ADHD and Driving

One newsletter reader recently submitted this question regarding their young adult child with ADHD, and programs available to help with his/her driving. Here was the question:

My (young adult child) has ADD (on medication) and has had several speeding citations and a car accident. Are there techniques to prevent these events? Any articles on tips to avoid driving incidents? Any researchers in this field with ideas? You noted facts but we could use solutions.

My answer to her focused on the issue of character, which I wrote a long article about in the last newsletter. My answer to this reader is printed in this article below.

Research on Driving and ADHD

But there is an interesting report out of Israel today about a program to help drivers who have ADHD to decrease ADHD-related traffic accidents. The report is dated November 4, 2008.

It seems that researchers from Tel Aviv University have developed a driver training program targeted to ADHD individuals. They teamed up with the occupational therapy departments in local hospitals to develop this program.

One of the lead researchers is Dr. Navah Ratzon from TAU's Department of Occupational Therapy. She played a big part in the program both from the OT side, as well as from the parental side. Dr. Ratzon has a teenage daughter with ADHD who keeps banging up the family car. So she helped to develop this therapist-led approach to training people with ADHD how to drive more safely.

In this program the OT’s help to train the drivers with ADHD using self-described state-of-the-art tools. They help the drivers to learn to systematically screen the visual field for potential hazards, including regular checking of the rear view mirror.

As a side-note, once upon a time I drove a bus for a day camp program for my summer job, working my way through college. We received similar re-training, as normal driving habits in a car are inadequate for driving a bus with 60 children in it. We were re-trained to constantly scan the field of vision, and to check our three large rear view mirrors every three seconds. So I can see where this type of purposeful retraining would be very helpful.

The research team admits that there is very little research on ADHD and driving.

The program encourages drivers with ADHD to take their re-training program, and also encourages drivers to take their medication for ADHD as prescribed for driving their cars. They point to studies that have shown that ADHD teens that use stimulant medications drive more safely than those with ADHD who do not.

Learn more about this research:
http://www.aftau.org/site/News2?page=NewsArticle&id=7857

Here were my comments to the reader regarding Character and Driving Behaviors

There are some minor editions to hide some details, but the concept is intact.

27 October, 2008

I'm not familiar with anyone doing research in this particular area, ie developing strategies for young adults to drive more carefully. I know that it is an area of great concern for many parents, so it would be nice to see.

Here, for what it's worth, is my thought: speeding is voluntary.

Speeding is an act of the will. People, even impulsive people, choose to enter a vehicle and to exceed the speed limit. When someone exceeds the speed limit they increase the probability that they will be involved in an accident that will injure an innocent party, perhaps a child - perhaps MY child.

Ultimately repeated speeding is selfish, and irresponsible. It shows a lack of concern or care for the safety and welfare of others, including children. Your son has to confront this issue in his life. Does he truly want to be so self-centered? I hope not.

Driving carefully is also a choice, an act of the will. Even impulsive people can make the decision to drive under the speed limit and in a focused and careful manner. This will decrease the probability that they will be involved in an accident that might injure innocent people.

Deciding to drive in a careful manner is an act of responsibility, and shows that one values and cares about other people as well as himself.

Each of us gets to define our own character. We may not get to define our reputations (how others see us), but we do get to define, and then develop, our own character.

To a great extent our character is shaped and defined by the things that we do, and by the things that we either fail to do, or decide on purpose not to do. Our character is revealed in the choices that we make, especially when no one is watching us.

I would ask your (child), now (a young adult), to consider what type of a (person) he/she wants to be. Would he/she like to be a self-centered (person) who doesn't really care about the welfare of others? Or would he/she like to be a (person) of integrity and honor, who cares for, and perhaps would even sacrifice for others?

Then, based on that choice, based on the choice of what kind of a person he/she would like to be, he/she can make other choices in life, including decisions about how to operate his/her motor vehicle in public.

I truly hope that your (young adult child) will choose wisely. Please give him/her my kindest regards.

Sincerely,

Douglas Cowan, Psy.D.

Teenagers and Depression

Depression in Teenagers

With as many as 25% of teenagers with ADHD being clinically depressed, it is important to understand what depression looks like, why it is important to treat it and manage it, and the treatment options available.

When we think of someone who is depressed, we usually picture a sad, tearful, lonesome person. But teenagers with depression don't look like adults with depression.

Current studies show that there are about as many teenagers who are depressed as there are adults that are depressed, about 10% of the general population. And as we have noted, as many as 25% of teens with ADHD are depressed. However, depression in teenagers doesn’t always look like depression in adults. Teenagers do not commonly display gloom, put themselves down, or talk about feeling hopeless like adults do.

Teenagers with Major Depression are described as often becoming negative and antisocial. Feelings of wanting to leave home or wanting to run away will increase. There may be a strong sense of not being understood and approved of by parents, siblings, or peers. The teen often changes, and becomes more restless, grouchy, or aggressive. A reluctance to cooperate in family ventures, and withdrawing from the family by retreating into their room is pretty common. School difficulties are likely even in those few ADHD teens who were doing pretty well in school, as concentration is even more affected than from the ADHD alone.

Sometimes the teen will stop paying attention to personal appearance, and sometimes they will adopt the “uniform” of social groups that profess depression or despondency as a way of life. They often become much more emotional “at every little thing.” Often there is an increased sensitivity to rejection in love relationships as well.

Which reminds me of a Cornell University study that reported that the leading cause of teenage depression was breaking up with a boyfriend or girlfriend. And that the younger the teen was in this relationship, the more likely the breakup would lead to depression.

Teenage boys will often become aggressive with their parents or peers, seem more agitated around the house, and get into more trouble at home, at school, or with the law. Teenage girls will sometimes become preoccupied with themes of death or dying, and become decreasing concerned about how they look.

Suicidal thoughts are common in depressed teens. Some studies suggest that 50,000 teens attempt suicide each year, and 5,000 are successful. That would be 10%. Other studies suggest that the number is 15% of depressed teens ending their life via suicide.

By the way, another study notes that of all the teenagers that commit suicide each year, only seven percent were receiving mental health treatment at the time of their death, and 93% were not receiving any treatment for depression.

Poor self-esteem is common with teenagers, but especially with those who are depressed, and there is often an increase in “self-destructive behaviors” such as alcohol abuse, drug abuse, and sexual promiscuity.

Parents are often confused and frustrated when their teens begin to act like this. Sometimes parents become stern disciplinarians, or even put the teen down, which only serves to increase feelings of guilt and depression. Other times, parents feel helpless, and stand by waiting for adulthood to arrive. Of course neither course is the best one to take.

And even with only a small percentage of teens with ADHD or depression receiving treatment, the use of ADHD medicines prescribed to girls was up by nearly 75%, and the use of antidepressant medications was up by nearly 10% in girls from 2001 to 2006.

To add to this drama, no doubt you've seen recent news headlines about a federal panel that recommended to the FDA that anti-depressant medications carry the strongest possible warning label for use in children and teenagers. This recommendation to the FDA shook the medical community, especially those who work with depressed young people, and now the FDA mandates that antidepressants used to treat adolescent depression carry the dreaded “black box” warning label.

What the media did not report well is the fact that 10% to 15% of children and teens with depression who receive no treatment will commit suicide. These 10% to 15% will not just think about it, but will actually kill themselves.

So what are we to do? If the media had their way it seems that no teens with depression would receive anti-depressants. As a result the suicide rate for those who could be using the medication would rise from just above zero percent to about fifteen percent, which is the suicide rate for depressed teens who are untreated. And, yes, while there actually are young people, and adults, who have become suicidal only after beginning treatment with an anti-depressant, remember that they were likely suffering from depression already, or else they wouldn't have been treated with anti-depressants.

And it is sadly true that some have in fact gone on to take their own lives after begining anti-depressant medications, which is absolutely tragic and heart-breaking. But so is the fact that untreated depression is very risky and potentially fatal. As many as fifteen out of one hundred young people with depression take their own lives unless they receive treatment. These young people should be allowed to receive a treatment that will lower the suicide rate dramatically, and without any stigma attached to it by the media.

With proper diagnosis and treatment a depressed teen, or adult, can be greatly helped. If someone close to you is suffering from depression, first please understand that depression is a very emotionally painful condition. Please take the situation seriously. If you know of a teen whose behaviors have changed and look like all that we have been discussing, let the parents know that there is help available, and encourage the family to seek help from a professional.

6 Ways to Communicate Clearly With Your Teen: Guest Author

Communicate Clearly With Your Teen

By Christine McGogy

How would you like to have a closer relationship with your teen again? Your ability to communicate effectively with your teen is one of the most precious skills you can develop to achieve this goal.

When we think of communication, we tend to think only of the way we can express ourselves. This is certainly important, but listening is the single most crucial of all communication skills.

As a mother of two teenage boys I know that it isn't always easy to communicate well with your teen. It's particularly frustrating when they aren't talking to you. However, when I started applying these techniques to our lives, I found that we started getting along better almost immediately. There was less arguing between us, and our relationship became stronger.

1. Focus, and Give your teen your full attention.

I know that this is a toughie, because we tend to be so busy. It seems like we are always multi-tasking. However, it is important in clear communicating that you make a point of stopping what you are doing and really listen to your teen (rather than just hearing them). When you give your teen your undivided attention they will know that you care, because you took the time to listen, and it will increase the chances that they will listen to you.

2. Get the Details - Hear what your teen is really saying!

Teens tend to give terse answers to questions, leaving out details that may be important. It's up to you to be able to get them to open up and draw them into a conversation. Here is an example:

Teen: "I hate my teacher!"
Parent: "Oh, you don't really mean that!"
Teen: "Yes, I do, I double hate him!"
Parent: "Well, I don't want to hear that kind of talk. I am sure you don't really hate him!"
Teen: "Yes, I do so, I hate all teachers!"
Parent: "Do you think hating your teachers is going to get you a good mark?"

And on and on the arguing goes....Here's an alternative:

Teen: "I hate my teacher!"
Parent: "Wow, you don't normally hate anybody. What did he do to get you talking like that?"
Teen: "A couple of kids didn't have their homework finished again today, so he decided to punish all of us by giving us a math test tomorrow!"
Parent: "That doesn't sound very fair!"
Teen: "No, it isn't fair at all. I wanted to go over to Rachel's tonight to hang out and listen to music. Instead I have to study for that stupid test. I am so mad at my teacher! He ruins everything!"
Parent: just listening.......

This teen was able to express herself and felt validated by her parent. You will notice that the parent didn't argue about the feelings the teen had. You don't have to agree with your teen's feelings; just acknowledge them. There is no such thing as a wrong feeling. We can't help what our teens may feel, however, we should set limits on behaviors that don't satisfy what we consider appropriate behavior. Expressing one's feelings is a healthy thing; although negative expressions of one's feelings should be avoided; like screaming or name calling.

A good way to avoid this is using ‘time outs' - wait and continue the conversation when everybody has calmed down.

3. Open-Ended Questions

Questions can be crucial to communicating with your teen. Ask them questions that they can't just answer with a "yes" or a "no". For example in the above scenario the parent could ask the teen,

"What could you do to help your teacher change his mind about the test?"
Teen: "I am not sure - this guy is so stubborn!"
Parent: "If you talked to him and came up with better ways for him to deal with the kids that aren't doing their homework?"
Teen: "Mmhhh, maybe I could give it a try....?"

4. Criticize Behaviors, Not Your Teen

Now, let's move from the listening to the talking part of communication.

When you want to see a change in your teen's behavior, use the "when you...I feel...because...I need ..." sentence. Using this wording (known as " I " message) doesn't attack your teen's personality; it merely talks about their action and that you'd like it changed and why.

Here is a scenario you might relate to: The chores haven't been done and your teen went out instead. This example shows not the best way of communicating by attacking them as a person and making statements you may not stick to anyways.

Parent: "You didn't do your chores! You are such a lazy slob! You never do your chores and I always have to do them for you. Next time you don't do them I am going to ground you for a week!
Teen: feeling pretty lousy...

Now here is an example with using the: when you...I feel...because...I need – technique:
Parent: "When you didn't do your chores before going out, I felt really mad.

We had an agreement about chores being done before going out and I need you to do your part of the chores or I am stuck doing them for you."

Teen: thinking – "I guess that makes sense."Remember when you start a sentence with "You are such and such…" , you aren't communicating. You are criticizing!

5. Let the Consequence Fit the Action

A fairly big problem that parents run into is looking for suitable punishment for broken rules. However, the penalty applied usually isn't related to the teen's action. As parents, we need to show our teens that each choice they make has consequences.

Parents tend to punish their teens by taking away something the adolescent enjoys; for example, no TV for a week. Take the above example of the unwashed laundry. It would be more beneficial to the development of your teen if you base the penalty on a natural connection between his action and the punishment. A good way of showing the consequences to his action in this instance would be having your teen do your chores as well as his next time, since you had to do his this time. When following this step you are practicing "silent communication" with your teen.

Letting your teen experience the natural consequence of his actions speaks louder than any words ever would! It illustrates to them that they will be held accountable for what they do. As they grow teens tend to get more privileges from parents. It is important for them to realize that with the extra freedom there is more responsibility that goes along with it.

6. Using Descriptive Praise We all praise our teen sometimes.

We tell them "You are a smart kid" or "You are a good piano player" etc. We mean well, but unfortunately this kind of praise doesn't get the desired effect of making your teen feel good about himself. Why is that? It is because what we are doing is evaluating their actions. With this type of praise, we aren't giving evidence to support our claims, and this makes the praise fall flat, and seem empty and unconvincing. We need to describe in detail what they are doing and as your teen recognizes the truth in your words they can then evaluate his actions and credit themselves.

Here is an example (evaluating praise):

Teen: "Hey Ma, I got a 90 on my geometry test!"
Parent: "Fantastic! You are a genius!"
Teen: thinking - "I wish. I only got it 'cause Paul helped me study. He is the genius."

Descriptive praise:
Teen: "Hey Ma, I got a 90 on my geometry test!"
Parent: "You must be so pleased. You did a lot of studying for that test!"
Teen: thinking - "I can really do geometry when I work at it!"

Describing your teen's action rather then evaluating them with an easy "good" or "great" or labeling like "slow learner" or "scatterbrain" isn't easy to do at first, because we are all unaccustomed to doing it. However, once you get into the habit of looking carefully at your teen's action and putting it into words what you see, you will do it more and more easily and with growing pleasure.

Adolescents need the kind of emotional nourishment that will help them become independent, creative thinkers and doers, so they aren't looking to others for approval all the time. With this sort of praise, teens will trust themselves and they won't need everybody else's opinion to tell them how they are doing. Another challenging problem is when and how we criticize our teens. Instead of pointing out what's wrong with your teen's actions, try describing what is right and then what still needs doing. Example: Teen hasn't done his laundry yet.

Parent: "How is the laundry coming?
Teen: "I am working on it."
Parent: "I see that you picked up your clothes in your room and in the family room and put it in the hamper. You are half way there."

This parent talks with encouragement, acknowledging what has been done so far rather then pointing out what hasn't been done yet. For more helpful information and examples on good communication with your child I highly recommend the book by Adele Faber & Elaine Mazlish called: How to Talk so Kids Will Listen and Listen So They Will Talk, Publisher: Harper, ISBN:0380811960.

Also, in the Fall 2005 a new teen version of the book is scheduled to be published - "How to Talk so Teens Will Listen" –ISBN: 0060741252.Keep your eye out for it!"

Parents need to fill a child's bucket of self-esteem so high that the rest of the world can't poke enough holes in it to drain it dry." - Alvin Pric.

Editor: From time to time we publish articles from guest authors, and we hope that you find them helpful to you.

Ability to Quit Smoking May Depend on A.D.H.D. Symptoms: Press Release Columbia University Medical Center

Press Release: NEW YORK - November 21, 2008

Tobacco use is more prevalent and smoking cessation less likely among persons with Attention Deficit Hyperactivity Disorder (A.D.H.D.) In a study of smokers with attention deficit and hyperactivity symptoms, those who exhibited elevated hyperactivity and impulsivity, with or without inattention, showed lower quit rates after 8 weeks than those with inattention symptoms alone or those without the A.D.H.D. symptoms. The study, now available online in Nicotine and Tobacco Research, could help smokers and physicians to better tailor cessation treatment for individuals with A.D.H.D.

“Greater understanding of the divergent associations that exist between the different kinds of A.D.H.D. have important public health consequences for smoking cessation and decreased tobacco-related mortality in this population,” said the study’s lead author Lirio Covey, Ph.D., professor of clinical psychology (in psychiatry) at Columbia University Medical Center and the New York State Psychiatric Institute.

“The effect of A.D.H.D. by itself on smoking cessation has rarely been examined; the effects of the individual A.D.H.D. symptoms on smoking cessation, even less so. To our knowledge, the effects of inattention or hyperactivity at baseline as separate domains of A.D.H.D. on cessation treatment outcome have never been examined,” Dr. Covey reported.

During the initial, eight-week phase of a maintenance treatment study, 583 adult smokers, 43 of whom were identified with clinically significant A.D.H.D. symptom subtypes using the A.D.H.D. Current Symptom Scale, were treated with the medication buproprion (brand name Zyban®), the nicotine patch and regular cessation counseling. Compared to smokers without A.D.H.D., smokers of both A.D.H.D. subtypes combined showed lower abstinence rates throughout the study.

Breakdown of the A.D.H.D. group by subtype, however, revealed a more complicated picture. The researchers found that by the end of the treatment, the proportion of abstainers among A.D.H.D. smokers with inattention were nearly identical to those without A.D.H.D. (55 percent compared to 54 percent, respectively).

By contrast, the A.D.H.D. subgroup with hyperactivity, with or without inattention, exhibited lower quit rates throughout the treatment period compared to smokers without A.D.H.D., essentially finding that only in the presence of hyperactivity and impulsivity, were differences observed between smokers with or without A.D.H.D. symptoms.

“The knowledge gained from further study of how these early onset disorders of nicotine dependency and A.D.H.D. are related could lead to early prevention of either one or both of these conditions,” concluded Dr. Covey. More research is needed to tease out why hyperactivity causes less cessation success.

The greater propensity to smoke and difficulty quitting among persons with mental illness is thought to play a role in the “hardening” phenomenon, or the increased resistance to smoking cessation among certain smokers.

Much evidence that nicotine improves attentiveness and performance deficits among persons with A.D.H.D. provides a “self-medicating” rationale for tobacco use among persons with A.D.H.D. Pre-clinical data showing that dopamine, a neurotransmitter relevant to attentional processes and impulse control, is released upon smoking, is consistent with the self-medication hypothesis.

A.D.H.D. is a neuropsychiatric condition that begins in early childhood and, in most cases, persists to adolescence and adulthood. The core symptom domains in A.D.H.D. are inattention and hyperactivity/impulsivity. A.D.H.D. has been sub-classified into three subtypes: predominantly inattention, predominantly hyperactivity/impulsivity, and combined inattention and hyperactivity/impulsivity.

For more information about smoking cessation and the A.D.H.D. study, Dr. Covey can be reached at 212-543-5736, lsc3@columbia.edu.

This study was supported by the National Institute on Drug Abuse (NIDA). In addition, study medications were donated by GlaxoSmithKline, Inc.

- ### -

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future health care leaders at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia’s College of Physicians and Surgeons was the first in the country to grant the M.D. degree. Among the most selective medical education institutions in the country, CUMC is home to the largest medical research enterprise in New York state and one of the largest in the United States. Visit www.cumc.columbia.edu.

Columbia Psychiatry
Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding of and current treatment for psychiatric disorders including depression, suicide, schizophrenia, bipolar and anxiety disorders, and childhood psychiatric disorders. Located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Medical Center campus in the Washington Heights community of Upper Manhattan, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at Columbia University’s College of Physician and Surgeons. Visit http://columbiapsychiatry.org/.

ADHD and Alcoholism

ADHD a Risk Factor for Alcoholism

March 27, 2007 –

Its really no surprise for those in the field, working with ADHD children and teens, but two new studies show that children with ADHD are more likely than other children to abuse alcohol in their teen years, and maybe beyond.

In one study, researchers found that 15- to 17-years olds with childhood ADHD reported being drunk an average of about 15 times during the previous year, compared to about 2 times for adolescents without ADHD.

Fourteen percent of the ADHD group was classified as alcohol abusers or alcohol dependent, but none of the youths in the non-ADHD group were. Before age 15, kids with ADHD didn't abuse alcohol any more than did other kids.

The study looked at 364 children with ADHD -- attention deficit hyperactivity disorder -- enrolled in the Pittsburgh ADHD Longitudinal Study.

Psychologist Brooke S.G. Molina, PhD, and colleagues interviewed the kids and their parents at the beginning of the study and again, eight years later, during adolescence (ages 11 to 17) or young adulthood (ages 18-25). They also interviewed 120 adolescents and 120 young adults never diagnosed with ADHD.

"Children with ADHD are believed to be at risk for alcoholism because of their impulsivity and distractibility, as well as other problems that often accompany ADHD such as school failure and behavior problems," said Brooke Molina of the University of Pittsburgh, corresponding author for both studies. "We found that children with ADHD are more likely to report heavy drinking in their teen years, and more problems from drinking, than non-ADHD teens... In the United States, 5% of teens have this problem. We found that in their late teen years, 14% of children with ADHD had these drinking problems."

When they reached young adulthood, the ADHD group did not, on average, drink more alcohol than did other young adults. But that is probably because so many young adults in America drink heavily when they go off to college, or get out on their own, that Even so, some of the ADHD group -- those with persistent ADHD problems -- seemed to be drinking even more than other young adults did.

Does ADHD Treatment Cut Alcoholism Risk?

Adolescent medicine specialist Cheryl Kodjo, MD, treats ADHD teens at the University of Rochester Medical Center in New York, where she is assistant professor of pediatrics. Kodjo says kids with undiagnosed, untreated ADHD certainly are at increased risk of drug and alcohol abuse.

"These kids don't fit in well with their peers and are not doing well in school," Kodjo tells WebMD. "They recognize they are not like other kids and may self-medicate with substances."

Kodjo says the crucial question is whether treating childhood ADHD cuts kids' risk of later alcohol and drug abuse.

"People who have ADHD have more of a tendency to be impulsive. If they are treated, theoretically the medications should control that, giving them a chance to think things through and be more organized," Kodjo tells WebMD. "The kids I work with who have ADHD have done pretty well as teens."

Molina says it's difficult to separate out the effects of ADHD treatment. That's because treatments vary, as does the severity of a child's ADHD. Some studies show that early ADHD treatment protects kids from later substance abuse -- but some don't, she says.

The Pittsburgh ADHD Longitudinal Study group is looking at the issue and expects to report new findings this summer, Molina says.

Meanwhile, Molina advises parents to remain involved as their ADHD kids reach adolescence.

"What we now know is that two-thirds of kids with ADHD will still have ADHD in adolescence -- and even more of them may be suffering academically," she says. "Parents and teachers cannot back off because academic performance does play a role in risk for alcohol abuse. So one thing must be to keep them on a good track in school."

"When ADHD teens complain that they need more independence, the message to give them is yes, you do need to learn to become independent -- and we will manage that change with you," she says. "It is important for parents, pediatricians, and teachers to monitor not only ADHD symptoms but how well a child is doing in school and how well a child is doing socially."

Researchers added that parental alcoholism and family stress add to the alcoholism risk for children with ADHD.

"One of the reasons that children with ADHD might be at risk for alcohol problems is that alcoholism and ADHD tend to run together in families," said Molina. "We found that parental alcoholism predicted heavy problem drinking among the teenagers, that the association was partly explained by higher rates of stress in these families, and these connections were stronger when the adolescent had ADHD in childhood. So, the bottom line is that when the child has ADHD and the parent has suffered from alcoholism, either currently or in the past, the child will have an increased risk for alcohol problems himself or herself."

SOURCES: Molina, B.S.G. Alcoholism: Clinical and Experimental Research, April 2007; vol 31, manuscript received ahead of print. Marshal, M.P. Alcoholism: Clinical and Experimental Research, April 2007; vol 31, manuscript received ahead of print. Brooke Molina, PhD, associate professor of psychiatry and psychology, University of Pittsburgh. Cheryl Kodjo, MD, assistant professor of pediatrics and adolescent medicine specialist, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, N.Y.

ADHD and Teen Problems

Here is the brief article on ADHD that generates the most hate email that I get. I'm not sure why. I don't cause ADHD in kids and teens, and I have spent most of my adult life trying to help children and teens with Attention Deficit Disorder. But what follows are the hard facts that parents, social workers, and physicians need to come to grips with.

ADHD is not a simple disorder to treat - and we must work to treat each individual, not just a diagnosis. Here are the facts about ADHD and anti-social behaviors. Please read them carefully before sending me one of those angry "anti-social" email responses. Thanks.

Anti-Social Behaviors and Attention Deficit Hyperactivity Disorder.

Anti-social behaviors are common with ADHD individuals. About 60% of Attention Deficit Hyperactivity Disorder kids are also oppositional or defiant. Some are even getting in trouble with the law. Impulsive-Hyperactive ADHD kids are the most likely to get into trouble than are the Inattentive ADHD kids, as they tend to crave the stimulation of anti-social behaviors, and impulsively "act-out". Because they are impulsive, they don't plan their crimes well, and are usually easily caught.

Teens who have ADHD, but are UNTREATED for Attention Deficit Hyperactivity Disorder average two arrests by the age of 18. About 20% of teens untreated for Attention Deficit Hyperactivity Disorder will be arrested for a felony, versus only about 3% of teens without ADHD. As many as 50% of all men in prisons have Attention Deficit Hyperactivity Disorder, and were untreated as children or teens for ADHD. It is also estimated that as many as 50% of all teenagers in juvenile facilities have Attention Deficit Hyperactivity Disorder but were untreated for ADHD.

Teenagers with Attention Deficit Hyperactivity Disorder - Impulsive Type ADHD - have 400% more traffic accidents and traffic tickets related to speeding, than teens without ADD ADHD. Please don't be too quick to let your ADHD teen start driving the family car.

Twice as many teens with ADHD, but untreated for it, will run away from home than teens without ADHD. About 16% of teens run away from home at some point, versus 32% of teens UNTREATED for Attention Deficit Hyperactivity Disorder.

Arson is often associated with Attention Deficit Disorder, as teens with untreated Attention Deficit Hyperactivity Disorder are three times more likely to be arrested for arson than those without ADHD: 16% vs. 5%.

Teenagers untreated for their Attention Deficit Hyperactivity Disorder are ten times more likely to get pregnant, or cause a pregnancy, than those without ADHD.

Teenagers untreated for their Attention Deficit Hyperactivity Disorder are 400% more likely to contract a sexually transmitted disease than teens without ADHD: 16% to 4%.

Around the house, the inattentive kids tend to be non-compliant due to not being motivated enough to remember the things he was asked to do.

ADHD causes problems in our homes, and in our nation. We need to learn more about Attention Deficit Disorder, how to diagnose it and how to treat it successfully. It is estimated that only about 40% of children and teens with ADHD will ever receive treatment for it, which is too bad since there are many good treatment options available.

Anti-Social Behaviors and ADHD

Anti-Social Behaviors and Attention Deficit Hyperactivity Disorder

Anti-social behaviors are common with ADHD individuals. About 60% of Attention Deficit Hyperactivity Disorder kids are also oppositional or defiant. Many are in trouble with the law.

Impulsive-Hyperactive ADHD kids are the more likely to get into trouble than are the Inattentive ADHD kids, as they tend to crave the stimulation of anti-social behaviors, and impulsively “act-out”.

Because they are impulsive, they don't plan their crimes well, and are usually easily caught.

If untreated for their ADHD and Anti-Social behaviors, these teenagers will:

• Average two arrests by the age of 18, with about 20% being arrested for a felony, versus only about 3% of teens without ADHD
• Often go to jail.

  In fact, as many as 50% of all men in prisons have Attention Deficit Hyperactivity Disorder, and were untreated as children or teens for ADHD.

  And as many as 50% of all teenagers in juvenile facilities have Attention Deficit Hyperactivity Disorder but were untreated for ADHD.

• Will have 400% more traffic accidents and traffic tickets related to speeding, than teens without ADD ADHD.
• Twice as many teens with ADHD will run away from home than teens without ADHD. About 16% of teens run away from home at some point, versus 32% of teens untreated for Attention Deficit Hyperactivity Disorder – ADD ADHD.
• Arson is often associated with Attention Deficit Disorder, as teens with untreated ADHD are three times more likely to be arrested for arson than those without ADHD: 16% vs. 5%.
• Will be ten times more likely to get pregnant, or cause a pregnancy, than those without ADHD.
• Will be 400% more likely to contract a sexually transmitted disease than teens without ADHD: 16% to 4%.

It is never too late to get help for your child or teen with ADHD, especially those who show little conscience, poor self-control, or little respect for others. Pick up the phone today to call for help.

Brain Changes Mirror Symptoms in ADHD

ADHD | Teenagers | Brain Changes

From the National Institute of Mental Health

The severity of attention deficit hyperactivity disorder (ADHD) symptoms in youth appears to be reflected in their brain structure, recent NIMH-supported brain imaging studies are finding. In one study, researchers found that the front part of the brain's memory hub, the hippocampus, tended to be enlarged in ADHD, particularly in children with fewer symptoms. They suggest that such changes might develop as a compensatory response that helps the child cope with the impatience and stimulus-seeking problems of the disorder.

The researchers also found that parts of an emotion-processing hub, the amygdala, were smaller in children with the disorder. The diminished size had a significant and positive correlation with severity of ADHD symptoms. In those with the disorder, researchers also observed poor connections between the amygdala and the pre-frontal cortex, which could contribute to problems with impulse control and goal-directed behaviors.

Drs. Kerstin Plessen and Bradley Peterson (Columbia University; New York State Psychiatric Institute; University of Bergen, Norway; and Pennsylvania State University) and colleagues used magnetic resonance imaging (MRI) to scan 51 children and adolescents with ADHD and 63 healthy peers in the study, reported in the July 3, 2006, issue of the Archives of General Psychiatry.

In another recent MRI study, NIMH intramural researchers found that parts of the brain's outer layer that controls attention is thinner in youth with ADHD and remains thin in those with less improvement, perhaps contributing to their impaired recovery. However, in teens who showed improvement, the cortex thickened on the right side, suggesting how brain changes may help explain improvements in coping with ADHD, report Drs. Philip Shaw and Judith Rapoport, NIMH Child Psychiatry Branch, and colleagues.

The 3-5 percent of school-age children with ADHD tend to be constantly impulsive, and inattentive. The disorder is thought to stem from brain circuit abnormalities. Symptoms improve in as many as a third or more of children with the disorder by their late teens. Yet, while previous NIMH imaging studies had shown that most parts of the brain are relatively smaller in ADHD, they did not look at how these differences might be related to clinical outcome.

To study this, researchers scanned the brains of 163 children with ADHD and 166 healthy controls, averaging about 9 years old. They re-scanned about 60 percent of each group again about 5.7 years later.

The ADHD group initially had a thinner cortex, most prominently in frontal areas that control attention and motor activity. These changes turned out to be much greater in patients who showed less improvement at follow-up, about six years later. In children with the best outcomes, an area of the cortex associated with attention (right parietal cortex) had increased thickness and resembled that of healthy peers by follow-up.

"The apparent normalization of cortical thickness in the better outcome youth may reflect a persistence of neural connections that provides an extended period for the sculpting of complex brain circuits supporting attention," suggested Shaw.

Despite the promise of the new findings, MRI brain scans are still an experimental research tool and cannot yet be used to diagnose or predict outcomes for individuals with ADHD, cautioned Shaw.

Brain regions (blue, purple) where children with ADHD have a thinner cortex are part of circuitry that controls attention and motor activity. Front of the brain is at top in this image, constructed from MRI scan data.

Source: NIMH Child Psychiatry Branch

Shaw P, Lerch J, Greenstein D, Sharp W, Clasen L, Evans A, Giedd J, Castellanos FX, Rapoport J. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2006 May;63(5):540-9.

Plessen KJ, Bansal R, Zhu H, Whiteman R, Amat J, Quackenbush GA, Martin L, Durkin K, Blair C, Royal J, Hugdahl K, Peterson BS. Hippocampus and Amygdala Morphology in Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry. 2006 Jul;63(7):795-807.

NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated.

Teenage Brains: A Work in Progress

From the National Institute of Mental Health, December 18, 2006

New imaging studies are revealing—for the first time—patterns of brain development that extend into the teenage years. Although scientists don't know yet what accounts for the observed changes, they may parallel a pruning process that occurs early in life that appears to follow the principle of "use-it-or-lose-it:" neural connections, or synapses, that get exercised are retained, while those that don't are lost. At least, this is what studies of animals' developing visual systems suggest. While it's known that both genes and environment play major roles in shaping early brain development, science still has much to learn about the relative influence of experience versus genes on the later maturation of the brain. Animal studies support a role for experience in late development, but no animal species undergoes anything comparable to humans' protracted childhood and adolescence. Nor is it yet clear whether experience actually creates new neurons and synapses, or merely establishes transitory functional changes. Nonetheless, it's tempting to interpret the new findings as empowering teens to protect and nurture their brain as a work in progress.

The newfound appreciation of the dynamic nature of the teen brain is emerging from MRI (magnetic resonance imaging) studies that scan a child's brain every two years, as he or she grows up. Individual brains differ enough that only broad generalizations can be made from comparisons of different individuals at different ages. But following the same brains as they mature allows scientists a much finer-grained view into developmental changes. In the first such longitudinal study of 145 children and adolescents, reported in l999, NIMH's Dr. Judith Rapoport and colleagues were surprised to discover a second wave of overproduction of gray matter, the thinking part of the brain—neurons and their branch-like extensions—just prior to puberty.1 Possibly related to the influence of surging sex hormones, this thickening peaks at around age 11 in girls, 12 in boys, after which the gray matter actually thins some.

Prior to this study, research had shown that the brain overproduced gray matter for a brief period in early development—in the womb and for about the first 18 months of life—and then underwent just one bout of pruning. Researchers are now confronted with structural changes that occur much later in adolescence. The teen's gray matter waxes and wanes in different functional brain areas at different times in development. For example, the gray matter growth spurt just prior to puberty predominates in the frontal lobe, the seat of "executive functions"—planning, impulse control and reasoning. In teens affected by a rare, childhood onset form of schizophrenia that impairs these functions, the MRI scans revealed four times as much gray matter loss in the frontal lobe as normally occurs.2 Unlike gray matter, the brain's white matter—wire-like fibers that establish neurons' long-distance connections between brain regions—thickens progressively from birth in humans. A layer of insulation called myelin progressively envelops these nerve fibers, making them more efficient, just like insulation on electric wires improves their conductivity.

Advancements in MRI image analysis are providing new insights into how the brain develops. UCLA's Dr. Arthur Toga and colleagues turned the NIMH team's MRI scan data into 4-D time-lapse animations of children's brains morphing as they grow up—the 4th dimension being rate-of-change.3 Researchers report a wave of white matter growth that begins at the front of the brain in early childhood, moves rearward, and then subsides after puberty. Striking growth spurts can be seen from ages 6 to 13 in areas connecting brain regions specialized for language and understanding spatial relations, the temporal and parietal lobes. This growth drops off sharply after age 12, coinciding with the end of a critical period for learning languages.

While this work suggests a wave of brain white matter development that flows from front to back, animal, functional brain imaging and postmortem studies have suggested that gray matter maturation flows in the opposite direction, with the frontal lobes not fully maturing until young adulthood. To confirm this in living humans, the UCLA researchers compared MRI scans of young adults, 23-30, with those of teens, 12-16.4 They looked for signs of myelin, which would imply more mature, efficient connections, within gray matter. As expected, areas of the frontal lobe showed the largest differences between young adults and teens. This increased myelination in the adult frontal cortex likely relates to the maturation of cognitive processing and other "executive" functions. Parietal and temporal areas mediating spatial, sensory, auditory and language functions appeared largely mature in the teen brain. The observed late maturation of the frontal lobe conspicuously coincides with the typical age-of-onset of schizophrenia—late teens, early twenties—which, as noted earlier, is characterized by impaired "executive" functioning.

Another series of MRI studies is shedding light on how teens may process emotions differently than adults. Using functional MRI (fMRI), a team led by Dr. Deborah Yurgelun-Todd at Harvard's McLean Hospital scanned subjects' brain activity while they identified emotions on pictures of faces displayed on a computer screen.5 Young teens, who characteristically perform poorly on the task, activated the amygdala, a brain center that mediates fear and other "gut" reactions, more than the frontal lobe. As teens grow older, their brain activity during this task tends to shift to the frontal lobe, leading to more reasoned perceptions and improved performance. Similarly, the researchers saw a shift in activation from the temporal lobe to the frontal lobe during a language skills task, as teens got older. These functional changes paralleled structural changes in temporal lobe white matter.

While these studies have shown remarkable changes that occur in the brain during the teen years, they also demonstrate what every parent can confirm: the teenage brain is a very complicated and dynamic arena, one that is not easily understood.

References
1 Giedd JN, Blumenthal J, Jeffries NO, et al. Brain development during childhood and adolescence: a longitudinal MRI study. Nature Neuroscience, 1999; 2(10): 861-3.

2 Rapoport JL, Giedd JN, Blumenthal J, et al. Progressive cortical change during adolescence in childhood-onset schizophrenia. A longitudinal magnetic resonance imaging study. Archives of General Psychiatry, 1999; 56(7): 649-54.

3 Thompson PM, Giedd JN, Woods RP, et al. Growth patterns in the developing brain detected by using continuum mechanical tensor maps. Nature, 2000; 404(6774): 190-3.

4 Sowell ER, Thompson PM, Holmes CJ, et al. In vivo evidence for post-adolescent brain maturation in frontal and striatal regions. Nature Neuroscience, 1999; 2(10): 859-61.

5 Baird AA, Gruber SA, Fein DA, et al. Functional magnetic resonance imaging of facial affect recognition in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 1999; 38(2): 195-9.

NIH Publication No. 01-4929
NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated.

Video Game Playing and Attention Problems

Can Excessive Video Game Playing Cause Attention Problems?

Yes, its just like you thought. The more your child or teen sits around watching TV or playing video games, the more at risk they will be for learning problems and attention problems. We have written about this before, and not to much has changed except that the research is starting to show up to validate what parents have known for years now.

There is a new study out of Iowa State University, published in Psychophysiology, that reports that young adults (they studied young men between 18 and 33 years old) who play around 40 hours per week of video games have more difficulty maintaining focused attention in the classroom or similar settings, and that certain brain wave patterns associated with attention were diminished in the video playing group over the control group.

One of the study’s authors is Dr. Craig Anderson, director of Iowa State’s Center for the Study of Violence. Dr. Anderson has studied the effects of a number of video games on human behavior. He has written an letter to parents that I would encourage you to read here: http://www.psychology.iastate.edu/faculty/caa/VG_recommendations.html and his website’s home page is here: http://www.psychology.iastate.edu/faculty/caa/index.html

As parents we have to understand that video games may be addictive to our children and teens. In fact, others have reported that up to 30% of all males who play video games regularly may be physiologically addicted to game playing. The more violent the game is, the more potentially addictive it may be.

Parents, please understand that your children are growing up in a culture that is far different from the culture that we grew up in. Our children don't know about Kennedy, Johnson, Nixon, Viet Nam, or even Jimmy Carter.

Our children have far more media and entertainment choices than we ever grew up with, and they don’t know that they can live without cell phones, ipods, video games, rental videos, cable TV, and the internet – because they have never known a world without them!

Children and teens live their lives saturated with media. According to the Kaiser Family Foundation’s most recent study of children ages 8 to 18:
• Young people spend an average of 6.5 hours per day with entertainment media, which works out to over 44 hours per week!
• Since young people often multi-task with media, they are actually exposed to about 8.5 hours of entertainment media every day, or about 60 hours per week.
• TV, videos, and music are the dominant entertainment media, averaging 4 hours every day.
• Internet use for fun averages about 1 hour per day.
• Playing of video games averages 1 hour per day.
• By comparison, reading books, magazines, or newspapers averages only 45 minutes per day. Doing chores averages 30 minutes per day, and doing homework averages 50 minutes per day.

Of course, we parents are the ones who have created this media entertainment environment for our children and teens to grow up in. Our homes average 3.6 CD players, 3.5 television sets, 3.3 radios, 3.9 DVD players, 2.1 video game consoles, and 1.5 computers. In fact, 25% of children are growing up in a home with five or more TV sets!

A recent study published in the Archives of Pediatrics and Adolescent Medicine by Columbia University’s College of Physicians and Surgeons, and the New York State Psychiatric Institute research team led by Jeffrey Johnson, and Tara Stevens of Texas Tech University.

This study shows that teenagers who spent a lot of time watching TV were more likely to have attention and learning problems “that persist, and interfere with their long-term educational achievement.” The researchers advise parents to limit the amount of time they let their children watch TV (or we would add any entertainment that is similar to TV viewing, such as video game play) to less than two hours per day, adding that they should only watch quality programming.

They specifically noted that video games have little educational value, and may promote attention problems in children. We are concerned by other studies that show that violent video games, they kind that can cause the release of adrenalin, can be highly addictive, and that about 30% of boys who play these games are already addicted to them.

The researchers found that watching TV for three or more hours per day at the age of 14 often resulted in attention problems, failure to complete homework, boredom at school, failure to complete high school, poor grades, negative attitudes about school, overall academic failure in high school later on, and failure to go on to college.

This list looks a lot like a list for someone abusing drugs too, doesn’t it? We have always been concerned that TV viewing acts on the brain much like a narcotic, and that too much viewing can be addictive. Though this study doesn’t address that issue, the list of results from too much viewing is certainly troubling.
The researchers conclude that we should restrict the time that our children and teens spend viewing TV or playing video games.

By the way parents, the American Academy of Pediatrics recommends that children under two years of age not watch TV at all. TV watching by infants has shown to be associated with problems of attention control, aggressive behavior, and poor mental development. The AAP views excessive television viewing by infants as “one of the major public health issues facing American children.”

Parents, its time that we come to understand that TV and video games are not our friends, and they are not our children’s friends. We were not created to spend 40 hours per week inside our rooms, sitting on sofas, playing video games or watching TV shows. We were made to move, to go outside and play, to work, to interact with others, to make conversation, to think.

It is time for us to re-evaluate how we let our children live their lives. It is time for us to re-evaluate our own lives. Please don’t let those that you love waste their lives in virtual worlds.