<p>For us the ADD came on top of some learning disabilities. Eventually the ADD became a bigger hindrance then the learning issues. Son did not have the concentration to do the complete any reading. And the progress was so slow that he did not retain any of it.<br>
We just recently got our accommodations from the collegeboard. I was surprised that it was granted so easily. I don't know what his counselor sent but he was granted 100% extra time and a reader. I was a little concerned as we are now working off a 504 versus and IEP. Your school will have forms from CB that you fill out a portion and the school fills out the rest. They give you the dates on the back of the envelope that it needs to be in by for each test date. The letter from the CB stated that he will have the accommedations as long as he attends the same high school that if he changes schools he will need to reapply.</p>
<p>WRT Strattera- there were 2 reported cases of liver damage out of 2 million users of the med. Both recovered competely after d/c of the med. They have put a warning on to d/c the med. with any sign of jaundice or other evidence of liver pronlems (dark urine, itching, etc).</p>
<p>Guys, please keep this thread going; I am leaving town for a week but will be back to check in again after Xmas. Happy holidays to all. Your wisdom on this issue is a real gift to me.</p>
<p>SBmom</p>
<p>SBMom,
I am visiting the forum while my son edits iteration 12 of his essay!! I private messaged you but then I read the entire thread. Can I just add a few comments. </p>
<p>Any medical doctor, not just a psychiatrist, can prescribe medication for ADHD. For controlled substances you need to have a DEA #, and even most GP's have those. Plenty of kids, unfortunately, get put on meds as the only intervention without thorough assessment. Medication is a tool. There are a lot of tools that can help people with ADD/ADHD and sometimes medication is indicated, but not always.</p>
<p>As for modes of assessment..there are a couple of options. The more you know, the more ways you can help any child. Assessment should not just generate a list of results of tests. The prescriptive nature of the recommendations is key. Recommendations should address ways to strengthen strengths, develop skills, bypass or accomodate areas of weakness. All of these (especially the first) are key. Sometimes medicine is needed to facilitate this, sometimes it isn't..</p>
<p>Lengthy, prescriptive reports are great for ideas and if you have a fantastic support services program at your school then there might be wonderful implementation as well. However, there can be difficulty putting them into action. Some prioritization needs to take place. YOu might need private support, if you can swing it, to get some remedial work done. This is just a reality and is case dependent.</p>
<p>As far as resources for assessment- beyond a psycho-educational or neuro-psychological assessment (the goal of which is to understand factors impacting learning including but not limited to IQ, memory, language, attention)...a medical exam is warranted. One group of professionals who have not been mentioned are Developmental-Behavioral Pediatricians-- who often do thorough neurodevelopmental assessments and a medical exam both. These are sub-specialist Pediatricians...</p>
<p>Books I'd like to add to the recommended list:</p>
<p>Should I Medicate My Child and Running on Ritalin...By Dr. Lawrence Diller
A Mind at a Time and The Myth of Laziness By Dr. Mel Levine</p>
<p>Both of these Doctors are Developmental-Behavioral Pediatricians.</p>
<p>The more expertise you develop in this area as a parent the more you will see that there are as many different perspectives on this issue as there are people who write about it! This is fine, since no 2 kids with ADD/ADHD are alike!</p>
<p>Monydad, the answer to your question is that if your child was diagnosed with ADHD based on a simple test or questionairre, without more -- then that was an insufficient basis for a diagnosis, ESPECIALLY if the recommendation was for medication.</p>
<p>I mean, I'm an anti-med type parent (I mean as far as my personal lifestyle - I don't judge others for their decisions, but in my family meds of any kind are used sparingly and as a last resort) -- and I also have self "diagnosed" myself and my son as ADD based on our procrastinating ways. If you saw the mess in my house, you would wholeheartedly agree. But I don't think that this is the sort of "diagnosis" that would support medical intervention -- though there's no harm at all in my reading self-help books with ADD in the title or trying suggestions and techniques aimed at trying to curb the mess and get thing done on time.</p>
<p>I think that before meds or prescribed -- or even before extreme behavioral interventions take place -- the initial screening via questionnaires needs to be supplemented by at least a thorough physical medical exam of the kid. (I think Robynm's post is very good and I agree 100% with everything she says). The bottom line is that there are all sorts of medical and health problems -- as well as emotional or mental health issues -- that can cause ADD-like symptoms, and you need to first rule them out before making a decision on medications. In some cases the meds given for ADHD are contra-indicated for some of the other conditions that can be mistaken for ADHD. For example, bipolar disorder in kids is often mistaken for ADHD, but meds like ritalin can trigger extreme manic episodes and make things much worse for the bipolar kid. </p>
<p>Bottom line - medical solutions (i.e. drugs) should be supported by full medical evaluations. It is true that many clinicians do not go this extra step and that, in our society, there is a trend toward overmedication -- this hurts the kids who really don't need the meds -- and it also hurts the kids who DO need the meds and will benefit from them, because the practice of careless, overinclusive "diagnosis" fuels the myth that ADHD is not real or is simply an excuse for poor behavior or organizational skills.</p>
<p>calomom-
Your points are right on the mark-- It is very important to understand, as I mentioned earlier and you beautifully reiterated, that there are many many causes of "ADHD-like" behaviors. The world we live in now demands a fast-paced, quick-shift ability that just simply wasn't there a generation ago. How many of us get frustrated if our email doesn't open if a few milliseconds? A brief self report screen is clearly insufficient to diagnose ADHD. A care manager at a managed care company I used to be on contract with asked me once "if I would "just throw one test" at this child so the MD would prescribe medication. I told them how inappropriate this request was. I tried to explain the reason, bu this person, with little if any clinical training, basically said I could do what I wanted but they wouldn't pay for it. All they wanted was one quick test. I resigned from their panel. It was not their license or integrity on the line, it was mine. But that attitude not only speaks the the money-driven insurance world, but also to the desire to have an instant response, a quick fix. A good work-up (medical and psychological) takes time, and behavioral interventions, which can be helpful for the ADHD-inattentive and overactive type (not so effective alone for the impulsive type) take time as well. Oh, and by the way, research has shown that extended time for a diagnosis of ADHD alone isn't really appropriate. A pre-med student tried to get this accomodation for the MCATs and it went all the way to the supreme court. CB hired the experts in ADHD (Barklay, Silver, etc) who spoke on their behalf, explaining that ADHD is often a time management, and that giving someone extra time doesn't help them manage it. If you give an ADHD kid an extra week to finish a project, they will still be finishing it at the 11th hour. As many of you said, procrastination, which is a time management issue, can ba a salient feature of ADHD. It is also very normal, and very common. If someone is distractible, then they can be put in a quiet room for testing.</p>
<p>My son's tests came back. I get the full written report in a few days but got the test results & discussed them with the Ed Psych. He is diagnosed as ADD (no hyperactivity) and his particular weakness on the tests was Processing Speed (27%). His intelligence testing put him in very high level on many areas (all 90%-99% and many scores that were years and years above his age level and his grade level.)</p>
<p>Ed Psych suggested mostly changing habits & systems re school work but did think Ritalin was worth a try from POV that Ritalin <em>might</em> be effective and if it was a big help it could be used as a stop gap help while he was getting his skills together and also as a periodic help with major projects, finals, etc. He did not seem to think that being on Ritalin long term was necessarily a good plan.</p>
<p>I thought it might be worth my S trying Ritalin just to see if it was a huge help. If not, he'd stop. But if it did help, he'd be able to decide when and where the Ritalin could be useful--- I'd hate for there to be a great tool out there that we did not even try due to what my H would call my 'birkenstock' natural-health bias...</p>
<p>Ed Psych recommended a pediatric neurologist to discuss Ritalin.</p>
<p>Now I am wondering if anyone has a POV to share on this...?</p>
<p>SBMom - your son's results sound very much like mine...processing speed for S was WAY below his other scores - although it was within average range - and he also tested in the 95-99 percentile in IQ as well as other tests... according to DR. the wide difference in scores was significant...I am NO EXPERT, but wonder if Ritalin is appropriate for ADD-Inattentive (which sounds like your S and is my S's diagnosis) - I have been under the impression that Ritalin was mainly effective for the hyperactivity.
It is a stimulant...but works in the opposite way for ADD, as I understand it (this is simplistic, I know...I'm sure others are more informed). FYI, my H was very anti meds as well, but they did help our S (Adderall at first; now Strattera...my nephew has had good results from Concerta...there are many options re: meds)
Good luck to you and your S!</p>
<p>SBMom- I am sure you are relieved to have the diagnosis. As I stated earlier I have never been a fan of medication but I think it is worth a try. Since your son is in a stable enviroment you would have good feedback from his school whether it is making a difference.
We took the same approach at exactly this time last year. I will say the first month he was on the meds. there were plenty of days that I was ready to give up on it. I am glad we stuck with it as it has done wonders.</p>
<p>ckr1147,
The stimulants work on all 3 core symptoms of the AD-HD pattern- inattention, impulsivity and hyperactivity (when it is present). The presence or absence of hyperactivity is not the single most important factor in determining whether or not to use medication, but the relative significance of the 3 core symptoms can influence which medication a doctor will start with. Stimulants also improve short term memory. </p>
<p>While a very high percentage of kids improve with medication, it is the success of everything else you do (whether with or without medication) that is more important in terms of long term outcome. Finding and nurturing areas of strength is key, for example...</p>
<p>For years the statistics I saw for ADD/AD-HD patterns was 5% of school aged kids. Now I am starting to see 8-10%. I think we are starting to see the impact (to some extent) of cultural influences like excessive video games,TV etc... just my opinion on that, haven't seen any studies...</p>
<p>Thank you for clarifying that forme, roby..</p>
<p>SBMom - you need to read up and get some other opinions. While I don't like Ritalin or other stimulants in general, a lot of experts who do advocate them say they are effeive for hyperactivity-type ADHD only -- a stimulant will help a person concentrate or focus - it will NOT help improve processing speed. Processing speed deficits are more likely a form of dyslexia, NOT ADHD -- in fact many researchers now believe that processing speed problems are the core deficit of dyslexia. See <a href="http://www.apa.org/monitor/mar00/dyslexia.html%5B/url%5D">http://www.apa.org/monitor/mar00/dyslexia.html</a> </p>
<p>Brain scan studies actually show that with dyslexia, the brain takes up to a half second longer to activate in response to seeing or hearing information - such as a sound or light flashed on a screen - and that this pattern is present in early childhood and may persist through adulthood. This could explain why many dyslexics have difficult keeping rhythms, understanding time, and relating sounds to symbols -- the internal delay may mean that they don't see or hear things in synch with their peers or teachers. </p>
<p>There's also an excellent article about Ritalin and other stimulant drugs here:
<a href="http://www.add-adhd-help-center.com/adhd_medication_information.htm%5B/url%5D">http://www.add-adhd-help-center.com/adhd_medication_information.htm</a></p>
<p>Bottom line: Ritalin may be effective to address behavioral issues, but NOT cognitive issues. If your son has normal processing speed but is easily distracted - reducing his scores - then a stimulant might help - but it will NOT speed up the way your son receives, responds to, and processes information. The processing deficit is an indication that your son should be tested for other learning disabilities. The consult with a pediatric neurologist is an excellent idea, because the neurologist may be able to perform more sophisticated tests to get a handle on the processing speed issues. Those can NOT be fixed with better study habits or more structure at home -- it is an innate problem that can be addressed with a variety of specific therapies or training -- (examples: neurofeedback, auditory integration training) -- but Ritalin would probably not help. I think your own psych's statement indicates ambivalence about Ritalin -- its just not addressing the core problem in any way.</p>
<p>Very interesting information....</p>
<p>My son does not have dyslexia in the classic sense because his reading is rapid, fluent, etc. But might he have the processing speed component without the reading fluency aspect?</p>
<p>Also, there were many observations of inattentiveness during his testing, so I believe that this is a real thing although the processing speed is its own issue.</p>
<p>We need more information...</p>
<p>SBMom - I don't want to get stuck on the word "dyslexia" because we are really focusing on the underlying issue: processing speed. A kid who reads well may manifest issues related to processing speed that might also be described as an auditory processing issue - there may be a subtle delay in translation of what he HEARS (rather than reads) which could appear to be inattentiveness or poor ability to follow directions. The processing delays could also result in subtle effects on physical coordination -- it really depends on exactly what is the area where the processing is slower. </p>
<p>The point is simply that you DO need more information -- "inattentiveness" could be a result or a symptom of a processing speed deficit as well as a contributing cause to poor test results. I mean, it is hard to concentrate if your brain isn't processing data in synch. </p>
<p>I don't know what tests were done with your son so far - but there are other tests that could help get a handle on exactly where his problems lie. Again - the main point is that Ritalin won't fix the processing speed problems, if in fact there is a problem.</p>
<p>Calmom, You raise good points. I will do more checking. As I mentioned before, meds do not appeal to me very much, so I would be happy to avoid them if possible...</p>
<p>I should mention that when my son finds the teacher "exciting" he tends to do well in the class (and this is irrespective of subject matter). Last year his best grades were geography & english. This year's best are in science & math... all because of teaching style and who is most dynamic.</p>
<p>The EdPsych thought this was indicative of ADD as well, in that 'excitement' enhanced my son's focus and without it, focus was difficult. Last quarter my son's academicv class grades ranged from A to D. If it were <em>all</em> cognitive, my guess is that the grades would be more consistent. </p>
<p>On the other hand, the cognitive component deserves attention as well, so we can sort out what problem is attributable to what cause and not leave out a key step in helping him.</p>
<p>Inconsistency, rather consistent inconsistency- is a core symptom of ADD and one of the reasons it is so misunderstood. Please read books by Mel Levine to best understand this...</p>
<p>Mel Levine also has books that kids can read as well. They are a bit corny in the writing style but it does give them some insight into how the brain is wired and how we all learn differently. My son has a few of them and I will see if I can dig them out of his room and get the exact titles.</p>
<p>SBMom - the inconsistency you describe is a characteristic of ADD, but I don't think it should be considered diagnostically significant. It is ALSO a characteristic of giftedness; individuality; creativity; independence; and it is ALSO the normal state of human attention: we pay attention to what we are interested in, we tend to lapse when we are not. Some people are more compliant and better workers than others, or are more responsive to external motivation like the desire to earn good grades or fear of negative consequences associated with bad grades. Your son may simply be the type of person who marches to the beat of his own drum, and has no particular desire to work hard to please teachers who bore him. </p>
<p>You said: "If it were <em>all</em> cognitive, my guess is that the grades would be more consistent. " -- That statement is not true, because it assumes that your son CARES about grades and WANTS to do well in all classes. It is not that your son is being defiant, it is simply that he doesn't happen to be motivated by external factors like grades. He is more internally motivated -- so he responds to those teachers who are better at piquing his interest or inspiring him. The pattern you describe reflects a a pattern of bad vs. good teaching, rather than something wrong with your son's brain.</p>
<p>I just meant that if his processing speed defecit was the key factor in his performance problems, wouldn't it effect even the subjects he enjoys?</p>
<p>You folks are talking about a lot of interactive variables here-- speed of information processing (auditory and visual) attentional issues, vigilance, learning issues, emotional/motivational/behavioral issues, etc. As a colleague of mine likes to say, sometimes a dog can have ticks and fleas. Part of the issue with sustained attention/concentration is the inability to internally maintain it in the face of a less stimulating task or mode in which it is presented. We all have some trouble with sustained attention (which is in part why TV commercials occur every 20' or less), and day-to-day variability in pur performance can also be expected. But Calmom-- if there is a core underlying cognitive issue, you would expect it to affect those academic subjects that are reliant upon this particular skill. It is sometimes a chicken-and-egg thing. A child may put forth less effot when they are unable to be successful in a task, so it becomes circular..Teachers, tutors, etc can hopefully, based on the results of a good diagnostic evaluation, help the student utilize their strengths to develop compensatory strategies. But just as you need your glasses to see and you need your hearing to be adequate to acquire info, so too you may need medication to help improve the ability to focus in order to encode the information in the first place.
And dyslexia is a very different and complex issue. Processing speed may be a variable, but is is a far more complex pholological decoding skill-- sound/symbol relationships, and the ability to understand the lexical representation of language is more complex than just processing speed. But that is a topic for a different discussion... Hope this helps</p>