. Eliminate, or at least reduce as much as possible, trans-fats (man-made
hydrogenated oils, which can be incorporated into your brain structure - processed
food, are full of them). These fats are also worse for your heart than saturated fats
and are potential carcinogens.
  4. Avoid food additives and highly processed foods.
  5. Supplement with a high quality multivitamin that contains trace minerals and
other supplements, especially calcium, magnesium, zinc, and B vitamins.

       ii) Elimination of Food Additives

       The belief that food additives can cause hyperactivity in children stemmed
from the research of Benjamin Feingold, M.D. It is commonly referred to as the
Feingold Hypothesis. According to Feingold, perhaps 40 to 50 percent of hyperactive
children are sensitive to artificial food colors, flavors, and preservatives. They may
also be sensitive to naturally occurring salicylates and phenolic compounds found in
many foods.

      Dr Feingold's assertion that food additives are a problem in learning disorders
has been subject to great debate over the past two decades. Practices that profit
from additives have responded by hiring their own researchers to combat the results.
Feingold's work has stimulated great debate, because the American food supply and
agribusiness is profitably enmeshed in the use of food additives.

       Dr. Feingold made his original presentation to the American Medical
Association in 1973. His strong claims were based on experience with 1,200
individuals in whom behavior disorders were linked to consumption of food additives.
Follow-up research in Australia and Canada has tended to support Feingold's thesis.

       iii) Allergy Tests

       The inattentiveness, distractibility and speedy thinking of some ADD
individuals is also thought to be potentially caused by common or unusual food or
environmental allergies.




                                                                                           57
        One way to test this theory is to remove all potential allergens from the
household. This includes all pets, all undercarpeting and carpeting and any sort of
plastic or man-made material that you suspect might be emitting fumes. If your
child's hyperactive behavior diminishes then environmental allergens as opposed to
ADD might well be the culprit.

       Testing for food and other common allergies is as easy as scheduling an
appointment at your doctor's for a series of scratch tests. If allergies are at the bottom
of your child's inattentiveness, then he or she may be prescribed a series of allergy
shots or put on a special "rotation" diet in order to eliminate symptoms.

       iv) Herbs

       Pyconogenal (pine bark), St. John's Wort, Chamomile, Kava Kava, SkullCap,
Valerian, Hawthorne, Passionflower and Linden are herbs that have been suggested
by various sources to relieve the symptoms of ADD. These herbs can be taken in
capsule form or by infusion.

       The author of this book does not support these claims. Always check with your
doctor first before supplementing with any herbs, ESPECIALLY if you are already on
medication. Some herbs and medications have been known to cause painful
chemical interactions.

       v) Homeopathy

        Homeopaths believe that the reason some children and adults suffer from
ADD and others do not is do to a susceptibility to developing the condition in the first
place. If you ask the parent of a child with ADD when he first noticed problem
behaviors or tendencies in his child, he will likely say from infancy or toddlerhood.
Homeopaths frequently observe that this predisposition depends on the constitution
of the individual from birth and may even be affected by the state of the parents prior
to conception and during pregnancy.

       Homeopaths recognize that ADD is a common trait shared among parents and
children and hypothesize that there is some mechanism that we do not yet
understand that causes ADD to be passed on generationally.

      When treating ADD, a homeopath will treat the disease and not just the
symptoms.

       Homeopaths believe that the cell membranes and synaptic endings of neurons
in our brains and nervous systems are composed of DHA, an omega-3 essential fatty
acid. These membranes go rancid unless protected with antioxidants. Since most
people don't get enough DHA, other types of fats are incorporated into the brain
instead of fats that support brain activity. This causes the brain of an ADD sufferer to




                                                                                       58
become dormant. Some studies have shown a relationship between fatty acid
deficiencies and ADD, learning disorders, and behavior problems.

       Homeopaths also recommend supplementing the diet B vitamins, magnesium,
zinc, and Vitamin C to prevent inattentiveness, hyperactivity and depression. Some
studies have shown a relationship between fatty acid deficiencies and ADD, learning
disorders, and behavior problems.

        A homeopath may also prescribe zinc to an ADD patient. A lack of zinc is
thought to deteriorate short and long term memory. Apparently the expression "No
zinc, no think" has some truth to it. Many studies have shown that zinc
supplementation is helpful with memory, thinking and I.Q.

        Studies show that cognitive development can be impaired when there are low
iron levels in the blood. Deficiencies in B vitamins, particularly vitamin B1 and choline
may also be involved.

       Low levels of essential amino acids can lead to neurotransmitter deficiency.
Higher than accepted levels may lead to overactive neurotransmitter. According to
homeopaths, the artificial sweetener aspartame can cause hyperactivity. Some
children are highly sensitive to aspartame and homeopaths advise keeping this
potential neurotoxin out of the child's diet. Aspartame is found in soft drinks or other
processed foods.

      Homeopaths will often treat ADD symptoms by applying "cervical segmental
dysfunction." This is a fancy term for applying pressure at the junction of the neck
and skull/

      They may also suggest that the following common allergenic foods be
removed from the ADD sufferer's diet: milk, cane sugar, chocolate, American cheese
and wheat.

       Unhealthy levels of lead, mercury, copper, or aluminum are thought to affect
memory, concentration, attentiveness and other vital functions of the brain. A
homeopath also might prescribe herbs that assist with the removal of toxic metal
accumulation. Blood tests and hair tests are available for accurate testing, but since
correction can so easily be accomplished using inexpensive homeopathic drops.

      Homeopathic drops function as a catalyst for the body's own inner healing
mechanisms. If the homeopathic remedy is not necessary, then nothing happens! If
not used excessively, there are no harmful side effects to worry about as are often
encountered with most prescription drugs.




                                                                                       59
CHAPTER IV. COPING STRATEGIES

I. Accepting the Diagnosis

       i) Cooperating With Professionals

       Many families go through a period of uncertainty during the time leading up to
the eventual diagnosis. The experience of "getting diagnosed" can be overwhelming
for some. It can either be perceived a blessed relief or a crushing disappointment.

       . Many parents experience this as a loss and need time to accept the
diagnosis. Parents and teachers may have different perspectives on this phase of the
process of acceptance. Teachers need to be patient with parents as they slowly
come to acknowledge the severity of their child's condition. They should not be too
quick to chastise or judge parents who become emotional or angry in parent-teacher
meetings.

       Parents need to listen carefully to teachers' observations about the child's
behavior and how it is affecting other students. However, they must remember that
teachers and schools do not make medical diagnoses. The classic symptoms of
ADHD, inattention, impulsivity, and sometimes hyperactivity, can be due to a variety
of causes including lousy educational methods.

       A parent might request that a specialist observe the child in class or go to
observe the class himself. Conferences with teachers and guidance counselors are
useful ways of gathering and sharing information.

        Finally, a thorough diagnostic evaluation is crucial. It is not a good idea to
diagnose and medicate a child based on a few checklists and a brief office visit. The
psychiatrist or other clinician should take a complete individual and family history,
interview the child, and review data from the school. The clinician should assess the
child for the presence of depression, anxiety disorders and learning disabilities.

         At the end of all this, a good clinician will discuss a comprehensive program
that is designed to address the child's difficulties

       ii) Coping With Medication

       Medication is often an important part of the comprehensive treatment of an
individual with ADHD.

        Ritalin is the most commonly prescribed medication for ADHD. It is important
to remember that it is a short-acting drug and only lasts 2.5 to 4 hours. Often children
are given a morning dose before leaving for school and do not get their second dose
until noon. If this is how your child's medication is scheduled, check to make sure that
he or she is feeling o.k. in the two hours just before before lunch. Some children may




                                                                                         60
experience a "crashing" effect as the medication wears off. If there is a problem
during this period, talk to your child's doctor about adjusting the timing of the
medication doses or switching to a medication that has a longer duration.

       Since teachers may not understand the short -acting nature of this
medications such as Ritalin. They may interpret the irritability caused by the "coming
down" phase of Ritalin as deliberate misbehavior. When teachers note difficult
behavior in a child on Ritalin, be sure to find out whether it is occurring at a specific
time of day. There are a number of medications that can be helpful for ADHD if the
stimulants are not sufficient. If the current regimen is not adequate, a comprehensive
psychiatric evaluation may clarify the roles of both medication and other
interventions.

       Part of dealing with medication is dealing with the issue of stigma. Some
children may think that only "bad" kids need medication.

        iii) Community and Extended family Support

      Community support is important during and after the time of the initial
diagnosis. Extended family can be an important source of support, but can
sometimes also be a source of tension. Parents often feel that extended family
members do not understand the situation. They need to understand that educating
grandparents family members, teachers and neighbors can take time.


II. COPING WITH CHILDREN

       ADD interferes with the child's home, school and social life. Unable to screen
out stimuli, the child is easily distracted. This usually intelligent child receives a label
of being "learning-disabled" and finds the nervous system cannot be slowed down to
focus long enough to complete an assigned task. Other symptoms may be head
knocking, self-destructiveness, temper tantrums, clumsiness and sleep disturbances.

       i) Behaviors of Toddlers and Infants

      Below are some of the behaviors that are identified with infants and Toddlers
who are suffering from ADD that are not necessarily found in older children.

                 Screaming
                 Restlessness
                 Poor or little sleep
                 Difficult feeding
                 Refuses affection and cuddles
                 Head banging or rocking fits or temper tantrums
                 Crying inconsolably




                                                                                          61
      ii) Behaviors of Older Children

      When it comes to ADD in older children in adolescents, expect the
unexpected, every day. Here are just few of the symptoms that tend to drive most
parents and siblings right around the bend.

                Impulsiveness
                Clumsiness
                Constantly moving
                Destructive or disruptive behavior
                Accident proneness
                Bouts of fatigue, weakness and listlessness
                Aggressiveness
                Poor concentration ability
                Vocal repetition and loudness
                Withdrawn behavior
                Restlessness
                School failure despite normal or high IQ
                Poor sleep with nightmares
                Poor appetite and erratic eating habits
                Poor coordination
                Irritable, uncooperative, disobedient, self-injurious, nervous, very
                 moody or depressed
                Hypersensitive to odors, lights, sound, heat and cold
                Nose and skin picking or hair pulling
                Bed wetting (enuresis)
                Dark circles or puffiness below the eyes
                Red earlobes or red cheeks
                Swollen neck glands or fluid behind ear drums


      iii) Behavioral Planning

       Conflicts arise around the house all the time. Children misbehave, they forget
their homework, don't listen, talk back or don't do their chores. When parents do not
create a united front or establish firm boundaries, children with ADD see an
opportunity to create even more havoc. Without a calm household with established
routines, chaos can erupt on an hourly basis.

       In the home, structure and behavioral planning can go a long way towards
benefiting the peace of mind of everyone in the family. However this is easier said
than done as one has to be careful not to create rebellious behaviors, such as
oppositional defiant disorder




                                                                                        62
       The key to developing a successful behavioral plan is to keep it consistent,
simple and include frequent rewards for good behavior. Make sure you use positive
reinforcement and follow through on your promises to the child.

        Daily rewards are more encouraging to children with ADD than weekly ones
as they cannot usually foresee into the future that far. Plans that involve the
immediate squelching of the child's behaviors never work. You will only meet with
rebellion.

       Many parents are often tempted to use corporal punishment because they feel
that nothing less will get a child's attention. Actually, one should especially avoid
such punishment in ADHD children because they are impulsive and more likely to
imitate a violent act. Parents must also teach their child to have a sense of personal
responsibility for their actions.

       iv) Childproofing

        . Impulsivity is a common feature of ADHD and it may manifest itself in
climbing tall trees, getting into medicine cabinets, and playing with power tools. Their
motor hyperactivity makes them quite fast, and they can be into tremendous trouble
in the time it takes a parent to reach for the salt shaker.

       Some ADHD children have coordination and balance disorders. Those who
do not often lack judgement or depth perception so before you know it, they have put
themselves in some kind of precarious or risky position.

    Many people think of childproofing as only for families with toddlers and infants.
All families should probably pay special attention to safety precautions extent until the
child goes to college.

        Many family crises could be minimized if valuable breakable objects were
locked safely away. Certain stain-repellant paints, vinyl wallpaper, and carpet
treatments make accidents less costly. Linoleum with the pattern printed through the
entire thickness of the material is less likely to show scratches and damage caused
by ADD children. Sometimes one can plan indoor traffic patterns to keep muddy feet
off certain surfaces.

       A basic rule of thumb: don't buy expensive furniture until your ADD children
have left home!

       v) Coping With Medical Personnel

   Children with ADHD are at increased incidence of injuries and fractures. If you
have an accident-prone child, make sure you have an emergency plan. Appoint
neighbors to watch your other kids in the event that you have to seek emergency
care.




                                                                                      63
      Multiple or odd fractures can raise the issue of child abuse amongst
emergency personnel. Be sure to explain to all involved that your child has balance
and coordination disorders as a result of having ADD or ADHD.

       If you do get accused of child abuse, insist that the emergency room
physicians contact your pediatrician so that he or she can discuss the case with
them. If you do get investigated, try to remain calm. Have a spouse or close friend
with you for emotional support.

       vi) The Reactions of Siblings

       Siblings may feel ignored as most parents focus all of their attention on the
child with ADHD.

        Make sure that you make spending quality time with your other children a
priority on your agenda. Give them plenty of understanding and frequent
opportunities to vent their feelings about the ADD affected sibling in private.

      Make an attempt to educate them about their siblings' symptoms and how to
handle them. Instruct them as to how they can help YOU deal with it. This makes
them feel, as they are part of the solution as opposed to being part of the problem.

       vii) Coping With Stigma

        Believe it or not, whom you decide to tell about your child's problem falls under
the discrimination of your child (if he or she is old enough to make that decision of
course.) Many times it is advised to let playmates and their parents get to know the
child first. That way the child is not stereotyped before he or she can even form
relationships with others.

         How much you tell the school about your child can also be a hard call. Usually,
it is a good idea to let the school know if your child has any special needs. However,
this can be a particularly thorny issue if your child is applying to a private school.
Some schools are more understanding about ADHD than others are. If a school is
trying to decide between one hundred children who are applying for ten spaces, you
could be denied because your child is an ADD sufferer. If you know the parent of an
ADD child who attends the school, they might be able to give you advice.

       If your child is currently attending a particular school, one should be sure to tell
the school nurse about any medications, even if they are given at home. Children do
have accidents at school and the information should be available in case of an
emergency.




                                                                                        64
       viii) Educational Needs

       Often simple changes in the classroom environment can make a big difference
for a child with a short attention span. The teacher can place him near the front of the
class and work out secret visual or oral cues to remind him or her to stay on focused
on the lesson.

       Sometimes, the parent feels that further educational intervention is needed or
the child will suffer devastating life-long consequences. As educational funding is not
abundant the parent may be put in the position of being an advocate for his or her
child.

       For children in the public schools, there is a specific, legally mandated system
to help determine the child's educational needs. If you feel that your child needs
educational testing or special education resources, ask for an official meeting to
review your child's educational plan. Often parents can assist the school in gathering
information to determine whether the child needs testing or special help

        When advocating for your child, be aware of your child’s educational and legal
rights. However don't put anyone on the defensive by quoting the law to staff
members. If your child has a special educational plan (IEP), always review it carefully
before the formal meeting. If possible, both parents should come to the meeting. If
one parent is feeling angry or frustrated, try to have the more serene parent do the
talking. If the special education process is confusing, you may seek out a
professional educational advocate to come to the meeting with you.

       If the school agrees to do the testing for your child they will often pay for it.
Attempt to meet with the school psychologist who is assigned to the testing process
to go over the test results before you meet with school officials.

      Another option, especially if the school is insisting that your child is just
naughty as opposed to afflicted with ADD, is to obtain outside evaluations at your
own expense, to bring to the school meeting.

        If you have any energy left over from dealing with your ADD afflicted child all
day, try to volunteer time for your child’s school. Volunteers can help to free up some
of the teacher’s time. This may indirectly, give the teacher time to focus on your
child's needs.

       Volunteering also gives the parent an opportunity to get to know the school
environment and some of the child's classmates. Having a good knowledge of the
functioning of your child's school can help clear up potential misunderstandings.

      Some parents choose to arrange for private evaluations or tutoring. Speech
therapy, occupational therapy and some other services may be covered by some
insurance plans. Some companies have dependent medical care plans which allow




                                                                                       65
the parent to put pre-tax money aside for medical and child care expenses. This can
be used to cover certain kinds of assessments and treatments not covered by
insurance or paid by the school. Check with your employer or tax specialist to find out
if you are eligible for this kind of funding.

       Many private schools have arrangements with tutors and speech therapists. In
these cases, the parents usually pay for the services. In some situations, a child in a
private school may qualify for free services funded by the public schools.

       ix) Homework

        A child with a short attention span may have more difficulty sitting doing
homework on his own. He or she may opt to play, bake cookies, watch T.V. or fall out
of a tree instead.

      All children need a solid routine, but ADD children need consistency even
more than normal children do. When it comes to homework, it helps to set a specific
time and place for the child to do the task every night

      If you feel supportive of your child, doing homework together can be a positive
opportunity for you to see how your child is doing academically. The parent can also
go over concepts that the child may have missed while not paying attention at school.

       Medication can also help children focus on homework. For some students,
particularly those with learning disabilities, the standard amount of homework is just
too much. They and their parents spend the entire evening arguing about getting it
done. There is no enjoyable family time left before bedtime. If this is truly the case,
the parent should talk to teachers about allowing your child to accomplish shortened
assignments without penalty.

       Conversely, if you suspect your child is not paying attention in class, you can
ask for extra assignments so that the student can make up the missed material
without encountering the distractions of the class room situation.

       x) Assistive Technology

       As most children with ADD and ADHD love screens and the excitement of
video games, you might want to try exposing them to computer-based educational
soft-ware.

       These programs provide immediate feedback and appealing visuals t that
makes the learning process seem glamorous to ADD kids (and normal children as
well!)




                                                                                      66
       Many feature cartoon characters who function like a tutor. Newer software
allows a parent to customize the program by changing the difficulty, deleting voices,
and changing the reward frequency.

        Many parents feel intimidated by computers and the Internet and allow their
children free reign with software and Internet surfing. It is better to supervise and
have ground rules. Some software programs and Internet sites contain over-
stimulating graphic violent or sexual themes. Children with ADHD may be more
vulnerable to the adverse effects of over-stimulation and might suffer nightmares or
try to mimic the behaviors.

       xi) Coping With Adolescents

      In the case of adolescents, the parent must continue to supervise homework
for more years than a parent of a normal teen does. Parents may accomplish this
gradual pullback by the use of calendars, checklists, and day planners

      Regular contact with teachers can give the parent feedback on whether they
need to be as directly involved in homework supervision.

       Older elementary school children and adolescents should be educated about
ADHD and, if applicable learning disabilities. For the adolescent, knowledge and
acceptance of his strengths and weaknesses can help him make good choices.
Denial of one's difficulties is common during the teen years.

       xii) Self-Esteem Issues

        Children with ADD are very sensitive. They often display shame-based
behaviors as well as anger, defiance and hostility to mask their guilt and fears of
criticism and disapproval.

        This is why it is very important to flatter, encourage and compliment a child
with ADD at every opportunity possible. Their natural tendency is to resist physical
affection, but kind words will help smooth a path to a mutual understanding between
the two of you.

       Make it a rule never to go to bed angry with your child. This can provoke all
kinds of sleep disturbances including nightmares and bedwetting.

        Ultimately the most important thing is to instill an attitude of responsibility and
mastery in your child. Do this no matter how small the achievement. This will help
him or her raise their sense of self worth as well as learn how to take responsibility
for his or her actions.




                                                                                          67
III. COPING WITH ADULTS WITH ADD

       I. How to Recognize Adult ADD

         Fidgeting, interrupting conversations, losing things, forgetting the reason for a
trip to the grocery store - everyone acts this way once in a while. But a long and
persistent history of restless, impulsive, or inattentive behavior may be a sign of Adult
ADD. This is especially true if these behaviors have existed since childhood and
result in problems at work, home, and/or in social situations.

       Adults with ADD tend to -


   Have difficulty concentrating or focusing your attention on one thing.

   Start multiple projects at the same time, but rarely finish them

   Never get organized

   Make To Do lists then ignore them
.
   Procrastinate

   Have trouble remembering appointments or obligations

   Have trouble staying seated during meetings

   Be restless or fidgety.

   Constantly lose or misplace things

    II. The Impact of ADD on Adult Life

ADD affects adults in all areas of life, often with disastrous consequences.

   Job performance. Their work performance may be inconsistent because they
    have problems organizing their work, managing their time, and concentrating on
    one task at a time. They may be forgetful and misplace or lose things. They may
    often be criticized for their erratic work habits, behavior or appearance. Many quit
    their jobs out of boredom.

   Personal relationships. Relationships may suffer for adults who have problems
    focusing their attention on conversations They also have trouble sensing the
    behavior and moods of others, as well as expressing their own feelings. They
    often say just exactly the wrong thing at the worst time. This is because they have




                                                                                       68
    damaged instincts as a result of being so misunderstood in childhood.

   Temper. Most ADD sufferers are impatient and easily make mountains out of
    molehills. These adults may overreact to minor stresses and display a short, quick
    temper. They come off as rude and intolerant to others.

   Problem-solving ability. ADD adults lack the ability accurately foresee the
    consequences of their actions. As a result, they may engage in risky behaviors,
    such as unprotected sex, alcohol and drug use, gambling or investing in unwise
    financial ventures.


    III. How To Recognize Your Own ADD - A Self Test.

       The following simple test may help you determine if you should receive further
testing for ADD or not. Simply check the appropriate number with a 5 meaning you
experience this symptom to a great degree and a 1 meaning that you have not
experienced it at all.

                                  ADD SELF TEST

Do you prefer to print because you have poor handwriting?

012345

Do others consider you to be clumsy?

012345

Do you become flustered as deadlines approach?

012345

Does your mind go blank when taking tests?

012345

Do you believe the harder you try, the harder it gets?

012345

Do you feel like cracking up when under pressure?

012345

Do you hesitate or clam up when people ask you questions about yourself?




                                                                                      69
012345

Does reading a book put you to sleep?

012345

Do you suffer from speeding thoughts or busy brain at night?

012345

Are you a night person as opposed to a morning person?

012345

Do you feel like you need a nap mid-morning and mid-afternoon?

012345

Do you often feel tired for no reason?

012345

Do you surprise easily?

012345

Do you prefer that other people not touch you too much?

012345

Did you come home with "bad" report cards in elementary school?

012345

Are you easily bored?

012345

Do you like to fantasize or daydream?

012345

Do others criticize you of a lack of attention to detail?

012345




                                                                  70
Do you tune out when people verbally give you directions?

012345

Are you always losing things?

012345

Do your eyes skip words when you read?

012345

Do you have sexual dysfunction?

012345

Do you detest changes in your daily routine?

012345

Do others constantly accuse you of interrupting them?

012345

Do others accuse you of not listening to them?

012345

Do you often feel unbearably restless and fidgety?

012345

Do you think better while pacing?

012345

Do you hate going to the movies because you have to still for so long?

012345

Do you often feel nervous or anxious?

012345

Are you addicted to shopping?




                                                                         71
012345

Do you say the wrong thing at the wrong time?

012345

Do you resent authority?

012345

Does waiting in line at the bank drive you so crazy that you have to leave?

012345

Do you often find yourself wanting to get into a situation and then feeling trapped by it
once you are in it?

012345

Do you collect a lot of tickets for traffic violations?

012345

Do you change careers often?

012345

Do you get a secret pleasure out of embarrassing others?

012345

Do you consider yourself to be a liar? Rate your ability to tell the truth?

012345

Do you have a messy office?

012345


Are you always late?

012345

Do you organize by putting things in heaps or piles?




                                                                                      72
012345

Are you easily overwhelmed by every day tasks?

012345

Rate the state of your finances with 5 being almost bankrupt and 0 being wealthy.

012345

Do you need a maid?

012345

Do you suffer from procrastination or put off things to the last minute?

012345

Do you start many projects and forget to finish them?

012345

Do many of your relationships have a fantastic beginning but a poor ending?

012345

Do you have to work overtime to make up for missed deadlines?

012345

Do you change your mind a lot?

012345

Do you feel like a failure in life?

012345

Do you feel less worthy than others?

012345

Do you feel cursed or like fate has something bad in store for you?

012345




                                                                                    73
Do you suffer from mood swings?

012345

Do you see the glass as half empty?

012345

Have you ever been accused of a crime?

012345

Do you have trouble sustaining friendships or romances?

012345

Do displays of affection embarrass you?

012345

Do others often accuse you of only thinking of yourself?

012345

Do people often refuse to look you in the eye or talk to you?

012345

Are you verbally abusive to others?

012345

Are you a drama queen?

012345

Are you a loner?

012345

Have you ever been arrested for a felony?

012345

Do you often feel that others are making fun of you?




                                                                74
012345

Do you have a short temper?

012345

Do you like gambling?

012345

Are you mostly right while other people are wrong?

012345

How much do you worry?

012345

How addictive are you?

012345

Do you find yourself switching around letters or words or printing them backwards?

01 2345

Do you mix up your words in sentences when you talk?

012345

Are you the only one who can understand your handwriting?

012345

Did you spend a lot of time in detention at school?

012345

Do you have a history of bedwetting past the age of five years old?

012345

Do you have a family history of ADD, mood disorders, manic depression or
substance abuse?




                                                                                     75
012345

Calculating your results.

If you answered mostly 0's, then this test is not applicable to your situation.

If you answered mostly 1's you are not likely to be suffering from any kind of
personality, mood or mental disorder

If you answered mostly 2's you are a well-balanced healthy individual.

If you answered mostly 3's you may display some ADD related sometimes but not
with a severity that require you to seek out professional help for the problem.

If you answered mostly 4's you may be suffering from a subtype of ADHD that
includes one of the components of ADD - hyperactivity, impulsivity and distractibility.
It might be a good idea to talk a physician regarding your problems.

If you answered mostly 5's then you might be suffering from ADD along with a
comorbid disorder such as manic-depression, paranoia, alcoholism or obsessive-
compulsive disorder. This is an indication that you should seek help for your
problems as soon as possible.




                                                                                      76
CHAPTER V. ANSWERS AND RESOURCES

I. Frequently Asked Questions


        hi my name is jessica gonzalez. i am 17 years old. i'm not quit an adult but i
think i have add. i'm really scared because i never new it until i saw the commercial
of adult add and well i took the test and it came out that i have add. and i don't know
what to do. i'm scared. what do i do.


      Jessica, you should do the following things in this order. Xerox this page if you
have to and ask a friend or a relative if they can help you keep on track.

        VISIT A DOCTOR. He or she will be able to put you on medication or tell you
what to do next.
        TELL A TEACHER OR SCHOOL COUNSELOR. These people are trained in
telling you how to get help.
        TELL YOUR PARENTS. Tell your parents. If they ignore what you are saying
still continue to visit the doctor and tell the teachers. Sometimes it takes time for
parents to recognize the problem

      Please don't panic. Realize that you may NOT have ADD because many
people have these symptoms. Also what we see on T.V. is not always reality. Stay
calm and remember to do the three things listed above.

         My son 13 yrs.old was diagnosed with ADD. He has trouble turning his
homework on a regular basis, i have worked with him trying to organize with tabs,
color coded notebook for different subjects. How do i help him with organizational
skills as well making him understand it is important to turn required homework in on
time....

       Chances are that your son finds all of the color-coded tabs on the notebooks
distracting and confusing. Perhaps try organizing all of the information in a single
binder as opposed to spreading it out over several notebooks. Suffers of ADD have
trouble keeping track of multiple objects.

       As your son may have an impaired sense of priorities and time there is not
much you can do to make him understand the concept of turning in his homework at
time. However establishing a set time every night as well as a set place in the home
every night for doing homework may help him establish a pattern in his mind that
makes doing homework a part of his daily routine.




                                                                                       77
      Your doctor may also be able to adjust his medication or prescribe new
medication that can calm him and help him focus more on matters at hand.

      I am a child care provider and one the children i care for was just diagnosed
today with ADD. i would like to know how to cope with it and how to cope with him
without going over the edge. I need help on discipling and how to make him
understand that he not an outkast of the other 3 kids in his family.

      Hi there, you are expecting to accomplish miracles overnight and that is just
not possible with kids with ADD.

       To cope with it you will need tolerance, patience and understanding. You must
not take any of his remarks or reactions to you or others personally. This is also true
of any unreliability, untrustworthiness or outbursts of temper that he may display.

       Disciplining a child with ADD is usually pointless as they very often forget the
very actions that caused their punishment in the first place.

       If the child is an outcast from his siblings you cannot paint the truth to him as a
pretty picture. Most children with ADD are very intelligent and feel humiliated when
people try to make them feel better by telling them lies or humoring them. You are
better off to talk to the parents and suggest that they get family counseling to deal
with the problem with the siblings.

      As you are not experienced with children with ADD, you might want to
recommend that the child's parents consider placing him in a facility where the
disease is completely understood. This minimizes the risk to your personal
culpability, harm to other children in your care and a potential lawsuit from other
parents should this child decide to harm another child.

       What is the best way to try to stay on task and actually FINISH something? I
love to be organized, but rarely finish what i start.

       The best way to accomplish a goal is to break it down into smaller, incremental
tasks. This is called "lining up all your ducks in a row." Then assign one or two tasks
to accomplish each day until you complete the task.

       If you are truly having trouble following 'to-do lists", schedules and calendars
then you might want to speak to your doctor about adjusting your medication.

        Different medications affect different parts of the brain when it comes to
discipline and attentiveness. A long-acting medication or an ant-depressant might
assist you in developing more long-term views of the future. If you are medicated and
not completing tasks it might be because your medication has lost its efficacy for you
in adult-hood.




                                                                                          78
      why do i feel so reluctant to participate in activities such as card games, or
group activities, am i as dumb as i feel? or is it the adhd?

    Never call yourself dumb. Studies show that individuals with ADD are often
MORE intelligent than average.

       There are many reasons why you might be feeling like this. It could be that you
find your friends or the games boring. Or it could just be that you prefer activities that
you do on your own.

       Remember there are a lot of people out there without ADD who prefer to be
alone rather than with others. They are called introverts. People who like to socialize
with others are called extroverts. It may not be the ADD at all. It may simply be that
you are a personality type that prefers to be alone.

        Is there any way to control symptom with out using drugs? Are there any diet
tricks to help me stay focused?

       Staying away from the caffeine found in chocolate, coke, tea and coffee is
thought to lessen symptoms of hyperactivity in ADD sufferers. You may also want to
try supplementing your diet with omega-3 fatty acids.

       How could a school miss it for 11 1/2 years? My daughter was just diagnosed
with very severe ADD She is in 11th grade. How do I make up for all those years?

      Many children, especially bright children are able to mask their symptoms of
ADD until they reach the later grades when they are required to work with more
complicated, abstract topics. ADD also masquerades as many different types of
disorders so her teachers may have chalked up any strange behavior to problems at
home, laziness or disobedience.

       You can't make up for all those years because they are past and gone.
However, you can proactively seek a consultation with the school so that they can
adjust her curriculum for her.

       i am an adult with add and am on medication. i am in college and am still
struggling with concentration and staying on task,especially while studying. do you
have any suggestions to help me improve on concentration?

        Make sure that you have a quiet place in your apartment or lodging that is
specifically used for the purposes of studying. Study at the same time every day for
an allotted number of hours. While studying resist such temptations as turning on the
television, radio or eating.




                                                                                       79
       If you are having serious problems with your concentration, a trip to a
physician to explain your problem may result in an adjustment or change in your
medication so that you can focus better.

      how do you gain control over your life when it is so out of control?    how do i
balance a busy life-house, child, job, dogs-

       People without ADD have trouble managing all these factors in today's busy
world so first of all it might help if you stop trying to be a perfectionist. Another
solution would be to simply and streamline your life so that there are fewer factors to
manage and take care of.

       Will I have this condition for life? Will the add ever go away overtime? Can
the mind over matter situation overcome the problem. Like mental coping, can it
manage the problem or do I have to be on meds for the rest of my life?

        ADD is not a matter of mind of matter. ADD symptoms improve or worsen
according to the number of stresses you have in your life. Chances are that you will
have ADD for life so it is important for you to practice basic self-care as well as avoid
situations that will provoke or worsen symptoms of the disease.

How do I help my 17-year-old sons and my 15-year-old son succeed in school if they
won't take medication for their diagnosed ADD?

       If they are being disobedient about taking their medication, family counseling
is recommended. Ask your physician or psychologist if they are good candidates for
behavioral or cognitive therapy.

       My most important question is how can I get my ADD under control? I have
tried Wellbutrin, but it doesn't seem to help at all with the ADD symptoms.

      Consult with your physician to see if he thinks any of the newer medications
such as Strattera or long acting Ritalin is right for you.

       I have adult ADD and I get bored so easily, even when talking to my spouse I
find myself tuning out and thinking of something else, how can i pay attention better?

       This may be a case of trying to hard to listen to the other person. Many ADD
individuals find the harder they try to do something, the harder it gets. Try to relax
and not think about your boredom while listening to other people speak.

       My daughter is 21 now, she is just about to finish collage, she is very bright
and has done very well. It is just that she looses things and her room is messy, what
can you suggest for helping her get organized. She was on ridilin (spelling?) but took
herself off when she started jr. high school. She self medicates with caffine (coffee),
which helps a lot




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       Cutting out the coffee would certainly improve your daughter's focus and
concentration. She would also benefit from a trip to her physician to discuss other
options for medication. Adults are often prescribed longer acting designer
medications that work for a longer period of time than Ritalin.

      What supplents will provide me better eyesight and dramatically improve my
focus? I am currently taking Ginko Biloba, L-Tyrosene, Gaba, Carnitine, Omega 3,6
and 9 along with Flax seed Oil ,Grape seed extract, a bunch!

       You have pretty much covered most of the supplements that are
recommended for eye-sight and improving focus. Bilberry seed and pycogenal are
herbs that are thought to improve the eyesight. Supplement with Vitamin A and zinc
might also enhance your brain function.

       How do you get your college-aged son to recognize aspects of his life that are
a result of ADD & that he needs to recognize it & then seek all the help he can get
from wherever he can get it?

       If your son does indeed have ADD than he is not likely going to listen to you.
As he is an adult he will not likely seek help until he hits "rock bottom." He must suffer
a great loss, such as the loss of a relationship or a degree before he is compelled to
recognize he has a problem and seek help. As you are not always going to be around
to take care of him, it might be a good idea to cut the apron strings. That way he can
learn to take care of himself.

       How parents can help 26 year old son with ADD disorder?

        In such a situation you can consult with a psychologist as to how to perform
what is called an intervention. This is where all of the relatives and friends of the
afflicted individual sit down together and encourage him to seek the needed help. He
may feel threatened or shamed by this, so it is important to have a counselor that is
trained in the procedure of such interventions be with you if you decide to take this
route.

II. RESOURCES

i) Associations

ADDult Support of Washington for Adults with Attention Deficit Disorder
Attention Deficit Disorder Association www.add.org
CHADD - Children and Adults with Attention Deficit Disorder
National Attention Deficit Disorder Association
Project Pursuit
Schwab Foundation for Learning
Tourette Syndrome Association




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World Attention Deficit Association. www.add.com

ii) Helpful Web- Sites

About ADD add.about.com
ADDmed www.admed.com
allRefer Health - Attention Deficit Disorder (ADD/ADHD)
http://health.allrefer.com/health/attention-deficit-disorder-add-info.html
# Attention Deficit Disorder and Parenting http://ld-add.com/
 Attention Deficit Disorders, Hyperactivity & Associated Disorders -
my.execpc.com/~calliope
Attention Deficit Hyperactive Disorders
http://www.geocities.com/Paris/Cafe/3813/addult.html
Internet Special Education Resources www.isr.com
One ADD Place www.oneaddplace.com
Learning Disabilities Online. www.ldonline.org
Northern County Psychiatric Associates. . www.ncpamd.com

iii) Books

All That Wiggles is not Hyperactive; The Over-diagnosis of ADHD
by Thomas G. Shafer, M.D. and Susan V. Shafer, RN (1993)
Attention Deficit Disorder: A Different Perceptive by Thom Hartmann (1993)
Daredevils and Daydreamers: New Perspectives on Attention-Deficit/Hyperactivity
Disorder , 7 by Barbara D. Ingersol, Ph.D. Ingersoll (1997)
Driven to Distraction and Answers to Distractions by Drs. Hallowell and Ratey (1996)
Help for the Hyperactive Child by William G. Crook (1991)
The Hidden Handicap by Dr Gordon Serfontein (1990)
The Hyperactive Child, Adolescent and Adult (Attention Deficit Disorder through the
Life Span) by Paul Wender, MD (1987)
The Hyperactive Child Book by Patricia Kennedy (1988)
If Only We'd Known by M. Sasse (1990)
If Your Child is hyperactive, Inattentive, Impulsive, Distractible by Stephen W. Garber
Ph.D (1990)
The Impossible Child by Doris J. Rapp (1989)
Is This Your Child? by Doris J. Rapp (1991)
Smart But Feeling Dumb by H.N. Levinson (1990)
The Suddenly Successful Student (A guide to overcoming learning and behavior
problems) by Hazel Richmond Dawkins, Dr. Ellis Edelman, Dr. Constantine Torkiotts
1990
Sensory Integration and Your Childby A. Jean Ayres (1979)
Total Concentration by H.N. Levinson (1990)
Women With Attention Deficit Disorder: Embracing Disorganization at Home and in
the Workplace by Sari Soden (1995)
You Mean I’m Not Lazy, Stupid or Crazy? By Kelly and Ramundo (1993)




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iv) Books on ADD for Children

Distant Drums, Different Drummers by Barbara Ingersoll, 1995
Eagle Eyes (A child’s guide to paying attention) 1991 by Jeanne Gehret
The First Star I See by Jaye Andras Cattrey
Learning to Slow Down and Pay Attention by Nadeau and Dixon
Otto Learns About His Medicine by Matthew Galvin
I’m Somebody Too by Gehret (1992)
My Brother’s a World Class Pain: A Sibling’s Guide to ADHD/Hyperactivity by Gordon
(1992)
Putting on the Brakes by Quinn and Stern (1991)

v) Magazines

Hyper~Talk
Addvance




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