Behavior modification as adhd treatment?
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Laura Higley La...@nitelinks.com
Does anyone know of non-ingestable alternative treatments for adhd? (We've chosen to avoid pills, drugs, and supplements until other treatment alternatives have been explored.) Can anyone point us to a place where we can find coping strategies that can help him maximize his adhd traits and continue to succeed in school?
nknisley nknis...@bcpl.net
What ADHD traits do you want to maximize?
And which ones are causing him problems that you might want to minimize?
Nancy Unique, like everyone else
Laura Higley La...@nitelinks.com
It seems the flipside of his most desirable traits give him the most serious problems. The behaviors causing him the most problems are at the same time his most powerful gifts.
Specifically, he can be very inattentive to certain tasks, especially when he feels bored. This is inconvenient for him and for others, and causing him heartache and grief, especially as the rest of the world tries to cope with this nonconformity. While he is being inattentive to something he finds boring, he is nonetheless often very attentive to many other things around him simultaneously.
I'm not sure boredom is the right word for the cause of his inattention, though its the word he uses. Even new tasks can turn his attention away, yet he can't identify what it is about a task that will cause his attention to wander, or what these tasks have in common. He has a problem breaking down complicated tasks into manageable parts. Yet he's intensely curious, and a deep font of knowledge on an incredible variety of subjects.
He seems to have a surplus of attention, and can juggle multitasking better than anyone I've ever met--doing several tasks at once, except whatever he happens to feel bored with. Previous teachers have tried to "catch him out" when he seemed to be zoned out, and would call on him to take up the reading next, waiting for him to be embarr***ed or flounder (most probably in order to motivate him into paying attention when that's asked for in school--which seems to be the entire time.) This strategy often backfires. While he isn't focusing the majority of his attention on the boring task, he can focus enough to know the place they are in the reading. This is one skill we want to maximize.
Unfortunately, he doesn't know how he does it.
What he and I aren't understanding is the mechanism that turns some or most of his attention away from whatever he is supposed to be doing. We're not sure if he needs to learn to catch himself when his attention begins to wander, or if he needs to learn to bring himself back once his attention has wandered.
When he is interested, he can forcefully prevent his attention from wandering. Often, his attention simply doesn't wander, all on its own, when he's interested, and no conscious force on his part is necessary. So far been unable to identify just how he accomplishes this.
Many times when he is concentrating hardest, he often physically trembles or shakes. I've noticed this when he's writing. Writing takes an incredible amount of his attention. Tongue between his teeth, pressing through the paper, he needs to sharpen his pencil after writing less than half a page. Even if the pencil didn't have a point, the writing could be discerned from the deep dents in the paper, like one of those tv shows where the detective finds out where the suspect has gone by coloring the blank dented paper with a pencil, revealing the writing by leaving the pressure dents unshaded. Moreover, he writes as legibly as the proverbial doctor. He avoids writing as much as possible. Subjects he could talk about for minutes to hours, in writing merit the fewest words he can get away with. When he is expected to write about any topic, he panics and his mind goes blank. We noticed this first in third grade, during timed math tests. In a minute, he would have to answer a certain number of questions. He would score 50 to 60 on these tests. Any time restriction makes him panic.
He's not sure what is scariest about a time restriction. My instinct tells me he feels just doesn't have time to exercise his repertoire of coping skills under strict time constraints.
In all the reading we've done, we have learned of the many gifted people who have had ADHD. We're very reluctant to stamp out the positive traits, and would rather learn strategies to deal with the negative aspects of these same traits. For our family, we've come to the conclusion that the rest of us who don't have ADHD should be making changes in our behavior too. Because non-ADHD traits seem to be normal, we don't know what it will be most helpful for the rest of us to learn. I know I'd like learn to multitask.
What we want to do is break down the process of certain behaviors, so we can learn alternate ways to accomplish the behaviors he most desires.
What's the process involved in paying attention?
What's the process involved in bringing oneself back from daydreaming?
At the same time, we want to break down the process of the behaviors he wants to control, so he can master these as well. As with any gift, the more control he has over when and how he uses it, the more successful he's likely to feel.
In short, he doesn't want to be at its mercy any longer, instead he wants it to serve him. We're confident some of this will come with age, but we're afraid that, in the process, he may lose his gifts if he doesn't learn how to use them.
He's not lazy though he's been called lazy. He's incredibly bright. He's somewhat immature for his chronological age. He wants to master his attention skills. He wants to write more easily and neatly. He wants to enhance his ability to absorb many things at once.
We are grateful for any help and insight.
tr ...@one.net (CorlissDeb)
Frustration is what behavior modification will produce without the medication.
On Tue, 12 Jun 2001 19:59:22 -0400, Laura Higley <La...@nitelinks.com> wrote:
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Colette tr...@one.net
"dkjyy" dk...@austin.rr.com
I hope this isn't true, because this is just about the situation we are in.
My son has not responded well to the meds we have tried so far and I am certainly not anti meds, we just can't find one that doesn't affect him negatively. So what happens with those who need some sort of treatment, but the meds aren't working well for them? I am hoping some type of behavior modification treatment can help. We are homeschooling, which helps a little, but I still have days where he is very difficult to teach. Is there anyone else on this list who use some type of behavior modification to work with their ADD kids?
Deanna ...
Laura Higley La...@nitelinks.com
We've read that medication and behavior modification together produce the most satisfactory results in a statistically higher number of cases--very much higher. But we haven't seen is anything that says behavior modification alone never works in any cases. We also haven't seen anything to indicate he must take medication he doesn't want to take, without trying something else first. Considering he's using neither medication nor behavior modification now, will behavior modification be worse than neither? Can you please point me to the studies that will help me show him why he shouldn't try what he wants to try? I've been looking, and I just don't see them; I don't think my research skills are equal to this task, but I'm trying as hard as I can to work with him, and not just hand him a fait accompli. Can you point me to some studies that show behavior modification never works in any cases, and do these studies show which behavior modification is used in those cases? Thank you so much for your thoughtful input!
I'd also like to know if anyone knows of behavior modification methods we can try. The studies we've read show behavior modification statistically improves the results of drug treatments; we wouldn't want to deprive him of the opportunity of behavior modification.
gotter ...@aol.com (GOtterBMe)
Laura said: "But we haven't seen is anything that says behavior modification alone never works in any cases." It's not that it will never work... but if you're already having difficult days, it sounds as if your child is not intrinsically cooperative. That makes behavior modification markedly harder to use without it turning negative on you and blowing up in your face.
The truth is that behavior modification is a very tricky intervention.
If I described your son accurately, you really need professional guidance in how to modify his behavior.
In addition you might want to get a second opinion. It is possible that you're dealing with more than ADHD (maybe you've already done that or something -- I just throw it out as an idea.)
J. Clarke nosp...@nospam1.nospam1
This is not something that is inherently provable.
If you are going to try to use behavior modification, you really need one-on-one time with someone who has both training and experience in the techniques as applied to persons with ADHD. Otherwise, meaning no offense, you are unlikely to get any kind of result and if you do you're as likely to make things worse as you are to make them better.
From some of your earlier posts it appears that you are currently thinking in terms of addressing the behaviors that exemplify the neurological abnormalities that constitute ADHD. You can try that if you want to, but if he truly has ADHD, you'll be wasting your time and frustrating him no end. Where the behavior modification techniques can help is with the consequences of those behaviors.
I'm going to give you an example. I used to have a horrible problem getting out of the house in the morning--first I'd have to search for my gl***es, then for my wallet and keys, and half the time I'd forget one or the other. Finally I hit upon a stratagem--there is a shelf near the door. On that shelf goes all the stuff that I need outside the house but don't usually need inside it. When I leave, I take everything on the shelf--if there's something I need to take and I can remember to put it on the shelf, then I take it. When I return, everything in my pockets goes on the shelf. I haven't taught myself to notice where I put stuff, what I've done is create a habit that lets me escape one of the consequences of that inability. This is the sort of thing you have a good chance of achieving with behavior modification.
Remember how be-mod works--you condition a response to a stimulus. That's all that it does. The stimulus can be subtle and the response complex, but in the end that's what is achievable. Since one of the fundamental problems that ADDers have is a tendency to ignore stimuli that do not seem "interesting", trying to use those stimuli to induce a response is an exercise in futility.
So, again, just to summarize--don't try to address the neurological difficulties with behavior modification--try to address the consequences of them.
To be very honest, if he is someone for whom the meds will be effective with acceptable side effects, which is usually the case, they _are_ the way to go.
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--John Reply to jclarke at ae tee tee global dot net (used to be jclarke at eye bee em dot net)
Laura Higley La...@nitelinks.com
The way I asked that comes across as somewhat unreasonable, now that you mention it. That wasn't my intent. But are there some studies that show just that, for all intents and purposes, though perhaps without ruling out some lottery-odds possibility, that behavior modification alone just plain doesn't work? What I've read is that it's less effective than medication alone, and both of those are far less effective than behavior modification combined with medication, so I don't think I'm researching in the right places.
<snipped huge chunks of excellent post, for bandwidth> And that may be what we decide. But I really don't think it's fair of me to make a decision he doesn't want for him without being positive his way won't work. There's a possibility he can try behavior modification in a safe environment, and if it doesn't work for him, he could be more likely to try another method, such as drugs. What we want to avoid isn't the side effects of the drugs, it's the direct, intended effect of the drug. On the other side of each behavior he wants to control is something wonderful that he wants to keep, and that I think the world will miss if he loses it. For example, when his mind wanders, he is open to more patterns, and exhibits more creativity. But when his mind wanders without his permission, it causes him grief and heartache. He wants to control when his mind wanders, and how far. From what I've read and from what other people I've talked to who use various drugs and herbal remedies have described to me, there doesn't seem to be a sense of controlling the mind-wandering; instead the mind-wandering just stops. Then, without the influence of drugs, the mind-wandering starts up again. (When we talked it out, it's this behavior he wants to control most.) And ultimately the best he can achieve may be using the drugs as a kind of mind-wandering switch.
Then again, after reading all the helpful answers here, I'm thinking maybe what we're looking for isn't behavior modification. Maybe we're looking to understand the mechanisms of learning, or heck we may be looking for something else altogether. That sounds like a very tall order, and not just a little scary to contemplate.
When my mother had her first stroke, she learned how to forge new pathways in her brain--she re-learned how to do simple tasks, such as speaking and walking. The part of her brain that used to do those tasks was dead, and new paths were necessary. Can people forge new pathways in the brain without stroke? Is it possible to learn another way of doing the things we customarily do another way, or can't do at all? Or does it just have to be an all-or-nothing proposition?
Laura Higley La...@nitelinks.com
You raise several very good points. And it's also possible we're not dealing with ADHD at all, and barking up the wrong tree.
gotter ...@aol.com (GOtterBMe)
Laura said: "Subject: Re: Behavior modification as adhd treatment?
From: Laura Higley <A HREF="mailto:La...@nitelinks.com">La...@nitelinks.com</A> Date: Wed, Jun 13, 2001 8:28 PM Message-id: <3B281359.44252A9@nitelinks.com> You raise several very good points. And it's also possible we're not dealing with ADHD at all, and barking up the wrong tree." Please understand -- no one here is trying to diagnose your child. But many of us have seen situations where a child was diagnosed with ADHD when the real problem was something else -- Asperger's and bipolar are still underdiagnosed, for instance. It just raises a red flag to me when no meds work.
I have seen behavior modification go off in parents' faces like an A-bomb, so learn all you can about it before using it. If it seems as if he's saboutaging it -- he might be...
gotter ...@aol.com (GOtterBMe)
Laura said: "The way I asked that comes across as somewhat unreasonable, now that you mention it. That wasn't my intent. But are there some studies that show just that, for all intents and purposes, though perhaps without ruling out some lottery-odds possibility, that behavior modification alone just plain doesn't work? " I should tell you that behavior modification is something I know a whole lot about.
Here are some of the limitations.
First of all, you can't start with behaviors you don't see, but wish you did.
So, for instance, if your son NEVER brushes his teeth without being told, having him brush his teeth without being told wouldn't be a good goal.
Second, if you made a list of problem behaviors, and had, say,seven, and four that you considered urgent, you would still have to pick two MAX -- and focus on them -- very consistently -- for months. Now -- is this ADHD of his hereditary? In other words, do you think maybe one of you has it also? If so, it may be very difficult for that adult to be very consistent.
Both parents have to be ABSOLUTELY on the same page -- ALL adults in the family have to be on the same page, so if Grandma lives with you, she has to be as committed to this as you are.
Both parents have to have a thorough knowledge of what you're trying to do.
This isn't something one can turn over to the other and say "Here, you can do that one, honey...".
Although I know a whole lot about it, when we set up a system of carefully reduced privileges for very specific behaviors it worked very well until one day when Dad got frustrated because their rooms were messy. He sent them in to "clean their rooms," a far too global and large task for them at that age.
When he wasn't satisfied with the results, he invoked this behavior modification system punitively, out of nowhere, and removed privileges.
Well, the kids blew up, and a couple of months of work nearly went down the tubes until we had a family meeting and he promised everyone that he wouldn't do that again.
Oy.
If your child has an oppositional streak, you may not be able to find a reward more rewarding than saboutaging your behavior modification system. That's called BIG TIME BACKFIRE.
tr ...@one.net (CorlissDeb)
With meds, if they are effective for him, he will be able to focus when medicated, but can have periods of his day when he is unmedicated. Having one's mind wander when one is supposed to be paying attention in school isn't all that great, trust me. Maybe you should have him tested and have a specialist in this area make recommendations. I think of rewards and withholding something fun as behavior mods, which our school suggested and tried with my son for years, to no avail. He was very willing, but forgot to do things. He didn't need a bribe once he could focus.
My son was against meds totally, until he met Dr. Michael Maloney, and he loved him so much for understanding his problem that I think he would have slept on nails if he would have told him to. He had a great rapport with his psychiatrist right off the bat, and that helped. Once he got on meds, he didn't need any bribes or fun things withheld. He was able to stay on task and focus well over a sustained period of time for the first time in his life, so all of the behavior mods were moot.
I know everyone is different, but this has been our experience, for what it's worth. My son is 15 yrs. old.
On Wed, 13 Jun 2001 21:26:54 -0400, Laura Higley <La...@nitelinks.com> wrote:
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Colette tr...@one.net
mark_prob ...@hotmail.com (Mark Probert)
It may work without meds. However, it is far more difficult, takes much longer, and. may leave emotional scars behind. Thisi snot to say that meds will prevent this, but, the simple fact is, it works better with meds.
Why would he not want to take medication if he has never tried it? My son would never dream of leaving the house without taking his meds.
Period. He knows he is better off with them.
How old is he? Is he old enough to be making such an important decision?
Your standard is backwards. What you should be looking for is the best possible treatment. Get him the best possible behavior mod, and with meds, it will work better. This has been shown to be the case. Have you read the multi-modal study?
nknisley nknis...@bcpl.net
May I suggest that what these tasks have in common is they are tasks being done by a boy who, if he has ADHD, cannot keep his attention focused. No matter how hard he tries. No matter how motivated he is. He can no more "force" himself to focus better than a child with asthma could "force" himself to breathe better. It's not a matter that is within his control.
Sounds very, very familiar.
Even the ADHD experts don't understand the mechanism that turns an ADHDer's attention away from what he is supposed to be doing.
This is something that one of my son's doctors suggested biofeedback might be good for: to teach someone with ADHD what "paying attention" felt like and to teach a person with ADHD to maintain attention.
Unfortunately, the doctor said that there's no reliable evidence that biofeedback would effectively do this or that any benefits would be long term.
This ability of you son to pay attention sometimes may be something ADHDer's call hyperfocus. In the opinion of many who live with ADHD or live with someone who has it, ADHD really isn't a deficit of attention.
Rather, ADHD is the inability to control *how much* attention to pay to some things.
In hyperfocus, someone with ADHD may become so absorbed in a task that they become unaware of their surroundings (ever talk to your son and he doesn't seem to hear what you say?), loses track of time, and may become very irritable if they a required to stop the activity. So ADHDer's report that they've become so absorbed in a task that they've forgotten to go to the bathroom until it was "too late." May I suggest that your son's trembling or shaking isn't because he is "concentrating hardest." It could be because your son is doing something very difficult for him to do.
When my son had a psychological evaluation, the psychologist told me that my son was trembling and talking to himself during a particular task was exceptionally difficult for him.
This also sounds *very* familiar. Thank goodness for word processors and Dragon Speak voice to text software.
My 17 year old ADHD son is also full of ideas and is extremely articulate. But he can't write. First, writing is physically difficult for him. (It's even painful for me to watch him writing.) But, second, he cannot seem to organize his thoughts into a logical pattern to write them down. Ideas don't flow, they don't connect.
Recently a doctor has suggested that my son's writing problem may be a learning disability and not solely due to ADHD. Have you had your son tested for learning disabilities?
<snip> I don't want to sound pessimistic, but you can't necessarily expect that attention will simply improve with age and that school will become easier, although it is true that some people eventually do learn ways to cope with ADHD.
I don't know how old your son is, but my son became less successful in school with each p***ing year, especially after he left elementary school. With each grade, teachers expect more organization, more independence. The work gets more complex. There's more confusion in middle school: changing cl***es, more teachers, teachers are less nurturing and their expectations are higher, the school is bigger, there are new kids, multiple homework ***ignments, more writing, more long-term projects with multiple steps.
While my ADHD gifted son was able to get through elementary school with good grades because he was so very bright, things fell apart when he reached middle school. He is in high school now, and school has *not* gotten easier for him.
It seems to me that what you want to do with behavioral modification goes beyond anything I've *ever* heard being done with behavior modification. I have never heard or read of an ADHD expert suggesting that by using behavior modification one can teach a child to pay attention, write neater, or "absorb many things at once." I've heard of behavior modification being used to teach an ADHD child things like sitting through dinner, or brushing his teeth, or not interrupting others in school, or staying in line at school. Things like that. I have never heard of behavior modification that would actually change someone's ability to pay attention.
But who knows. Maybe it has been done, and I've just never come across it. I will guess one thing: if it can be done, it won't be easy and it won't be quick.
Even if it can be done, you'd have to ask yourself, do you really want your son to spend more years of frustration while you try to do this?
Nancy Unique, like everyone else
nknisley nknis...@bcpl.net
Not to teach someone to pay attention. The only behavior modification program I've read in detail is for modifying oppositional behaviors, and it would not be suitable for teaching someone to pay attention.
The recent study I'm familiar with shows that treatment combining medication with behavior modification as well as management with medication alone are *significantly* superior to behavior modification alone in reducing ADHD symptoms.
"The (Multimodal Treatment Study of Children with ADHD) results published in December 1999 indicate that long-term combination treatments as well as medication-management alone are both significantly superior to intensive behavioral treatments and routine community treatments in reducing ADHD symptoms." http://www.nimh.nih.gov/events/mtaqa.cfm Nancy Unique, like everyone else
Laura Higley La...@nitelinks.com
He knows several other children taking medications. He has been with them on a daily basis, both when they are taking the medication and when they aren't. He has observed the medication is designed to suppress qualities he wants to keep along with the qualities he would like to control. Most of the children he knows accept this, and some are happy with it, feeling much better off than they were before.
Their teachers are happier too. Still, he doesn't want to totally stop not focusing. He wants to learn how to use his personality traits to his advantage.
By the same token, he wears gl***es too. He wouldn't consider leaving the house without his gl***es. He does know the gl***es don't fix his vision problem, they only help him see better in spite of his vision problem, and only while he's wearing them. The bad aspects of wearing gl***es are something he's learned to live with, the price, to him, is worth the benefits. If he didn't want to wear his gl***es when he isn't at home, I couldn't force him to do so. But I'd work with him to change his attitude about the gl***es, not only through his personal experience of gl***es, but also by exploring alternatives.
When we can make an informed decision, the price of the medication may prove to be worth the benefits, as it has proven to be for many other people.
He's 11. That he can articulate his reasons so clearly tells me they merit consideration. He's not old enough to see the ramifications for his choices 70 years down the road, but he's definitely old enough to have his opinions about himself at least listened to.
Yes I have. We haven't seen this method will be the best in his case, or even likely best in his case. The drug-behavior modification method has been proven to work in a large number of cases. There seems to be a great resistance to trying something else first. We need to explore the reasons for that resistance. Such as, if we mess up, he'll likely be worse off, for reasons x, y, and z. We want to learn all about it so we can make an informed decision.
We're interested in learning about behavior modification methods, and other non-drug, non-herbal (which are still drugs, as far as we are concerned) alternatives. Without this knowledge it wouldn't be fair to start a course of medication guaranteed to produce results he absolutely doesn't want for himself. If after learning all we can, we decide the medication is the way to go, he'll likely learn to live without his gifts, and take the bad with the good, but he shouldn't be forced to do that if there are alternatives.
Laura Higley La...@nitelinks.com
I wonder how we can break down the tasks of paying attention into their smallest components. He may find that most of them he can do, or he may find he can't do any of them, or something in between. I wouldn't even know where to go to find this information. I've been looking in libraries and at schools, and of course on the Internet. What I had hoped was in a support group such as this, many others who have surely asked the same questions would be able to tell me where they looked and some of what they found. It seems I'm asking the wrong questions in the wrong ways. That's very frustrating.
Exactly so! What you're saying, and what we learned from this and other studies we've read, convinces us we need to learn the behavior modification components, because we absolutely wouldn't want to be without that. Even if alternatives to medication prove not the way to go, the behavior modification wouldn't be something to deprive him of. That's why I'm so excited about learning more of what will help him, and what will not. We don't want to be without this information, waiting for the information to be dispensed to us by a doctor or other professional, bit by bit, as the professional sees fit. Information won't hurt us, but ignorance just might. We need enough information to understand the process, so we can help and not be roadblocks.
We also want to know which behavior treatments were tried in these studies, and which were not. What we are faced with is trying to apply science to individual families. There are many variables in a family. The rest of us will need to learn to change some of our behaviors too.
Laura Higley La...@nitelinks.com
(lots of snipping of great post, for bandwidth) I know another little boy who has a processing disorder. He was unable to communicate with anyone except his mother. She learned how to teach him to communicate with others, with a great deal of help from many other people, by building on his strengths, many mistakes, and a lot of love. The learning curve was steep. Along the way, the entire family had to change. The going wasn't all smooth. At 6 years old, he can now read and write and draw, as well as speak. The difference between the two disorders is very likely great, and perhaps comparisons aren't beneficial. However, the people with one disorder had a great deal of knowledge and a number of different solutions for families to try. What I see with this disorder is one solution, and that solution throws out the good with the bad.
We're looking for the mechanisms by which this disorder operates and the mechanisms by which attention itself operates.
I'm so frustrated and sad. I am looking for knowledge and understanding. I know we're not being told, "We can't tell you that. You can only deal with this problem this way." Still what I know and how I feel don't always coincide. Not very wise, but I don't know how to change my feelings.
Without this knowledge, we will continue to feel powerless and at the mercy of forces we can't even understand. With knowledge will come the tools to make the right decision.
Hopefully we'll have the wisdom as well.
Again, that makes me so sad. Part of me feels I should teach him to be grateful there's a medication that takes away his problems even though it takes away his gifts at the same time; and to be grateful that even though nobody understands how the disorder works, there's something that can help at least part of the problem, but that's a hard pill to swallow. Right now, I can't be sincere if I try to teach him this. The knowledge and understanding will help me help him.
That's what I've read. And part of that is the same problem with the medications we know of. The benefits wear off when the pill does. It's a real dilemma.
YES! (Sorry, got excited there.) I know lots of non ADHDers who have that same problem. Every kid I've ever seen with a gameboy does this. And most people with access to a tv set. Or ADHD is more widespread than we've been lead to believe.
Oh, no doubt. I have observed this when he's concentrating hardest--and he usually does concentrate hard on difficult tasks. Thank you for clarifying what I was trying to say.
We're starting to learn touch-typing. It's going well!
Not yet, but we will! This was probably never considered due to his high grades and high test scores.
I want to thank you (and everyone else here) for your kind and thoughtful answers. It's so wonderful not to be alone.
The number and scope of posts has been very heartening to my son also, and to the rest of our family.
Unfortunately, the medications we know of will not help this either. At least, that's what the professionals have told us, though again, maybe there's more information we can find out. We don't want him to have to conform with someone's ideas of what will help him be happier. Without gifts like he and others like him have, the human race will stagnate and never try anything new.
And others have told us the same thing.
That's for sure. And it may not even do for him what he wants. He might not be any happier with the results.
Please understand, I'm just a helper here. This is his personality and these are his gifts. I'm just his mother, but he is him. No, I don't want to stand by and watch him do something very very difficult with uncertain outcome, while something easier, albeit with a mixed outcome of both good and bad, could have been done for years. I lived with the pain of migraine headaches until I was 25 years old. At 8 years old, a doctor told my mother I just didn't want to go to school, (I loved school) and so nothing was done for my headaches, until when pregnant and unwilling to take even a tylenol, I wound up in the emergency room convinced I had some kind of brain tumor or something. I don't want to watch my son suffer the emotional equivalent or worse. By the same token, he has a say in this matter. He knows what he feels like now. He may not know what it's like NOT to feel this way, and so may not have the perspective, but surely it's his right to decide for himself. It's my job to help him make the best decision. The easiest decision may not be the best one, but an uninformed decision has to be the worst.
Christopher Eliot empiremas...@mediaone.net
I think Colette's message is part of the truth; the meds really are important.
But, there are different degrees to which ADHD affects people. For those most strongly affected, the meds are virtually indispensable. For those in the middle, the meds are merely incredibly helpful.
If your child can't use meds then you can probably expect to work twice as hard for half as much progress. And, I agree with Colette that secondary emotional fallout is likely unless you are extremely good with the behavioral methods.
The "letter of the law" with behavioral methods is that you only use them to shape behavior that is within control of the child. It works then, and as a result psychologists tend to make pompous statements like "if it doesn't work then it isn't being used correctly." The problem is that psychologists have no answer for the times when the child cannot control himself. That is "outside of the realm" of behavior modification.
Now if you put a behavioral psychologist in a box with an unmedicated kid 24/7 you will eventually observe that the psychologist starts to act like: a parent.
Mark_Prob ...@hotmail.com (Mark Probert)
Listened to, yes. COntrolling, no. If he is doing poorly in school, if his peer relations are suffering, if his relations with his family are bad, then the status quo must be changed. As a parent, it is YOUR responsibility to discuss these aspects of his life with him, and tell him what you observe.
Obviously, since you asked, there are some real big problems. Address them. What was tried in the past has not worked. You have to change course.
True. This 'resistance' is based on years of obsrvation of the failures of trying something else first. IOW, people have been there, done that, and know that "something else" needs help to work.
It seems that by the time you finish this 'analysis' his childhood will be over.
(You are right about that, herbs are drugs. So far, useless in doing anything about ADHD.) What about the consequences of not doing so? Has he been shown that many non-treated ADHDers fail in life?
I get the distinct feeling that you son is not actually thinking for himself as you would believe, but is actually reflecting your message back to you.
You are free to do what you want. I just hope that you quit delaying what will help sooner, rather than later.
Christopher Eliot empiremas...@mediaone.net
The "MTA" study is the biggest long term study of ADHD. It is an ongoing study but they released a progress report a while ago.
Basically, they have three groups of kids with ADHD. One gets meds alone, one gets meds+behavioral therapy and one gets behavioral therapy alone. There must also be a group that gets nothing.
The statistical results (so far) have been that the meds produce significant benefits. The meds+behavioral therapy produce statistically indistinguishable benefits. The behavioral therapy alone produces no statistically identifiable benefits.
I am being careful to say "statistically identifiable". This does not mean that one or two individuals are not gaining. But, overall, this study shows no benefit from behavior modification (with or without meds) while meds show a big benefit.
I'm sure someone has citations for this study. (Biederman et al.) However, despite these statistical results, people do believe that behavior modification is helpful, even the researchers who published this study. But, they could not measure it.
Christopher Eliot empiremas...@mediaone.net
[...] I love technical descriptions. :-)
J. Clarke nosp...@nospam1.nospam1
This is a common misconception. Please understand that what I am saying on this point is first-hand experience. I have ADHD. I do take medication. I do understand what it does in a way that someone who hasn't experienced it will never be able to comprehend.
The medications have not "suppressed" any qualities that I find important. The way I interact with others has changed enough that they notice and comment. This is not because anything is being suppressed--
it is because I can pay close enough attention to them to identify and respond to social cues, and because I can edit what I am about to say before it comes out of my mouth, neither of which are possible for me without the medications. I do not notice that I am any more or any less creative, what has changed is that I can isolate one of the ideas that is rushing through my head and actually _do_ something with it. I have many interests, and a superficial knowledge of many subjects. The meds are allowing me to put some depth into that knowledge--to take an example, I took a rather esoteric and advanced engineering course 20 years ago. I p***ed it, barely, and never really understood the material. When I had been on meds for about a month, I came upon the text for that course and started reading it. I found that I could actually follow it, wasn't bored by it, and realized halfway through page 3 that I had never managed to get that far into it before. My appearance improved, not because anything was being suppressed, but because I was actually remembering to look in a mirror before I left the house. My social life improved, vastly, both because I was noticing social cues and because I was able to get myself organized to act instead of just thinking about it. My house became clean, not because anything was suppressed but because when I tripped over something I noticed that I had tripped over it and moved it out of the way.
There have been times when I did feel that certain aspects of my personality had shut down--at those times I felt very much like I imagine that one of Star Trek's Vulcans would feel--very logical, very precise, but not very emotional. I recognized that when I see that I am overmedicated and need to cut back the dose a bit, which has always corrected that situation.
They merit consideration, but he still does not have enough information to make the choice. Until I experienced the effects of the meds first hand, I was _very_ skeptical--I'm nearly as conservative as Rush Limbaugh, and my views on ADHD and the medication of children were rather closely parallel to those of Roger Schlafly and other nutcakes of his stripe. I thought it horrible that we as a society were drugging kids into submission. I'm not going to go through the personal epiphany that led me to seek treatment--I believe you can find it on groups.google.com if you care to search hard enough--suffice it to say that I found out that it doesn't work that way.
My advice is to try them. If they don't work, or if he doesn't like the effects once the dosage is properly adjusted, he can quit. Ritalin is out of your system in a few hours after the last dose you take. Dexedrine the same. Adderall takes maybe a day to be totally gone. The antidepressants (Wellbutrin etc) take longer both to achieve an effect and to leave the system.
The major reasons are that (a) you aren't going to know if meds in conjunction with behavior mod will work better in his case than behavior mod alone unless you try both, and (b) you can dink around for years trying to make be-mod work and never be sure that the problem is not misapplication of technique, (c) in general one tries the thing that is most likely to provide the greatest relief in the shortest time, and falls back to other approaches only when that has failed, and (d) those who have been there and done that know that living with untreated ADHD can be a living Hell--we have a gut-level antipathy toward anyone who would deprive another one of "us" of the treatment he needs. I'm not saying that that is what you are doing--it's clear that you are very concerned and very worried and trying very hard to do what is right. But still, the thought of this poor kid going through what I've gone through is distressing.
Guaranteed? There's no guarantee that he is even going to _notice_ the effects of the meds. There are some individuals on whom they have no effect at all until the dosage gets large enough to induce a "high", and that's very much greater than the therapeutic dosages. Different individuals respond differently.
If he responds to the meds the same way I did, he's not going to give up _anything_ except a lot of frustration. I can quit taking meds any time I want to and go back to the way I was. But I do not want to be that way ever again.
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--John Reply to jclarke at ae tee tee global dot net (used to be jclarke at eye bee em dot net)
Dave Knapp d...@usa.net
Where in the world did he get the idea that ADHD medication "suppresses" qualities? There is, AFAIK, no scientific evidence that stimulants used for ADHD treatment suppress any qualities; they work by giving one the _ability_ to control aspects of behavior and attention, not by removing any control.
My personal experience with ADHD medication is that it does not suppress _any_ of the positive aspects that go along with ADHD. The whole myth that Ritalin turns kids into "zombies" is completely false.
Medication doesn't force you to focus; it simply makes focus possible.
I would suggest that your child, who sounds very intelligent, has bought into some myths about medications that are inaccurate, and that he is allowing his beliefs about how the medications behave to color his attitude towards their use. The frustrating part of this is that the placebo effect is such that he probably would perceive the medications as having the effects he expects them to have even if they don't have that effect! Such is the power of the human mind.
The best thing you can do for your child is to educate him further about how ADHD medications actually work.
The only treatment related to behavior modification that has been scientifically shown to be effective in the absence of medication is EEG feedback training. However, it is far more expensive than pharmaceutical therapy, and the long-term effectiveness has not been well documented.
-- Dave
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