Who Understands an ADHD Kid?

Dear Child,

I am the mum of a child who has ADHD, just like you. I know that you often feel sad because you get into trouble lots and don't do well in the school classroom. But I want to tell you that sometimes it is good to be different from the rest of the children. Maybe you feel that life and school is much easier for other kids? Well, yes it can be a little easier for people who are average. But children like you, who tend to be EXTREMELY good at some things and not so good at other things, often find that life can be less of an easy ride. Let's take school for example.

There are many children just like yourself in school, who can do the work, and who are even very, very good at some things, but who behave in a certain sort of way that is somehow different from the rest of the children. You feel you need to move about lots, so you end up wondering around the classroom for no apparent reason. Maybe you find it really hard to concentrate on what you are supposed to be doing. Perhaps you even get so frustrated that you shout at people or even lash out when you lose your temper.

Because of this behavior, teachers and other adults find these things difficult to deal with and they may even do and say things to you, which you feel is unfair. They cannot understand that sometimes certain children act on the spur of the moment and they often find your behaviors hard to deal with. Because they are grown ups, they sometimes don't see children as individuals, they see them as a mass and it's wrong. Because of this you are often left feeling sad, or cross, or frustrated at those adults.

Not all teachers are like this though. As you go through school you will find one or two who will like you for who you are, and accept the things you do without judging you. If you can find a teacher like this, make him or her your friend. Go to them when you are having problems.

What about home? Do you sometimes feel that your parents love your brothers or sisters more than you? You know, it may feel like this from time to time, but believe me your parents love you just as much as the other children in your family. Perhaps you feel that because you get into trouble more, that your parents prefer your brothers or sisters? Well, when your parents tell you off it is not YOU they are unhappy with, it is just the behavior that has got you into trouble that they are unhappy with. It can be very difficult when you are young to understand this. But I know! I am a mum to 2 children - 1 boy with ADHD and one younger daughter without ADHD. I love them BOTH in different ways, and I would hazard a guess that your parents are exactly the same.

All I can say to you is this: some of the greatest names in history were said to have symptoms like the ones you have. Winston Churchill, Albert Einstein, Walt Disney, Richard Branson, Tom Cruise, Robbie Williams, Thomas Edison, Robin Williams, Stephen Hawking...the list is much, much longer than this. All these people have made the world a better place for others BECAUSE of the way they are, not despite the way they are.

Love, Gail

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One of the main difficulties in diagnosing teenagers who may have Attention Deficit Hyperactivity Disorder is that all teenagers are begging to show some ADHD-like behaviors when their hormones kick into overdrive. To that extent, ADHD teens become typical adolescents, only more so. Attila was no exception. Attila survived childhood despite his potential for disaster. We now recount some of his exploits in adolescence.

Attila's Room

The adolescent search for identity did not strike Attila lightly. Take, for example, his room. Within the limits of available space and furniture, he tried every possible arrangement of furniture except leaning the bed on top of the radiator (actually he did try that, but he kept sliding to the bottom of the bed, so he put it back on the floor).

Attila's room was a prime example of the Law of Entropy - any system will degenerate into chaos over time. Even if there were a blender large enough, Attila could not have created more of a mixture of clothes, books, sporting equipment, camping gear and assorted collectibles. The floor had not been seen in years, but was believed to have been carpeted. Attila's search for identity started and ended with the search for anything in his room.

Attila the Scientist

Living in a small house with three sisters, Attila could only be creative if he found a place so unpleasant that his sisters would leave him alone - the furnace room was perfect. His creativity there found it's expression in the form of experimentation. Doctor Frankenstein would have been proud of him!

Chemistry and electrical experiments had a certain fascination for Attila. In the era before computer chips, tube radios provided Attila with untold ideas for new (and probably lethal) electrical devices. He was headless of the potential to curl his teeth on household voltage. He rewired parts from toasters, TV's, train transformers, and anything else he could scrounge from the neighborhood.

Attila's corner of the furnace room looked as if a tornado had hit an electrical supply house. Unfortunately (of fortunately depending on your point of view), Attila's explorations of electrical science were cut short when the main circuit breaker in the house blew for the third time. It was then that his otherwise supportive father told him he would be grounded until he was 26 if it happened again.

Chemistry was the next phase, and Attila tried every combination of every substance he could put his hands on. Some were not as disastrous as others. Some simply fizzed or changed colors. Some ate holes in the table. Long before toxic waste and environmental hazards were issues he discovered that simply pouring his concoctions down the laundry room sink was not a good idea. When the drain backed up and filled the tub with something that looked and smelled like 'The slime that swallowed Syracuse,' mother was not pleased.

"Attila the teen" was an accident about to happen, and it often did. On one occasion Attila won the praises of his school mates for being responsible for early dismissal from school due to a small accident that occurred in the chemistry class. Here's what happened. 'Chrome Dome,' the balding chemistry teacher, had set a two quart glass container of Hydrogen Sulfide on the wide shelf by the window so that students could get the small portions they needed for the day's experiment.

Attila came to the container and impulsively decided to open the window for some fresh air. Yes, Attila knocked over the container on himself and it broke on the floor. For those of you who may not remember, Hydrogen Sulfide smells like rotten eggs. There may be more unpleasant odors, but rotten egg was quite sufficient in this case. The odor soon filled the room and made it's way to the hallway. From there it proceeded to travel through the air ducts to fill the entire school.

As for Attila, no amount of water from the locker room showers could get the odor off Attila his clothes. Thankfully his gym sweat suit and sneakers were less smelly than the Hydrogen Sulfide soaked shirt, pants and shoes. The chemistry phase came to an end when Attila was unable to explain to his parents what he had mixed together that stained his hands a bright blue-green. Six weeks of scrubbing and the heckling of school mates about wearing gloves to class convinced Attila that chemistry was not his calling.

Attila and Puberty

The end of a promising chemistry career came with the discovery of girls. Attila's hormones raged and zits emerged at a time long before the appearance of full-frontal nudity on TV. It was a time when biology class curricular stopped short of exploring the human body and teenagers may actually have known less about sex than their parents.

Attila began to change from boy to man. His body grew by leaps and bounds. His brain had no idea where the ends of his arms and legs were. He became the perpetual klutz. We are not talking about just having difficulty walking and chewing gum at the same time. Before his body went on strike, Attila could pour milk into his mouth from an arm's length away. Now he couldn't drink from the foldout top of the carton without wearing half of the contents. As if that were not enough, fate (which had cursed him with terminally cute freckles earlier in life) now decreed that the skin upon his face would look like a red raspberry. So armed, Attila entered the social arena of dating.

Attila's Rebellion or Thank God for Aunt Grace

Finally, no discussion of Attila's teenage years would be complete without a word about rules and rebellion. The struggle for the independence of the American colonies a church was a picnic when compared to Attila's rebellion.

With the anxiety that only parents of an ADHD boy can muster, Attila's mum and dad drew the battle lines of curfew, household chores, dating, and last but not least, THE CAR. Later in life, Attila came to realize the truth about how he had lived to become an adult. It was all because of Aunt Grace.

When the angry arguments about rules and limits became hot at home, Attila hopped on his bike and burned excess energy off on the three mile ride to Aunt Grace's home. Unknown to him at the time, Attila's mum would call Aunt Grace and warn her of the coming invasion and of the latest issue Attila would carry to her door. When he arrived in her kitchen, she would give him the customary hug and kiss and offer whatever choice morsels of home cooking that were at hand. It was like putting a red hot horseshoe in cold water. As they chatted, Attila would 'chill out'. As she offered advice, he would listen. The words that fueled the flames, when spoken by mum and dad could be heard when spoken by Aunt Grace.

The author wishes to thank his parents, aunts and uncles (especially Aunt Grace) for remembering all of those stories about him as a teen. Those of you who have a good Attila story about yourself or your ADHD child, please send to the author - he likes to know that he wasn't the only one who grew up like that.

Copyright George W. Dorry, Ph. D. - Dr. Dorry is a psychologist in private practice who specializes in the assessment and treatment of childhood and adult ADD. He is the founder and director of The Attention and Behavior center in Denver, Colorado. He is a member of the ADDAG Board of Directors and served as their first Chairman of the Board from the organization's inception in March 1988 until January of 1995.

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Accenting the POSITIVE side of ADHD and knocking down the walls of ignorance

Hello There. I'm Gail Miller, author of the book, "The Wild Child."

It's about a mother, driven to the edge of despair by her unruly son, and her fight with the authorities for recognition and treatment for his condition.

I'm also an ADHD activist and sort of the "covergirl" for parents of adhd kids in Britain.

Since I am here in England, I plan to not only share my experiences, knowledge, and insights with you, but I also want to give a British slant on how attention deficit hyperactivity disorder is perceived here, what's being done about it and resources available here and on the net to help you help your child be the best he or she can be.

And, as if you didn't know, it's not easy being the parent of an adhd child. I'll share my thoughts about that with you.

So come on inside. There's lots of great information. Read my story. Maybe you'll see at least part of yourself in it?

Feel free to navigate through my website and read true ADD/ADHD stories and articles about what is Attention Deficit Disorder, how to cope with your ADD child and ADHD treatment & management issues. Here are the contents:

Table of Contents

• What ADHD Is Not
• My Story: Everyone's Got One
• 50 Tips on the Classroom Management of ADD
• "ADD/ADHD Humor"
• ADHD: Challenging Children. Oh, What Fun!!!
• Can You Relate?
• Getting an ADHD Diagnosis for Your Child
• Keeping Your Sanity
• The Lighter Side: 'Attila the Teen' Memories from a Middle-Aged AD/HD Author
• Surviving an ADHD Sibling
• The Hidden Gifts Of ADD
• The Management of Adult Attention Deficit Disorder
• Thoughts On the Medical Treatment of ADD/ADHD: A Physician's Perspective
• Work Issues and ADHD
• ADHD Children and Coping With Tantrums
• A Letter to A Misunderstood ADHD Kid
• Can ADHD Be Inherited?
• Good Things About Being ADHD
• Living with an ADHD Child: The Real Story
• Multi-Modal Treatment of ADHD: What Every Parent Needs To Know
• Myths About ADHD
• Why Am I Different?

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In 1998, my book Wild Child - A Mother, A Son and ADHD was published. Since 1995, I've been writing a hardcopy newsletter and this year have gone online with The ADD/ADHD Gazette.

I've been an advocate for families affected by Attention Deficit Hyperactivity Disorder (ADHD) since 1995, when my own son was diagnosed. I founded the Yorkshire (UK) support group. I manned the telephone helpline for two years, speaking with literally hundreds of desperate families, offering up emotional support, giving practical advice on education issues, state benefits, management strategies, etc.

Because of my campaigning, two ADHD clinics have been set up in my area, where before there were none. I also did a large mailing to hundreds of schools, raising awareness of ADD and ADHD.

Oh! You want to know a bit more about me? Okay, here goes:

"George Miller, a blond, angelic looking boy, stomps loudly down the stairs and crashes in. It's 6 a.m. and he has that look in his eyes again. The glassy, red-eyed look that his mum, Gail knows so well. Dashing into the kitchen, he pulls cereal, bread, tins, and anything else he can get his hands on out of the cupboard, while mum tries in vain to prevent him from trashing the kitchen. Having failed to find anything that he fancies for breakfast, he throws himself onto the floor in a fit of rage. With thrashing limbs & a spine-tingling wail, he bangs his head against the door frame in temper while Gail tries her best to calm him."

"While Gail prepares breakfast, George tips all the toys from his sister's toy box out onto the floor. Spider men, trains and blocks fly everywhere. "Where is it?" he screams maniacally, banging his fist on floor. He doesn't clear any of the toys away, but dashes to the couch, pulling off the cushions. When mum enters the room, he is teeter-tottering on the cushions, laughing hysterically & uncontrollably. This room, like the kitchen, looks like it has been hit by a tornado. It is now only 6.20 am. Gail sighs and braces herself for the exhausting day ahead. By bedtime her head will be pounding, her chest will be tight with stress, her throat will be hoarse and she will be mentally, not to mention physically, exhausted."

That "Gail" is Me

The woman outlined is me and the boy is my son, George. He was diagnosed with ADHD just before his ninth birthday. I first knew that there was something different about him when he was a year old. He wouldn't sleep, would cry for hours on end, but wouldn't be comforted. As soon as he could walk, he became hyperactive and accident prone. I voiced concerns to the health visitor as he had started having violent tantrums. He didn't play properly and was very destructive. His attention span was poor and just the physical strain of looking after him was exhausting. Things got worse when he got to school. George stuck out like a sore thumb. He couldn't sit still and was often to be found wandering around the classroom for no reason. Teachers found it hard to look after him as he couldn't stay on task long enough to learn and he often disrupted the class. It was as if there was one rule for him and one for others.

Things got worse and we saw a string of heath-care professionals over the years, who couldn't (or wouldn't) help us. George would butt into conversations, throw the most almighty tantrums and he would engage in thrill seeking behavior. One of his favorites was zipping himself up in a sleeping bag and throwing himself downstairs repeatedly. He also had strange ritualistic behaviors; hiding his underwear, repeatedly take his duvet out of it's cover, (so every morning I would have to stuff the thing back in) and he would sleep with his pajamas over his daytime clothes. All this was extremely worrying for us. George had the dubious honor bestowed upon him by one teacher of being "the worst pupil I've ever had the misfortune to teach in the whole of my career." This was so frustrating for me.

How could my child have turned out like this?

In 1995, when George was eight, things had sunk to an all time low. I was on the edge of a nervous breakdown as his aggressiveness and violence were escalating and apart from his symptoms, he now had the added pressure of having no friends and teachers who didn't like him. He was constantly frustrated because although he was a bright lad, he just didn't know what he was supposed to be doing in class. This was down to his frequent lapses in concentration and his difficulty staying seated. He would argue and quibble with everyone and when he got frustrated, he would go and bang his head against a wall in temper.

Later on that year, I heard about Attention Deficit Hyperactivity Disorder (ADHD) and after some research I realized that this was what was afflicting George. I contacted the National Support Group, here in Great Britain, which gave me the name of a specialist who did indeed diagnose George with the condition. Shortly afterwards, George was also awarded a Statement of Special Needs which meant he would get one-on-one assistance in class.

You are not alone

By the time I founded the West Yorkshire ADHD Support Group, I had already done a lot of research and one thing I learned was that Attention Deficit Hyperactivity Disorder affects up to 20% of our schoolage children to some extent. Realizing that there must be many thousands of families out there suffering just as we had done, I told my story to the local press and the phones went mad. Suddenly, I found myself speaking to hundreds of desperate parents whose families had been blown apart by ADHD. Marriages had broken up because of it, children were being threatened with exclusion from school. Many were already excluded.

Often, mothers cried sharing their stories of how psychiatrists accused them of having poor parenting skills...the same psychiatrists who they had gone to for help. I certainly understood how they felt on this one. It had happened to us on occasion.

Since this time, I have worked hard to raise awareness among parents and professionals about ADHD and it's impact. The mass of paperwork I accumulated throughout the years prompted me to write a book entitled "WILD CHILD!" (A Mother, A Son and ADHD) which chronicles our ten year struggle to get recognition and treatment for George's condition.

George is now twelve, and has recently had a further diagnosis of Asperger syndrome (high functioning autism) and his behavior is still extreme, so we use a variety of techniques to manage him. Unfortunately they don't always work; the understanding is just not there. He has no learning difficulties, but his social skills are still severely lacking. There is no cure for these conditions; they can only be managed. Sometimes ADHD symptoms subside with age, but often they remain into adulthood.

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It would be great if we could say that there are good and bad careers for people with Attention Deficit Disorder (ADD), but that would be impossible. Everyone has their own differences and preferences and what might seem an ideal job for one ADDer, might not be ideal for another.

However there are some things you can bear in mind when trying to select a career field. First, look into something which you already enjoy or have skills in. My son George already knows he wants to go into electronic engineering. Just as well really, as he was rigging up alarms, bells and buzzers at seven years old, whilst at the same time, he hadn't yet mastered how to tie his shoe laces! Last Christmas, he turned our fairy lights into flashers and last year he repaired his Grandparents' video recorder, something that would have some of the rest of us stumped for sure.

People with ADD often don't like repetitive tasks, so going into a job which requires sitting in one place for long periods and carrying out tasks which might be considered 'boring' might not be the best of professions to consider. If you are one of the more creative ADDers, office work might be a bad choice because you are more likely to stick with something which has you creating an end product. ADD people are notorious for flitting from one thing to another, so to avoid this possibility you should ideally find a career which fits you like a glove as far as is possible.

Do you see yourself working outdoors or indoors? This, to some extent, depends on the locality in which you live. Should you live in the country, you might find yourself in a more outdoorsy type job. In any case, indoors or out, your chosen vocation should have lots of novelty. A job where you can say "every day is different" would be for more suitable than one where you find yourself feeling frustrated at the lack of variety in the tasks you have to perform.

At the end of the day, only you know what you would like to do in life, but it has been shown that ADD people excel in certain types of careers. Some of them are listed below:

• Acting,
• artist or photography,
• business,
• journalists,
• media-related jobs,
• music,
• radio or television,
• science, writing.

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All young children can be difficult, and many go through "terrible twos" (and threes) where tantrums are a frequent part of daily living. But children who have ADHD (Attention Deficit Hyperactivity Disorder) have more frequent and aggressive tantrums which after a hard day with them, can make you feel you have done ten rounds with the world heavyweight boxing champion!

We all know that most ordinary children have tantrums, and fits of rage are as common in girls as in boys at an early age. As children get older, one hopes that they get out of this way of behaving. It is never easy trying to find ways to alleviate these situations, as something which seems to work one day, has no effect whatsoever the next. However, I have a few suggestions which just MAY work from time-to-time.

Some of the tips are more suited to the younger child, but with ADHD you may have to deal with tantrums in children who should be well past them, in which case the last three suggestions may be more appropriate. Please don't come back to me if they don't work! After all, I am still dealing with tantrums in a twelve year old, and I often don't have all the answers. However, some of them may be worth a try:

• Prevention. Can you spot early warning signs which indicate your child is building up to a tantrum? If so, try to step in and calm them before it escalates into a full scale war.

• Distraction. Does the child have a favorite book, toy or cuddly animal? If so, it is sometimes possible to distract them enough in the early stages to stop their outburst from becoming a full-blown tantrum.

• Reassurance. Talk in a soothing voice throughout, and promise that they are safe and that they are going to be okay. Keep doing this until they have regained control of their emotions. If the child wants a cuddle and a good cry after calming down let them.

• Stay calm. This, admittedly, is a difficult one, as ADHD mums are usually at the end of their tether most of the time anyway because of the constant pressure. Staying calm however, helps you to stay in control of the situation, especially if you manage to keep your temper.

• Don't retaliate. Don't match aggression with aggression. You'll just lose it!

• Stand your ground. Don't, if possible, give in to a screaming child, even though it is very tempting. If you do, it will just give them the message that if they scream long and hard enough, they will eventually get what they want.

We all know that theory is great, but often doesn't work with our children. However, you may just find one of the above suggestions works on occasion.

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NOT ALL CHILDREN ARE CREATED EQUAL

As much as you try to be equal in what you give and expect from each child, children are different and the Attention Deficit Hyperactivity Disorder (ADHD) child is more different than most. Start from that honest acknowledgement and you have taken the first step toward understanding and improving the level of sibling rivalry in your family. You can be fair to all, but not always equal, because the ADHD child has different needs. Let's look at those differences and how they affect the family with an ADHD child.

Imagine a mobile sculpture with each member of your family a doll suspended by wires that hold the sculpture together. Now imagine the ADHD child's doll with a motorized helicopter blade on top. Yes, you get the picture. The high speed, random motion of the ADHD child tends to throw the entire system into chaos. Everyone is affected! Everyone is involved in the process of trying to balance the system. While the adults in the family may have an understanding of what is happening, siblings generally do not, unless Mum and Dad know about and explain ADHD and how it is affecting the ADHD child and the entire family system.

THE FAMILY CIRCUS

No tightrope walker has ever had as difficult a job as a parent trying to balance the attention given to an ADHD child with that given his or her siblings. It is easier to watch the child who sticks close to Mum or Dad than the ADHD child who can instantly disappear into the street, the toy store at the mall, or the attic crawl space. A pre-school ADHD child needs more supervision than one parent can give without a lion tamer's chair and whip (and we don't recommend that.) Tag-team supervision, with at least two people frequently trading off the task, may seem like ganging up on the child, but it works. Do not feel as though you are not a good parent if you ask for help in "taming" an ADHD youngster.

"But why do I have to watch him again ... you always make me do it?!?" Older siblings usually do not mind an occasional request to baby sit, however they are often caught in the double bind of responsibility without authority. Remember how difficult it is for you to keep your ADHD child under control and out of trouble? It is even more difficult for the older sibling who does not have the natural parental authority to be ringmaster for the family circus. Limit how long and how often you have the older sibling in charge of your ADHD child. It is often better to pay an adult or child-care center to care for the ADHD child than to push the limits of brotherly or sisterly love.

ATTENTION!!

All children are "black holes" for attention, sucking up as much as any parent will provide, but ADHD children do demand more attention than their siblings. That demand can cause the siblings to be resentful or to imagine that the parent loves the ADHD child more. The sibling who usually does what is asked the first time may be angry at the ADHD child who is easily distracted from getting dressed and holds up the entire family. Be aware of that possibility, and plan to start the ADHD child earlier so everyone is ready to go at the same time.

When impulsivity personified, in the form of an ADHD child, bursts into every conversation with whatever happens to be on his or her mind, even the most patient siblings will start looking through the Yellow Pages for the number of the used child market to see what they can get on a trade-in. Parents who wish to avoid coming home to find that an older brother got a great deal swapping their ADHD child for a neighbor's dog are well advised to enforce clear limits on the ADHD child's behavior. Listen to the concerns and complaints of siblings with an open mind because they are communicating their distress. If they feel you are not hearing that distress, they may act out their anger towards the ADHD child.

LET THE GAMES BEGIN ...

If you are not careful, siblings can chose sides for the Super Bowl between two teams; the Saints and the SINNERS. Siblings who are age-appropriately "good" can appear and sometimes intentionally act better, exaggerating the contrast with the ADHD child's less appropriate behavior. Unless you like striped shirts and whistles, and enjoy the role of referee, it would be better to stop that form of scape-goating . You do not have to discourage a child who is applying for a sainthood, unless it is at the expense of another.

When it is, praise the improvement in the saint-to-be's behavior, but then clearly describe that scape-goating will have a predefined negative consequence. For example, "If you tease Johnny about how much better you can do that, then you will lose the benefit you normally receive for doing it." Encourage all children to excel on their own merits, not through trying to look better by knocking down someone else. Siblings sometimes regress or step out of their usual roles to imitate the behavior of the ADHD child. "Well ... if he gets so much attention from Mum and Dad for doing that - maybe I can too." While this is probably close to the top of your list of THE LAST THING I NEEDED TO HAVE HAPPEN, it can be a catalyst for discussion at a full family meeting (NOTE; NOT to be held at mealtime.) Clear GAME RULES, which are explained to all children at reasonable intervals, are at the core of improving any child's behavior.

THE AMERICAN (FAMILY) REVOLUTION-THE STRUGGLE FOR INDEPENDENCE

Gradually, over the years between diapers and diplomas, each child must learn to be responsible and self-sufficient. Parents sometimes fall into the protective fallacy of doing for children what they are able to do for themselves. That keeps children dependent as opposed to encouraging independence. It gives children the false impression that they can manipulate the world to get what they want without effort on their part. A household works best when everyone does his or her share of the chores. You will also have fewer rebellions with which to contend. ADHD children are hurt by being excused from their chores, and helped by your insistence that, even if they march to the beat of a different drummer, they still have to do their share. What ever the task, it can be "chunked" into do-able parts so that the child can accomplish it. "First take the milk and butter off the table and put them in the refrigerator ... O.K. you did a good job doing that, now put the place mats aside and wipe the table." It is easy to forget to praise or to set aside the special moments each day for every one of the troops. Maybe it is only when you tuck them up in bed at night, but be sure to affirm their importance as a person, your love for them as they are, and to acknowledge, beyond that, the improvements that every child can accomplish. These are important moments for you to. Without that affirmation on at least a daily basis, you forget the essential distinction between the child you love and the behaviors that you do or do not like. Keeping the distinction in mind will help you to promote independence and growth in your child.

SHARING

ADHD children can be less socially and emotionally mature than we would expect for their age. When the young ADHD child grabs a sibling's toy with a "I want what I want and I want it now" attitude, it is not surprising that the sibling does not want to play any more. Separating them until the issue subsides is more likely to be effective than insisting they share at that time. There is a very different aspect to sharing that goes beyond the sibling's understanding of ADHD. A parent may learn about ADHD through a local support group. This information can then be shared with extended family members, family friends, and teachers. Support groups offer many other reading materials to pass along to others.

LAST, BUT NOT LEAST

On a personal and hopeful note, my family went through many difficult times when I was a classic ADHD boy. When asked why I ended up working with ADHD families, I claim it was my Mother's curse; "When you grow up, I hope you have to deal with kids like you!" So, to my parents, whose patience was sorely tried, and to my sisters who, at best, tolerated an outrageous brother, I offer sincere thanks. Not long after my sisters and I passed the trials, tribulations, and raging hormones of adolescence, we gradually outgrew the struggles of childhood. We have successfully settled into a truly caring relationship. Despite the many conflicts we went through and the incessant teasing which still persists, we actually love each other dearly. Although it may seem impossible in the midst of your day to day experiences, in the long run the passage through can strengthen us all.

Copyright George W. Dorry, Ph. D.
Dr Dorry is a psychologist in private practice who specializes in the assessment and treatment of childhood and adult ADD. He is the founder and director of The Attention and Behavior center in Denver, Colorado. He is a member of the ADDAG Board of Directors and served as their first Chairman of the Board from the organisation's inception in March 1988 until January of 1995.

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Ideas For Home Management

We've all done it. Tried to muffle a snicker when our 'specialist' asks us to make a 'star chart.' This supposedly will encourage our child to work towards rewards and learn that they will get no attention, positive or otherwise, from bad behavior. Does this strategy work? Does it cocoa!

Unfortunately, many techniques which work with 'normal' kids just do not with ours. What these practitioners just don't understand is that the mechanism which remembers the reward and gives that good feeling when one is given, is dulled in our children.

What does work then? Well, there aren't any management strategies that work every time, with all kids. What I have found is that something which works on one particular day, may not work the next day. The kids are just too inconsistent, and don't learn from experience. Therefore, it is better to take each occurrence as it comes and don't rely too much on experience. Take it an hour at a time!

Try these tips:

1. If yours is the kind of kid who won't get up in the morning, try offering an incentive. One parent told me that before, his son just wouldn't rise on being called each morning. But he changed his call from "Johnny, get up. It's breakfast time," to "Captain 'Crusader's' starting." Because the kid was going to get to see his favorite cartoon NOW, he was soon downstairs, sitting, eating his breakfast ... in front of the cartoon of course, but hey who cares, he was up! This has continued and now the problem has been solved - for now.

2. One way to ease the pressure is to ACCEPT. Learn about ADHD and what behavior you can expect. The more I learned, the more I started to see that some of the baffling things that George does, are just part of his make-up. I also stopped beating my head up against a wall to make him comply with things which weren't that important. Like putting clothes on the right way. If he's happy wearing clothes inside out and back to front, it's OK with me! Well, most of the time.

3. If you are going through a particularly bad patch, where everything but everything seems to be going wrong, your child seems to be going backwards, and he is picking up so many strange habits and bad behaviors that you don't know where to start, try focusing on one or two of the WORST misdemeanors and forget the rest for the time being.

4. It is important to distinguish "inability" from "non-compliance." I know this is difficult, but when you start to learn what the child can and can't control, you have a better idea of when to punish and when not to.
   
   Easier said than done, I hear you say. It is difficult, but by learning as much as you can about ADHD and devouring all the information you can about what to expect, the emotional rollercoaster you are on will subside.
   
   I used to beat my brains out about George's inability (or was it refusal) to get ready for school in the morning. It was one long week-in, week-out battle after another. Then one day I just said "forget it." In the space of 8 or 10 minutes I could have him washed, dressed, hair brushed and ready...if I did it for him. Some parents would be unhappy about this, but I decided to make life easier for ME.

5. Now, although George is eleven, I wash him, brush his teeth and comb his hair every day. Dressing, he more or less, he does for himself now, but only if I lay things out for him the night before. I do, however, often have to turn his clothes the right way as he still has a penchant for wearing things back-to-front. It's ten minutes more work for me, but the aggravation factor has decreased a hundred fold in the mornings! I have accepted that motivation is not George's strong point!

6. Look for the good things and see the whole picture. Although things can be really bad at times for us, and George goes through periods when he is the devil himself, we do accept that things are much better than they were two years ago. He has caught up with his school work and is starting to shine in certain things. Handwriting has improved, swearing has decreased, hyperactivity has decreased. When things look really bad, I think of the all round improvements. There's no magic formula-just a stubbornness to get through this and a hope that things will turn out okay in the end.

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A talk by Roger Yeager, PhD, M. Ellen Gellerstedt, MD, and Dan DeMarle, M.S.

Dr. Yeager was up to bat first, and he noted that our audience was made up of people who have been dealing with the subject of ADHD for a long, long . . . long time, while others were quite new. He gave a brief introduction to the topic so we were all starting on the same foundation for the presentation. He explained that the term ADD was and would be used although the technically correct term is now ADHD. The speakers were going to use these terms interchangeably tonight.

ADD is a biologically based difference in how some areas of the brain function. That means a couple of things: it is not caused by bad parenting, and it's not just a willful child and, believe it or not, it isn't caused by sugar. ADD is around for the long haul; it doesn't go away so it is necessary to look at it from that perspective. In addition to the usual list of characteristics, Dr. Yeager noted resilience, imagination, creativity, boundless energy, and risk-taking as examples of the exciting aspects of ADD.

"ADD can be thought of as a skill deficit problem", he noted. It was frequently a question of degree and frequency. Tonight's talk, although directed at parents, would be of value to adults with ADD if they reflected on their younger years.

Every child and family has unique strengths and needs. Parenting challenging kids requires that you become a chef, not just rely on a cookbook recipe. When using a cookbook approach, you have to follow a recipe exactly and if you're missing some of the ingredients, or don't like the results, you're stuck. But if you're a chef, you know how to substitute or what to improvise. You know what's possible and when and how to use the possibilities.

"Tonight, we'll give you some recipes but also show you how to become a chef in the field of behavior." Just as the techniques and strategies must be tailored to the individual situation, often a team of people have to work together to execute the treatment. Prepare a custom developed plan to enhance the strengths of a family and teach skills to compensate for the deficits. Treatment is not a "One size fits all" proposition. There are four areas the team would address tonight.

What is the goal of treatment? To get a good fit of children's skills/deficits and those of the parents. Find a coach, one who will help keep the "big picture" in mind, and monitor progress over time.

Educate yourself, your family and others about ADD as a skill deficit and how it manifests itself in your situation i.e. know that a lack of organization in a child is a skill deficit, not stupidity. Parenting difficulty is a lack of special skills, not incompetence. Part of the education process is to learn what does and what doesn't work.

Mental Health Interventions include behavior management. There are caveats to this which include: positive reward systems help; use consequences rather than reasoning; don't yell or hit; expect performance; don't blame, don't shame or humiliate; avoid inconsistency; affirmations are important; and avoid the "how comes".

Individual Therapy - Why is it needed? Where is it not needed?

Family Therapy - Remember that ADD may exist in only one member of a family, but it affects the whole family.

Social Skills Training is also an important area to be aware of.

Dr. Yeager then turned the microphone over to Dan DeMarle who addressed educational interventions.

Dan noted that an analogy would be helpful for his portion of the talk. Imagine yourself as a terrible gymnast, which isn't too much of a stretch for some of us?! Although strong in other areas, you just hate gymnastics. But you know that for the next 12 years, you'll be judged on your gymnastic ability. Either you'll pass or fail. Then you're told that the way you perform may well affect your future children's quality of life. This is very much the way children feel as they're going through school.

ADD kids are at risk for difficulty in school. "Children with ADD are fragile learners, power learners, active learners and at risk for problems with self-esteem. ADD kids need to be involved, both mentally and physically, in what they're being taught. For children with ADD, we must learn that if it's important, make it novel. If you can't make it novel, make it active", Dan said. Using the right instructional techniques for these children enables the child to turn their natural activity level from a negative into a positive.

In school there are strategies for both environmental modifications and interventions to change behavior. There are ways we can teach children to do better on homework. Don't become the "homework monster", though, when there's trouble in this area. More important than turning a particular assignment in the next morning is that the child needs to know you are a loving, caring parent they can turn to when they need you the next time. One solution may be to split up the homework between parents. Another way may be to involve a tutor.

Schools can and should be an invaluable asset to you as a parent working with your child. Unfortunately, in many cases the parent and school can be at opposite ends of a tug of war with the children caught in the middle! What we want to happen is to have parents and school staffs working together for the benefit of the child's future! The two most important aspects of the parent/teacher relationship are effective communication, and having a joint understanding of the child's strengths and needs both at school and at home. Again, a coach (particularly at school) can be an invaluable asset.

As parents, it is important to be "informed consumers" so we can help the schools make appropriate decisions about education. It's important to find the treatment tools that work and that we find new ones when the old ones don't work as well, and help the schools do the same.

As a closing thought, recall the analogy of gymnastics. As a society, we make children go to school. Yet as members of our society, if we make these fragile learners go to school every day, then we as parents and child advocates must help to insure that going to school is a useful and productive activity for these fragile children.

Ellen Gellerstedt then addressed us.

Let's put some things in perspective i.e. get the big picture. We may have all these thoughts and this information flying around in our heads, but it is important to realize every child, every parent, and every family is unique. You don't need 100 strategies or interventions in action at once. We have to know that what the child needs in 1st grade may have nothing to do with their needs in the 5th grade. You don't have to know it all. There's a lot of expertise in our community - - Use them!

A physician can do a number of things: diagnosis, medication, help monitor progress over time, monitor what's going on with new treatments. "All that's hyper is NOT hyperactivity." Some causes of symptoms similar to those of ADD include Anxiety, Depression, Learning Disabilities, Obsessive Compulsive Disorder, Tourette's Syndrome, Oppositional and Defiant Behavior, Thyroid Condition, Manic-Depressive Illness, Lead Poisoning, Processing Problems, Seizures, Family Disruptions and a Chaotic Environment.

When should we think about medication? Medication doesn't cure ADD but it can, temporarily, alleviate some of the symptoms that are causing children so much trouble.

The long term goals of ALL treatments are: Confidence, Self Awareness, and Independence. We need to have them learn the skills they need so they can make their mark in the world.

Learn and understand what medication can do as well as what it cannot do. Medications used for ADD CAN'T cure ADD, CAN'T motivate someone, CAN'T give them skills, CAN'T make them either smarter or dumber, and CAN'T eliminate oppositional or defiant behavior. Medication CAN be extremely important, but it can't be the only treatment. Dosage and schedule must be individualized. Talk to your doctor often. Physicians can also help with networking or getting a team to work together.

In summary, there is no generic ADD. The hallmark of Multi-Modal Intervention is to enhance the strengths and teach the skills that are deficient. ADD is a biologic entity; the characteristics of it may be life-long. Many of the traits are blessings while some are true disabilities. The needs for the child and family change over time, and members of the team may change over time. The goals of treatment are to maximize the development of the child's cognitive, social and academic abilities and to maximize the growth of the family and the unit. There are no magic cures, but the situation is far from hopeless.

Roger Yeager, PhD - Psychologist, M. Ellen Gellerstedt, MD - Pediatrician, and Dan DeMarle, MS - Educator are with the Behavior Pediatrics Program at the Rochester General Hospital.

This article appeared in the Winter '94 GRADDA Newsletter. The Greater Rochester Attention Deficit Disorder Association. PO Box 23565, Rochester, New York 14692-3565. e-mail us at gradda@net2.netacc.net

Thanks to Dick Smith of GRADDA and the authors for permission to reproduce this article.

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Human beings are rarely created in perfect form, so the great majority of us arrive in this world with unique differences. Some differences are blessings; others are handicaps. Poor vision, for example, is a common handicapping condition that affects millions of people throughout the world. I consider poor vision a condition of "human-ness." People can also have other conditions such as diabetes, asthma, thyroid conditions, ADHD, etc.--all well recognized differences that can impair the pursuit of a normal life if not dealt with in some manner.

ADHD is characterized by a prolonged history of inattention, impulsiveness, and variable amounts of hyperactivity. It is important to emphasize that all of these symptoms are normal human characteristics. All of us are forgetful and inattentive at times. We all at times become nervous and fidgety, and we certainly are impulsive to some degree. It's part of our "human-ness." ADHD, then, is not diagnosed by the mere presence of these normal and characteristic human behaviors, but from the DEGREE to which we manifest these symptoms. ADHD people have an overabundance of these normal human characteristics.

WHO SHOULD TAKE MEDICATION, AND WHY?

Returning to the vision analogy, there are a number of options open to an individual who has bad eyesight. One option is to attempt to correct the problem. This could involve wearing glasses to correct the visual deficiency. Perhaps glasses can totally correct the problem, or perhaps they can only partially help. After the glasses are in place, we are in a position to assess what further problems are interfering with success. Then we can address these issues as well.

ADHD is a medical condition. Dr. Alan Zametkin has clearly demonstrated that there is something uniquely different about the metabolism of the brain affected by ADHD. If a person meets the criteria for a diagnosis of ADHD and is not succeeding academically or socially up to expectations, medication should be a PRIMARY OPTION of therapeutic intervention. The opportunity to eliminate the symptoms- toms of a medical condition partially or completely should be available to all. Many children benefit enormously from the use of medication. Many families who understand ADHD and its clinical manifestations prefer to try medication as a PART of their treatment plan. As many as 80% of individuals will show a positive response to one of the medical treatments.

Since it is impossible to determine who will respond favorably to medication, I always offer a trial of medication to each diagnosed patient. If medication will help alleviate the symptoms and does not elicit any unfavorable effects, then the patient may choose to utilize medication as one part of therapy for ADHD.

WHAT IMPROVEMENT SHOULD BE SEEN?

In the early 1930's, Dr. Charles Bradley noted some dramatic effects of stimulant medications on patients with behavior and learning disorders. He found that the use of stimulants "normalized" many of the systems that we use for successful living. People on medication IMPROVED their attention span, concentration, memory, motor coordination, mood, and on-task behavior. At the same time they DECREASED daydreaming, hyper- activity, anger, immature behavior, defiance, oppositional behavior. It was evident that medical treatment allowed intellectual capabilities that were already present to function more appropriately. When medication is used appropriately, patients notice a significant
improvement in control. Objective observers should notice better control of focus, concentration, attending skills, and task completion. Many children are able to cope with stress more appropriately, with fewer temper outbursts, less anger, and better compliance. They relate and interact better with siblings and friends. Less restlessness, motor activity and impulsiveness are noted.

It is very important to remember what medicine does and does not do. Using medication is like putting on glasses. It enables the system to function more appropriately. Glasses do not make you behave, write a term paper, or even get up in the morning. They allow your eyes to function more normally IF YOU CHOOSE to open them. YOU are still in charge of your vision. Whether you open your eyes or not, and what you choose to look at, are controlled by you. Medication allows your nervous system to send its chemical messages more efficiently, and thus allows your skills and knowledge to function more normally. Medication does not provide skills or motivation to perform. ADHD individuals often complain of forgotten appointments, incomplete homework, miscopied assignments, frequent arguments with siblings and parents, excessive activity, and impulsive behaviors. With medication, many of these problems dramatically improve. Patients successfully treated with medication typically can go to bed at night and find that most of the day went the way they had planned.

WHO SHOULD PRESCRIBE MEDICATIONS?

Medications can be prescribed by a licensed physician only. This person may serve as a coordinator to assist with the multiple therapies often needed, such as educational advocacy, counseling, parent training, and social skill assistance. Parents and adults should look for a physician who has a special interest and knowledge in dealing with ADHD individuals.

MEDICAL TRIALS

It is necessary to establish a team for an appropriate evaluation of the medication trial. I gather information from sources who spend time with my patients. This might include parents, teachers, spouses, friends, co-workers, grandparents, tutors, piano teachers, coaches, etc. As gradually increasing dosages are administered, input is gathered from these observers. Various rating scales are available to assist in gathering factual data. However, the true assessment is whether the ADHD patient's quality of success in life has improved. For this information, I find no scale takes the place of conversations with observers.

When evaluating patients during a trial of medication, I will treat them throughout the day, seven days a week. Treating them only at school or only at work is totally inadequate. I need all involved observers, assisting in the evaluation process. Furthermore, I want to know if treatment has an effect on non- academic issues. After the trial of medication, if positive results are evident, then the family and/or the patient can make informed decisions as to when the medication is helpful. Many patients find the medication is helpful throughout all waking hours. Others may need it only during certain times of the day.

WHAT IS THE CORRECT MEDICATION?

At the present stage of medical knowledge, there is not a method of predicting which medication will be most helpful for any individual. At best, physicians can make educated decisions based on information about success rates with individual medications. In general, a large percentage of patients will respond favorably to Ritalin or Dexedrine, and one of these is usually my first choice. If one stimulant does not work effectively, the others should be tried, for experience has proven that individuals may respond quite differently to each one. Many patients respond remarkably well to imipramine or desipramine, and some physicians feel this group of medications is under used. Each family and physician must be willing to try different medications in order to determine the best and most effective therapy. This is the only way to find the appropriate treatment modality. In some patients who have multiple diagnoses such as ADHD and depression, or ADHD and oppositional-defiant disorder, or ADHD and Tourette Syndrome, combinations of drugs are being successfully utilized for treatment.

WHAT IS THE CORRECT DOSE?

If medications work, there is a best dose for each individual. Unfortunately, medical knowledge is not at a point where it can predict what the correct dose will be. This is not an unusual circumstance in medicine, however. For a person with diabetes, we must try different forms and amounts of insulin to achieve the best control of blood sugar levels. For people with high blood pressure, there are many medications that can be effective, and often a trial of multiple medications and dosages is needed to determine the best treatment. For ADHD medications, there is no magic formula. The dose cannot be determined by age, body weight, or severity of symptoms.

In fact, it appears that the correct dose is extremely individual and is not really predictable. Again, similar to people who need glasses, the kind of prescription and the thickness of the lenses is not dependent on any measurable parameter other than what you say enables you to see well. The dose of medication is determined solely by what ADHD patients need to improve their symptoms. You must be willing to experiment with carefully observed dosage changes to determine your child's correct dosage. Once the correct dosage is determined, it does not seem to change significantly with age or growth. Medication continues to work effectively through the teenage years and into adulthood if needed.

SUMMARY

Individuals with ADHD will present with a variety of well-defined symptoms and behaviors. Medication may be extremely helpful in alleviating some of these symptoms and will make the other forms of accompanying therapies much more meaningful and effective. Families must be willing to work closely with their physician to identify the correct medications and establish the best dosage levels.

MEDICATIONS: OVERVIEW

RITALIN TABLETS (methylphenidate)

Form: Short acting tablets administered by mouth. Ritalin 5 mg, 10 mg, 20 mg Dosage: Very individual. Average 5 mg - 20 mg every 4 hours. I prescribe 5 mg to start and raise by 5 mg every 4-5 days with close observation until correct dose is achieved. Duration of Action: Rapid acting Ritalin starts to work in 15-20 minutes, which is extremely helpful for the child who has trouble starting his day, Some children will need medication 20 minutes BEFORE time to get up. It will last about 3'/24 hours, and so the effective dosage will need to be repeated every 31/2-4 hours to maintain positive effects during the waking hours. By virtue of its short action, Ritalin is discontinued every night and must be restarted each morning. Effects: Ritalin is one of the best and most dependable medications for treatment of ADHD symptoms. It specifically improves concentration, memory, and control of frustration and anger. Possible Side Effects: Moderate appetite suppression, mild sleep disturbances, transient weight loss, irritability, motor ties may occur if dose is too high (will disappear on lower dose). (Patients with Tourette Syndrome -- if Ritalin makes ties worse, discontinue. In some Tourette patients, ties decrease on stimulants.) Overdose effects with stimulants: depression, lethargy, "loss of spark." If this occurs, lower the dose. Pros: Excellent safety record. Very easy to use and evaluate. Very specific control of medication timing. Most dramatic improvement for many individuals. May be used with most other commonly used medications. Cons: Must be administered frequently during the day. Inconvenient to use at school. May experience moderate rebound reaction -- anger, frustration, temper when medication wears off. Possible roller coaster effect during the day as medication level fluctuates.

RITALIN SR 20 (methylphenidate sustained release)

Form: Long acting tablets administered by mouth. Ritalin SR 20. Dosage: Very individual. Two to three tablets may be needed. I use it primarily in conjunction with regular Ritalin to smooth out peaks and valleys and prevent rebound. I give 1/2-1 tablet of Ritalin SR 20 with each dose of regular Ritalin. Duration of Action: Long acting, about 6-8 hours. BE AWARE -- although called SR20 it actually appears to release only 5-7 mg of medication (not 20 mg) over 6-8 hours. Effects: Same as Ritalin tablets. Possible Side Effects: Same as Ritalin. Pros: Excellent safety record. May be most effective when used in conjunction with regular Ritalin. Tends to smooth out the peaks and valleys of regular tablets. Given with regular Ritalin 15-20 minutes before the child gets out of bed in the morning, it will prolong the positive effect of regular Ritalin to five hours (the lunch hour). Cons: Does not always work in a predictable fashion, and sometimes not at all.

DEXEDRINE SPANSULES (dextroamphetamine)

Form: Long acting, administered by mouth, Dexedrine Spansules 5, 10, 15 mg. Dosage: Very individual: Average is 5-20 mg. Duration of Action: Very individual. May take 1-2 hours to be effective. Usually lasts 6-8 hours. In some it may be effective all day. In others it may only last four hours. Effects: Same as Ritalin. Possible Side Effects: Same as Ritalin. Pros: Excellent safety record. May be the best drug for some individuals: longer acting, smoother course of action. May avoid lunch time dose at school. Cons: Slow onset of action. Remember, it takes 1-2 hours to work and may require a short-acting dose at first in the AM to start the day.

DEXEDRINE TABLETS (dextroamphetamine)

Form: Short-acting tablets administered by mouth. Dexedrine tablets 5 mg. Dosage: Very individual: Average 1-3 tablets each dose. Duration of Action: Rapid onset of action 20-30 minutes. Lasts 4 hours. Effects: Same as Ritalin. Possible Side Effects: Same as Ritalin Pros: Excellent safety record. Rapid acting. Some patients who do well on Dexedrine prefer the tablets over the Spansules. The more rapid rate of onset is apparently more effective for these individuals. Cons: Same as Ritalin.

CYLERT (pemoline)

Form: Long-acting tablets administered by mouth. Cylert 37.5, 75 mg. Dosage: Very individual. Duration of Action: Slow onset of action, thought to be a medication that will last all day, but in most cases lasts 6-8 hours. Effects: Same as Ritalin Possible Side Effects: Same as Ritalin. However, has been known to cause mild liver damage. Pros: Long acting, may eliminate lunch dose. Cons: Not as safe as the other stimulants. Would only use if other stimulants are not effective. Should NEVER be first drug of choice. Has caused hepatitis and death. Must do liver function blood test every six months.

TOFRANIL and NORPRAMINE (imipramine and desipramine)

Form: Tablets administered by mouth. 10, 25, 50, and 100 mg tablets. Dosage: Very individual. I start with a low dose 10-25 mg, and raise slowly as needed. Duration of Action: Variable. Often has a 24-hour effect, and therefore can be administered at night. Some patients prefer to split the dose and take every 12 hours. Effects: Often relatively low doses can improve ADHD symptoms within a few days, but may take 1-3 weeks for full effect. Higher doses may improve depression symptoms and mood swings, which are often seen in ADHD individuals. Possible Side Effects: Nervousness, sleep problems, tiredness, and upset stomach, dizziness, dry mouth, unusually fast heart rate. May affect conduction time of the heart, leading to irregular heart rate. May affect blood count (rare). Pros: Often works when stimulant medications are not helpful, and may be the drug of choice for many individuals. Prolonged duration eliminates school dose. Smoother course of action. Often helps with mood swings and depression. May be used in conjunction with stimulant medications. Cons: Can affect the heart conduction rate, therefore requires an EKG prior to the medication trial and after treatment level has been established. Can affect the blood count, therefore requires a complete blood count with all illnesses. Need to be careful when taking other medications. Consult doctor for list of medications to avoid. Medication needs to be increased and decreased gradually. Should not start and stop abruptly.

CLONIDINE (catapres)

Form: Patches applied to back of shoulder. Catapres TTS-1, TTS-2, TTS-3 (expensive). Tablets administered by mouth. Catapres tablets--1 mg., 2 mg., 3 mg. (low price) Duration of Action: Patches will last 5-6 days. Tablets are short acting, last 4-6 hours. Effects: Often will improve ADHD symptoms, although not always as dramatically as Ritalin. Decreases facial and vocal ties in Tourette Syndrome. Often has a dramatic positive effect on oppositional defiant behavior and anger management. Possible Side Effects: Major side effect is tiredness, particularly if raised too quickly. Will normally disappear with time. Some patients may notice dizziness, dry mouth. Some will notice increased activity, irritability, conduct disorder and should discontinue the medication. Pros: Excellent delivery system if patch is used. No pills required. Frequent positive effect on oppositional defiant behavior, and obsessive compulsive behavior. Does not effect sleep or appetite. Positive effect on tic behavior. Cons: Does not usually work as well as Ritalin for ADHD symptoms. Patch causes skin irritation in many and cannot be tolerated.

ADDERALL (four amphetamine salts)

Form: Long-acting tablets: 10 mg and 20 mg Dosage: Very individual, usually between 5 mg and 20 mg, once or twice a day Duration of Action: Usually last 6-12 hours. May be given once or twice a day, depending on length of therapeutic effect. Duration of effect varies from person to person. Effects: Same as Ritalin Possible Side Effects: Less affect on sleep, appetite, growth and rebound. No roller coaster effect. Pros: Only needs to be given once or twice a day, often fewer side effects. Very nice medication when effective. Cons: Does not work well for everybody. Relatively new on the market and not much clinical experience at this time.

WELLBUTRIN (bupropion hcl)

Form: 75 mg (yellow-gold) 100 mg (red) Dosage: 75-300 mg daily (average) in three divided doses Duration of Action: Long acting medication (half-life of 24 hours) Effects: A few studies suggest improvement in ADHD. In general, not as good as stimulants. Very helpful in conjunction with stimulants for depression. Possible Side Effects: Can cause seizures (1/4000) if dose STARTED too rapidly. Raise dose slowly. Cannot use if seizure disorder is present. May cause dry mouth, anorexia, rash, sweating, tremors, tinnitus Pros: Very good medication to use for treatment of depression Cons: Very little evidence that it is helpful for ADHD. Studies are still in progress.

WELLBUTRIN SR (bupropion hcl long-acting)

Form: 100 mg (blue) 150 mg (purple) Dosage: 100-150 mg twice a day Duration of Action: Effective for over 24 hours Effects, Possible Side Effect, Pros, Cons: Same as Wellbutrin

Dr. Mandelkorn trained in pediatrics and adolescent medicine and was a mental health fellow under Dr. Michael Rothenberg. An adult with ADHD who has a son with ADHD, Dr. Mandelkorn specializes in the diagnosis and treatment of ADHD in children and adolescents. He maintains a private practice in Mercer Island, Washington. His ADHD clinic presently follows over 600 children with ADHD. Dr. Mandelkorn lectures nationwide about management.

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