washingtonpost.com  > Live Discussions > Education
Transcript

Teacher Says: Facts About ADHD

Evelyn Vuko and Harold Koplewicz, M.D.
Post Education Columnist and Director, New York University Child Study Center
Tuesday, October 7, 2003; 2:00 PM

Today's topic is 'Fact vs. Fiction about Attention-Deficit Hyperactivity Disorder.' Though attention problems have been on our radar screens for decades, ADHD is still a confound and confusing disorder, especially when someone tells you your kid has it.

Harold Koplewicz, M.D., founder and director of the New York University Child Study Center joins Post 'Teacher Says' columnist Evelyn Vuko on Tuesday, Oct. 7 at 2 p.m. ET. Dr. Koplewicz, an Arnold and Debbie Simon Professor of Child and Adolescent Psychiatry, recently addressed the US Senate as part of a Children and Adults with Attention/Hyperactivity Disorder (CHADD) educational initiative to introduce the science behind the disorder and dispel common myths and misperceptions.

Evelyn Vuko (washingtonpost.com)

_____More Education_____
Education Section
School Guide
_____More Live Online_____
Keep up with the conversation. Sign up for the Live Online e-mail newsletter.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

________________________________________________

Evelyn Vuko: Welcome, Dr. Koplewicz, we are grateful you are with us today to discuss Attention Deficit/Hyperactivity Disorder. If the huge number of questions we've already received are any indication, ADHD continues to be a worrisome and confounding disorder. Please begin today's chat by highlighting the current science behind it and dispelling the most commonly-held myth. Welcome chatters! Harold Koplewicz, M.D.: I am delighted to be here. ADHD is a common, real and treatable disorder. It's not caused by bad parents or teachers. It is a no fault brain disorder. The good news is that we know that there are effective treatments.

_______________________

Evelyn Vuko: Hello, chatters and welcome to our discussion about attention-deficit hyperactivity disorder. With us today is Harold Koplewicz, MD, a psychiatrist; founder and director of the New York University Child Study Center. Let's get started...

_______________________

Bowling Green, Ky.: I am a single mom of a 15 year old son who was diagnosed at 8 years of age with ADHD and unfortunately the learning disability as well.
He has mood swings and appears angry a lot. Possibly the problem he has combined with his age is the real cause however I have been told that there is a certified Chiropractic Neurologist that has been treating ADHD children without medication and to great success.
What if anything do you know about this area of medicine and if this is just simply an unrealistic approach to his problems? I just want to help him cope with normal day-in-day-out stresses and anxiety. Thank you!

Harold Koplewicz, M.D.: To date the only treatments for ADHD that have proven effectiveness are medications. There are more than 200 controlled studies proving that medication works better that placebo in the treatment of ADHD. Unfortunately chiropractic has not produced one controlled study. There are many anecdotes (one or two cases)of positive results but nothing large scale or controlled and therefore one cannot responsibly recommend it.

_______________________

Bethesda, Md.: Are you aware of any research being done on long-term prognosis of ADHD and ADD? Our son (14) is being treated with Aderall, and we've been wondering if there is new information on trends for when (if ever) ADHD resolves or changes with adulthood.

Thanks.

Harold Koplewicz, M.D.: ADHD is a lifelong illness. The good news is that hyperactivity seems to diminish during adolescence the bad news is that impulsivity and inattention continue. The two studies that have examined ADHD children grown up have followed these individuals for more than 20 years. Left untreated they drop out of high school 10 times as frequently as the controlled group, have more car accidents, more convictions, more felonies and use more medical services. One finding that needs investigation is that earlier treatment may have a positive affect on long term outcome.

_______________________

Phoenix, Arizona: Is there a viable alternative to medication for ADHD?

Evelyn Vuko: You might want to check out a resource called Developmental Delay Resources which provides workshops, seminars and publications about non-pharmacological supports for learning disabilites. Log onto www.devdelay.org

Harold Koplewicz, M.D.: A study recently completed called the MTA The Mulimodal treatment of ADHD found that psychosocial interventions were not as effective as medication. That said many families would rather use organizational skills training, social skills training, and behavioral therapy to treat their children's symptoms of ADHD. I would highly recommend that you consult with a clinical psychologist with expertise in behavioral therapy and ADHD.

_______________________

Louisville, Ky.: My son has been on some form of Ritalin since the first grade. He was diagnosed with mild ADD at that time. IN recent years, however his teachers and I have noticed extensive "bleed through" of his symptoms (which seemed to have gotten significantly more serious over time.) This year (8th grade) I took him off of his Concerta. He's struggling, but actually doing better academically. I'm not sure what to think about that. Is there a level of maturity necessary to logically address and overcome one's own symptoms without medication?

Harold Koplewicz, M.D.: Clearly the symptoms of ADHD change depending on one's developmental stage of life. Your son deserves a second opinion to evaluate the original diagnosis and potential treatment options.

_______________________

Fort Lauderdale, Fla.: My son (8 years old) has been taking Aderall RX for about two months for his ADHD. While we notice a great improvement in his behavior at school (paying attention, staying in seat, finishing class work, etc), we have noticed that he has become very angry and emotional at home after school. This behavior is unlike my son. My understanding is that this may be due to the medication wearing off, but what do I do? I am afraid to ask the doctor to increase the medication to get him through the rest of the day because my son already has difficulty getting to sleep at night. My worry is that if I increase the ADHD medication, then I will need to give him something to sleep and I am wary of so much medication. Do you have any suggestions?

Harold Koplewicz, M.D.: Your concern is very reasonable. It is possible that your son is rebounding off the medicine in the afternoon and that is making him edgy and irritable. Possibly another form of Adderal in the afternoon with a small dose may do the trick or possible lowering of the original dose should be considered. Either way you have to have this conversation with your son's doctor. It's important that you develop a dialog with him so that you can work as partners in helping your son receive the best treatment possible. Clearly his doctor cannot do this without your input and impressions.

_______________________

Rochester, N.Y.: My 17 year old daughter was diagnosed with ADHD May 2003 near the end of junior year in high school. Because of my concerns about her lack of organization skills, frequent missing assignments, and inconistent academic performance, the school psychologist interviewed her, tested her with a Test of Variables of Attention, and collected Connor rating reports from teachers and both parents. Although her official school records in the early grades did not indicate behavior consistent with ADHD, the psychologist believed she currently exhibited behavior consistent with the diagnosis of ADHD. The pediatrician agreed and started my daughter on stimulant medication which has helped her somewhat. I have many questions. Please answer where you can: Is any additional testing needed to "confirm" the diagnosis? Is there a standard for this, and should my child have more testing? I don't doubt the diagnosis, but the application for extended time on the SAT and ACT seems to require that more tests be performed to confirm the diagnosis, perhaps to quantify the "health impairment". Is my daughter to get minimal improvement with stimulant medication since her ADHD does not involve a large hyperactivity component? What else might be helpful for her? I have asked the school psychologist and guidance counselor for a 504 plan mainly to provide her with in-school coaching for organization and planning of assignments, and for additional time for big tests (i.e. unit tests, midterms and finals), but it is October 7th and the school has not responded. What do you suggest I do? Gen

Harold Koplewicz, M.D.: You're right. The diagnosis of ADHD require symptoms before the age of six. Lots of times when a child has ADD without the H and is very bright he or she does not have enough problems to come to the attention of the teachers or parents. However, that does mean that your daughter doesn't have ADD. She should have more than a minimal response to the medication. In general I believe that no medicine is better than any medicine unless it is absolutely indicated and has a positive effect on the child's symptoms. Therefore your daughter does need more evaluation. I would recommend that you contact a university affiliated hospital that has a department of psychology or child psychiatry and get your daughter neuropsychological testing. This exam will explain how your daughter learns, how she attends and what accomodations she needs.

_______________________

Great Falls, Va.: I think that ADHD is fueled by a more sedentary life that our children are experiencing now. Has there been scientific studies done to prove or dispell the fact that an excessive amount of watching TV, using computers and playing video games enhances ADHD?

Harold Koplewicz, M.D.: ADHD has been around for hundreds of years. The first study that used medication for this disorder dates back to 1937. We also have studies that show that kids with ADHD move around more than average kids. In fact they even move around more in their sleep. However, when treated they move around less even on the sports fields which is good since they now are paying more attention in games like soccer and getting the ball in their opponents goal not their own.

_______________________

Fairfax, VA: There's a school of thought (pardon the pun) that ADHD is somehow connected with, or grows out of, reading difficulty. For example, recently in Fairfax County the "Gibson Report" submitted to the School Board said, "Students with a learning disability, emotional disturbance, or other health impairment (including ADHD) could, in some cases, do very well with effective support levels common to all students, especially in reading." What effect, if any, does a reading program have on students with ADHD?

Evelyn Vuko: Any kind of academic support program will help a kid who has an attention deficit. I have found that private tutoring, for example, whether it's to support reading weakness or to coach with homework or study skills can have a profoundly beneficial effect on kids with ADHD.

Harold Koplewicz, M.D.: ADHD and reading disability are commonly found together but are not linked. Reading programs for children with dsylexia usually use a multisensory approach to teach them to read. This addresses the fact that dsylexics lack phonemic awareness (the ability to hear the different sounds of our language). One can have ADHD and be a great reader and therefore a reading program will not help.

_______________________

Great Falls, Va.: Do you think that food additives play a large role in the manifestation of ADHD?

Harold Koplewicz, M.D.: This question has been around for a while and has been extensively studied. Approximately 20 years ago Dr. Rachel Klein tried to prove that the Feingold diet (a diet free of all additives) was an effective treatment for children with ADHD. She conducted a controlled study that was double blind meaning that the parents, the children and the doctors didn't know which children were receiving the good diet and which the additive diet. At the end of the study the parents and doctors couldn't differentiate the children on the Feingold diet.

_______________________

Phoenix, Arizona: Is exercise a viable modality for ADHD? Same question for nutrition and supplements.

Evelyn Vuko: Recent studies have found that multi-faceted programs that include all kinds of supports like family counseling and home and school-coordinated behavior programs are extremely effective for kids with ADHD. Many parents of my students routinely involve their kids in actitivites which promote focus and concentration, like martial arts. And it only makes good sense to avoid foods known to create allergic reactions in kids like milk, wheat, peanuts, etc.

Harold Koplewicz, M.D.: There are many things that a parent can do to help their child when they have a problem. Clearly organizing them, coaching them and keeping them in structured activities is a good idea. While allergies and food additives have been accused of causing ADHD we have no definitive proof that this is true. If time, money and resources are limited we have to stick to treatments that have proven effectiveness.

_______________________

Great Falls, Va.: How is the brain chemistry different in a person with ADHD?

Harold Koplewicz, M.D.: Great question. A new study that was completed at NIMH has shown that the brains of children with ADHD are 3-4% smaller in total brain volume than normal kids the same age. These kids with ADHD had never taken medication. Specific areas of their brain; the cerebellum were as much as 6% smaller. These areas of the brain have different chemicals or neurotransmitters which we believe effect attention, impulsivity and hyperactivity.

_______________________

Germantown, Maryland: My 10 year old daughter has many of the related ADHD problems, one that concerns me the most is she has such a hard time making and keeping friends. She tends to be over powering and nasty. What suggestion would you have to help us with this matter.

Evelyn Vuko: Start by reading a book called "Raise Your Child's Social IQ" by licensed clinical social worker, Cathi Cohen.

Harold Koplewicz, M.D.: Unfortunately kids with ADHD miss social cues. They want to have friends but are more frequently rejected and not picked for social activities. Participation in a social skill training program with a social worker or a psychologist may make sense.

_______________________

Laurel, MD: Dr. Koplewicz, my son, as a kindergartener, was identified by his teacher as ADHD. He was a bright, but fidgety child. In 3rd grade, one of his teachers suggested he be evaluated for ADHD by other teachers and his pediatrician. The evaluations suggested that he was borderline from this teacher, but normal according to the other teachers. His doctor asked questions about my son's grades and relationships with other students. After informing the doctor that my son was an "A" student and popular with the other children, he said that my son couldn't have ADHD. My son is now in 10th grade and taking honors and A.P. courses. Why do teachers insist on labeling children as having ADHD? And, how do parents handle the aftermath?

Evelyn Vuko: It is your job to gently educate the teachers in your child's life. Keep them current about achievements outside of school and never be afraid to let them know when their comments or attitude could be negatively affecting your child.

Harold Koplewicz, M.D.: Teachers are very valuable resource for parents. They can tell us how our kids behavior compares to a larger group of children. Therefore, if a teacher tells you that your child is doing something out of the ordinary I would pay attention. However, teachers are not clinicians and shouldn't make diagnosis or make treatment recommendations. An evaluation that tells you that your child does not have ADHD is as important as one that tells you that your child has a problem.

_______________________

Bluffton, S.C.: Please explain "executive function" and the deficits in this area ADHD children have. what, if anything, can be done to improve their functioning in this area?

Harold Koplewicz, M.D.: Executive functioning relates to the way an individual prioritizes and organizes information and tasks. Routinely we have found that kids with ADHD pay attention to everything and do not focus on the most important tasks that need attention. Russell Barkley,Ph.D. has in several books disussed interventions that may be helpful.

_______________________

Washington, DC: What are your thoughts about combining ADD/ADHD students with non-ADD/ADHD students? Do you think that both of these groups can maximize their learning experience in a combined atmosphere?

Evelyn Vuko: I have found many of my students sensitive to the needs of others and often more patient than some adults in dealing with a friend's special needs. I think putting kids of all abilties, talents and needs together can help them all, not just those with ADHD.

Harold Koplewicz, M.D.: ADHD students and ADD students should be mainstreamed unless they have some severe cognitive disability. Properly treated kids with ADHD can be very successful. Every ivy league college in America have LD programs that help students that have ADHD.

_______________________

Bluffton, S.C.: if a child has been diagnosed with pervasive development disorder, is attention deficit hyperactivity disorder part of that diagnosis as a general rule. what new medicines are available and what is the safety of their use, particularly if other psychopharmacy agents are being used?

Harold Koplewicz, M.D.: PDD or pervasive developmental disorder is on the spectrum of autistic disorders. Frequently kids with PDD are hyperactive, inattentive and impulsive. These kids have PDD not ADHD. However some of the medicines that have been effective in treating symptoms of ADHD in very low doses can be effective in this patient population as well.

_______________________

Washington, D.C.: Can you recommend a book for parents regarding effective discipline strategies & responses for ADHD kids that are forgetful, impulsive, that are often disrespectful, rude yet also exhibit loving & kind behaviors?

Evelyn Vuko: Read books meant for teachers about how to help maintain discipline because ideas that work for 25 kids do wonders for only one--books like: Setting Limits in the Classroom by Robert J. MacKenzie. Or order The Discipline Checklist ($5.95) from the National Education Association by calling 800-229-4200 or by logging onto www.nea.org/books

Harold Koplewicz, M.D.: I think Evelyn is absolutely right.

_______________________

Fayetteville, N.C.: Can a Child who has much needed seizure control and is currently on Depakote display all the classic symptoms of ADHD and OCD as a result of the Depakote; or is this how my child is wired with out this medication ? He is currently 6 and has been on Depakote since 18 months .Adderall was first recommeded by his neurologist when he was 2 1/2 .He has been on Prozac since age 3 1/2 and Adderall since age 4,later replaced by ,Adderal XR , Ritalin and now Strattera.

Harold Koplewicz, M.D.: In 1996 I wrote a book title "It's Nobody's Fault" (Times Random House). In it I suggested that choosing ones parents wisely was the most important task of childhood. Clearly your son has done this. Having a child with a seizure disorder and psychiatric symptoms is harder than being the parent of a symptom free child. ADHD and OCD are no fault brain disorders. Therefore it makes sense that children with seizure disorders more frequently have psychiatric symptoms than others. To date Depakote (originally designed as an antiseizure medicine and now used for very moody children) has not been reported to cause ADHD or OCD symptoms.

_______________________

Sherrill, N.Y.: Hi, I have a son with ADD and he is in the 9th grade for the second time and not doing good the second time around either. The school has made him take a language and has never modified his homework although he has a difficult time.... what should I do?

Evelyn Vuko: Get him a private tutor, immediately. Find someone who can coach him in the foreign language as well as provide homework and test-taking strategies. Call his school guidance counselor or the head of your PTA for a reference.

Harold Koplewicz, M.D.: Your child should also receive an evaluation from the committee on special education in your school. He probably deserves accommodations including extended time. Let's get his guidance counselor or school psychologist to partner with your to get your son what he needs and legally deserves.

_______________________

Alexandria, VA: The number of children diagnosed with ADHD had risen sharply in the past decade. Do you think this is because of a growing awareness of ADHD, or could the actual incidence of ADHD be increasing?

Harold Koplewicz, M.D.: ADHD has been around for a long time. I believe that the increased public awareness and the effectiveness of the treatments available has made it easier for parents to seek help for their kids. Ned Hallowel and John Ratey's book "Driven to Distraction" has made a big difference.

_______________________

Washington, DC: Where can I find names of doctors with experience in ADHD to have my child evaluated? Are there professional organizations I can turn to for resources?

Evelyn Vuko: Evelyn Vuko: Turn to Children and Adults with Attention-Deficit Hyperactivity Disorder at www.chadd.org or the National Association of School Psychologists at www.nasp.org

Harold Koplewicz, M.D.: I would also recommend the American Academy of Child and Adolescent Psychiatry www.aacap.org and the American Academy of Pediatrics.

_______________________

Manassas, VA: There have been concerns in the past that medication for ADHD can stunt growth. Have any recent studies explored this aspect of medication?

Harold Koplewicz, M.D.: The most impressive, largest and longest study examining kids with ADHD grown up has concluded that the psychostimulant medications slow growth but in the long run the kids are the same height as the controlled group. They just take longer to get there.

_______________________

washington, dc: Have you seen children or adults with ad/hd go from taking medication to not taking medication over time. That is, have you seen folks improve sufficiently to stop taking meds?

Harold Koplewicz, M.D.: High School is the hardest time for people with ADHD. You have to go to multiple classes in a short period of time and take many required courses. College gives you the freedom to take courses that you are interested in. People with ADHD have trouble more than usual with boring subjects and therefore when they are doing novel, interesting tasks they have less trouble focusing and paying attention. Therefore there are times in their lives where they will not need as much or any medicine because of the environmental demands not because of previous treatment.

_______________________

Phoenix, Arizona [For Evelyn only]: As a followup perhaps in the future when discussing this topic, www.ADDWarehouse.com is a good resource for books for ADD adults and children. Thank you. Warren
-I will not submit any further private messages. I did send you an email earlier in the chat.]

Harold Koplewicz, M.D.:

_______________________

Lincoln NE: What about the use of PET scans or Brain Spect Imaging to diagnois ADHD?

Harold Koplewicz, M.D.: Brain imaging tools have given us a better understanding into the differences of children with ADHD. However, at the present time these tools are too expensive and not sophisticated enough to make individual diagnosis. We are at least a decade away from using them for diagnosis. In the meantime we have to make diagnosis the old fashioned way by taking a clinical history.

_______________________

Virginia Beach, Va.: I have a fifteen year old son who has been diagnosed with AD/HD, without the hyperactivity. He has also been identified gifted. Beginning in the 7th grade, his grades have suffered because he lacks organizational skills. He would do his homework and some place between home and the classroom, it got lost, most often found in a heap at the bottom of his locker. But orally, he did great but no oral testing is done except in Foreign language and that didn't help him pass Spanish!

During that year we moved him out of Advanced classes, with no improvement in performance, and same issues. Guidance counselors in middle school refused to grant a 504 because "he can do the work if he wants to do it".

Now that he is in 10th grade, what do you suggest I do? Gifted Resource teacher says keep him in Advanced classes to keep him stimulated. Guidance counselors say drop him down to core classes. He also refuses to take medication- the latest being Metadate.

Evelyn Vuko: Stay tuned for Teacher Says chat coming in November that deals specifically with how to help kids with ADHD or ADD get organized! In the mean time, keep him in the Advanced classes. It provides clear proof that he's got what it takes to do the work and succeed. He needs all the clear proof you can offer him.

Harold Koplewicz, M.D.: It's essential that you have your son receive neuropsychological testing and stay on top of his guidance counselor.

_______________________

Folsom, Calif.: Does anyone OUTGROW ADD/ADHD?

(OR do all children continue to have it as adults?)

THANK YOU!

Harold Koplewicz, M.D.: Unfortunately ADHD is a lifelong illness. The symptoms change as we grow older. Most commonly we become less hyperactive but still are more fidgety than the average person. The most difficult symptom that individuals with ADHD have throughout their life is with executive functioning: prioritizing work, giving attention to things with the shortest deadling and recognizing what is most important to do first causes the most distress and difficulty. Treatment works at all ages.

_______________________

Evelyn Vuko: Thank you for taking the time to participate in today's chat. I am so sorry Dr. Koplewicz and I only had an hour to try to answer all your questions and concerns. I hope that we've helped in some small measure to increase your understanding and dispel your fears about this disruptive disorder. Please watch for two November and December Teacher Says chats which will focus on how to help kids with with ADHD become better behaved and more organized. Let's learn all we can, together.

_______________________


© 2003 Washingtonpost.Newsweek Interactive
Viewpoint: Paid Programming

Sponsored Discussion Archive
This forum offers sponsors a platform to discuss issues, new products, company information and other topics.

Read the Transcripts
Viewpoint: Paid Programming