**************************************************
The New Look ADD / ADHD Gazette
The FREE online ezine all about ADD and ADHD.
**************************************************

*** ISSUE #16 ***
September 4th 1999

IN THIS ISSUE:
Adult Emailing Discussion List
Rathbone CI's Learning Difficulties Helpline
Letter
Help For A Reader Please
The Scientific Status Of Alternative Treatments For ADHD
Resources
Books


***********SPONSOR *******************************

REDIRECTING CHILDREN'S BEHAVIOUR - The awesome class
being taught all over the world is now available as a home course
with a 2 hour video and workbook. Further details at
http://www.theparentingnetwork.com/162.htm

**************************************************

I have just found out about this emailing discussion list for adults
with ADD. It's purpose is to allow adult ADDers and those who
have to relate to them a place where they can discuss any issue
that is relevant. This is a 'safe space' to discuss personal aspects
of living with ADD as an adult, helping an ADD adult we love, or
serving the needs of ADD adults in a professional capacity.
To subscribe, send email to LISTSERV@...
and in the body of the message, put SUBSCRIBE ADDULT

-------------DID YOU KNOW ABOUT-----------------------------

RAISING YOUR SPIRITED CHILD
(A Guide for Parents Whose Child Is More Intense, Sensitive,
Perceptive, Persistent & Energetic by Mary Sheedy Kurcinka
The “strong-willed” or "difficult" child often leaves parents
feeling impotent, inadequate and frustrated. More intense,
persistent, perceptive, and uncomfortable with change, these
children can challenge any parent. Here, a refreshingly
positive viewpoint, offers parents strategies and emotional
support in bringing up their ‘spirited’ child.
http://www.amazon.com/exec/obidos/ASIN/0060923288/theaddadhdgaze
-----------------------------------------------------------------------------
-

Rathbone CI's Learning Difficulties Helpline (soon to be
renamed special education advice) and can be contacted
either via our freephone number 0800 917 6790 or on the
above email address. We provide free advice on special
education to parents and professionals concerned about
a child with special needs. This can be about school based
support, the statementing process, appeals, school
exclusion procedures or school admissions. We will also
look through children's Statements and give independent
advice about the content. We produce a variety of leaflets
and a guide to the statementing process, all of which can be
emailed free of charge. We also produce a termly newsletter.
From our call statistics ADHD is the second most common
special need that parents phone us about, so there are a lot
of parents out there either experiencing problems in getting
provision or fighting to keep their child in school and not
excluded. - LDH@...

**********************************************

Dear Gail,
I just read your newsletter and the letter from the woman who
was being charged by the University for all those tests. She
is being ripped off. I work closely with many of the colleges
in this area, sending adults to school. If I feel someone is
ADD or LD I refer them to vocational rehabilitation for testing.
Once voc rehab, which is funded through tax dollars, has
determined a disability the school has to provide
accommodations. I have never had a client who had any out
of pocket expenses. And most schools have a disability
resource center. Once they get the info from voc rehab they
provide all kinds of services, tutors, note takers, etc.
Best wishes - A

**********************************************

I received this plea for help and am publishing it in case any
subscribers can help this lady. The letter is edited, but this gist
is that she thinks her son may be Aspergers but so far they
only have a ADHD diagnosis. Her son has been prescribed
Imipramine 10 mg.

"At first I wanted testing for learning disability done before
beginning the meds, but after yesterday I decided to get
started on them. Although he was unable to swallow the
pill yesterday, his behaviour today made me try again.
Fortunately he was able to take the med. I can't believe
how quickly he fell asleep tonight!

Anyway, I was worried about giving this medicine and
wondered if anyone has any experience with it they could
share. Also, do I continue inquiring about Asperger's or
should I give this a try first? Any advice on his being
tested for learning disabilities? I know he has the speech
processing problem. (Actually, all four of my boys have
this problem but the two oldest ones are in their mid-20's
already.) I just don't want to go through in school what
we have already gone through with the older boys."
Nancy

If anyone has any advice to offer Nancy, could they please
contact me here at theadhdgazette@... and I will
pass the letters on. Thanks.

----------HAVE YOU HEARD ABOUT-----------------------------

***********************************************

The Scientific Status Of Alternative Treatments For ADHD

At the NIH Consensus Conference noted above, Dr. Eugene
Arnold, an emeritus professor of Psychiatry from the
University of Ohio, presented a very interesting talk in
which he summarised the current scientific evidence for a
variety of alternative treatments for ADHD. I know this is
an area that many people have interest in, so I wanted to
present his paper in some detail.

Based on his review of the existing research literature,
Dr. Arnold rated the alternative treatments presented on
a 0-6 scale. It is important to understand this scale before
presenting the treatments. (Note that this is one person's
opinion based on the existing data - other experts could
certainly disagree). The scale he used is presented below:

0 - no supporting evidence and not worth considering further;

1 - based on a reasonable idea but no data available;
These would be treatments not yet subjected to any real
scientific study;

2 - Promising pilot data but no careful trial; These would be
treatments where very preliminary work appears promising
but where the treatment approach is in the very early
stages of investigation.

3 - Supporting evidence beyond the pilot data stage but
carefully controlled studies lacking; This would apply to
treatments where only "open" trials and not double-blind
controlled trials have been done.

(Let me briefly review the difference between an "open" trial
and a double-blind trial because this is a very important
distinction. Say you are testing the effect of a new medication
on ADHD. In an open trial, you would just give the medication
to the child, and then collect data on whether the child
improved from either parents or teachers. The child, the child's
parents, and the child's teacher would all know that the child
was trying a new medication.

In a double-blind trial, the child would receive the new
medicine for a period of time and a placebo for a period of
time. Neither the child, parents, nor teacher would know when
medication or placebo was being received. The same type of
outcome data as above would be collected - during both the
medication period and the placebo period.

The latter is considered to be a much more rigorous test of
a new treatment - whether it be a new medication, a dietary
intervention, or some other alternative - because it enables
researchers to determine whether any changes reported /
observed are above and beyond what can be attributed to
a placebo effect. In an open trial, you can not be certain that
any changes reported are actually the result of the treatment,
as opposed to placebo effects alone. It is also the case that
it is very hard for anyone to provide objective ratings of a
child's behavior when they know that a new treatment is
being tried. For these reasons, "open" trials - even if they
yield very positive results - are considered to be only
preliminary evidence in support of any new treatment.)

4 - One significant double-blind controlled trial that requires
replication; (Note: Replicating a favorable double-blind study
is very important. The literature is full of initially promising
reports that could not be replicated.)

5 - Convincing double-blind controlled evidence but needs
further refinement for clinical application. This rating would
be given to treatments where replicated double-blind trials
are available, but where it is not completely clear who the
treatment is best suited for. For example, a treatment may be
known to help children with ADHD, but it may be effective
for only a minority of the ADHD population and the specific
subgroup it is effective for is not clearly defined.

6 - A well established treatment for the appropriate subgroup.

Of the numerous alternative treatments reviewed by Dr. Arnold,
no treatments received a rating of 6 and only one - dietary
treatments that involve placing children on diets that eliminate
their exposure to certain foods or food additives that they have
allergic reactions to. Dr. Arnold concludes that there is
convincing scientific evidence that some children who
display symptoms of ADHD can derive significant benefits
from appropriate dietary treatments. The important task, as
he sees it, is to determine what percentage of the ADHD
population dietary responders constitute (i.e. is it a very
small minority of a larger proportion; the general view
among mental health professionals is that the percentage is
quite small) and to better identify the child who is likely to
respond to dietary treatment. Preliminary evidence suggests
that the type of child most likely to respond is a pre-schooler
with a history of prominent irritability and sleep disturbance.
Dietary interventions are also more likely to be helpful if there
is a family history of migraines, or if a parent can give a
definite example of a food/behavior change connection.

There were two alternative treatments for which a rating
of 4 was assigned (i.e. a convincing double blind trial that
requires replication. This treatment involves relaxation
training using a type of biofeedback procedure (i.e. EMG
biofeedback). There is some preliminary evidence that
relaxation training does result in reductions in ADHD
symptoms (recall a recent article reviewed in ADHD
RESEARCH UPDATE about the possible benefits of
massage) and Dr. Arnold believes that this treatment
approach warrants further investigation. It is not clear
what the magnitude of the benefits are nor how long they
would be expected to last.

The second treatment for which some positive data from
controlled, double-blind trials exist is "deleading" (i.e.
reducing lead levels in the bloodstream). Positive effects
are restricted to those children who have elevated blood
lead levels to begin with; for such children, Dr. Arnold
argues that deleading would be the treatment of choice.
How low a blood lead level this treatment should extend
is currently unknown.

Several alternative treatments received ratings of "3",
indicating promising results from initial studies, but for which
the necessary double-blind controlled studies are lacking.
Several studies have found that essential fatty acids tend to
be lower in children with ADHD, and some preliminary data
suggests that supplementing fatty acids in children with
ADHD who have been shown to have low levels of these
substances may result in behavioral improvement.
Controlled trials of fatty acid supplementation should be
pursued, although one would expect any beneficial effect to
be restricted to those children with ADHD who are first
shown to be deficient in their levels of these substances.

Promising data from open trials of providing glyconutritional
supplements (glyconutritional contain basic saccharides
necessary for cell communication and formation of
glycoproteins and lipids) have also been obtained. These
results are from only 2 studies, however, with small sample
sizes. Once again, placebo controlled trials are necessary.

Promising initial results using several types of mineral
supplements have also been reported. Iron
supplementation has been associated with improvements
in parent behavior ratings for ADHD boys, although no
comparable improvement in teacher ratings was found.
Magnesium supplementation has also yielded some
promising preliminary results for children with ADHD
who were also none to be deficient in magnesium.
No double blind trials of either type of supplementation
have been conducted.

What about herbal treatments, an approach that is
frequently touted? Two open trial studies using a "Chinese
herbal cocktail" have reported extremely positive results,
including the complete disappearance of all symptoms in 23
of 80 subjects with no recurrence for 6 months, and
improvement reported in 90% of participants. Careful,
controlled trials of Chinese herbal treatments are certainly
warranted. (Interestingly, Dr. Arnold could not find any
systematic data for using pycnogenol for treating ADHD,
even though this is widely marketed via the Internet and
other vehicles.)

Other treatments for which encouraging preliminary support
has been reported include biofeedback, meditation, and some
forms of perceptual stimulation and training. Controlled trials
of all these approaches are lacking, however, and research
on the latter two approaches has not been published in
over 10 years.

A number of alternative treatments were assigned ratings
of 0 by Dr. Arnold, indicating that he views them as being
not worth pursuing. Among these treatments are:
eliminating sugar from children's diets, vitamin
supplementation, amino acid supplementation, and hypnosis.

There would seem to be several general conclusions that can
be drawn from Dr. Arnold's excellent review of alternative
treatments for ADHD? First, in contrast to the more standard
treatments of stimulant medication and behavioral therapy,
there are no alternative treatments for which comparable
empirical support exists. Thus, there is really no alternative
treatment that one could responsibly recommend prior to
trying more standard treatments (exceptions may be
deleading for children with high blood lead levels and
thyroid treatment for children with known thyroid dysfunction.)

Second, there are a number of promising alternative
approaches that would be reasonable to consider if more
standard treatments are not effective. Although the necessary
data to support the more routine use of these alternatives
does not yet exist, one hopes that the required double blind
studies that provide support for these approaches will soon
be available. Given some of the encouraging initial results
reported for several approaches, it is somewhat surprising
that more work in these areas has not been conducted.

Finally, it should be noted that several alternative treatments
reviewed, if they are clearly demonstrated to be effective,
are likely to apply to only a subgroup of the ADHD population.
For example, it would not make sense to provide nutritional
or mineral supplementation to a child who is not deficient
in either area to begin with.

=================================================
The above article comes from David Rabiner's ADHD RESEARCH
UPDATE. David Rabiner, PhD Licensed Psychologist. Visit
http://www.helpforadd.com for information and services designed
to help parents promote healthy development of children with ADHD.

Receive a FREE trial of ADHD RESEARCH UPDATE by going to
http://www.helpforadd.com/nresearch.htm
************************************************

Resources
http://www.pathfinder.com/time/magazine/1998/dom/981130/cover1.html
is where you will find an article about Ritalin from Time Magazine.
Entitled The Age Of Ritalin, the blurb goes:- A little pill makes
everything a bit easier, not just for children with severe attention-deficit
disorders but for more and more kids who are just a little too spacey or
jumpy, is there something wrong with the kids, or with us?

http://www.nisw.org.uk/pubs/stand/scont.html What we should expect from
social workers - this book is published by the National Institute of Social
work. I have worked with both the authors in the past and I have a very
high regard for both of them.

**********************************************

Books

Here are 2 new books I have just picked up on. They are very
different, but worth a mention.

THE OUT OF SYNC CHILD by Carol Stock Kranowitz
http://www.amazon.com/exec/obidos/ASIN/0399523863/theaddadhdgaze
This text is smart, sharp and accessible to bewildered parents of
children with behavioural and sensory problems. The author is
knowledgeable about her subject and illustrates it poignantly,
offering soloutions to parents who suffer in silence while their
children, their playmates and teachers suffer too.

YOU CAN FEEL GOOD AGAIN; Common-Sense Therapy for
Releasing Depression and Changing Your Life by Richard Carlson
http://www.amazon.com/exec/obidos/ASIN/0452272424/theaddadhdgaze
It might seem like there is no way out of that dark, bottomless pit
called depression seems a dark, yet here the author with his simple
to read and down to earth book, shows you that you can be well
on the way to healing yourself within six weeks. By not worrying
over yesterday and thinking about tomorrow we can make our own
lives great - now. A small book which can enhance the quality
of life of anyone who reads it.

***********************************************

IMPORTANT DISCLAIMER
Items herein are published for education/information purposes
only. Any therapy, product, service, or featured web site mentioned
does NOT imply endorsement by The Gazette. Accuracy and
content of any web sites featured cannot be guaranteed. Views
and statements written by contributors are not necessarily the
views of The ADD / ADHD Gazette.

**********************************************

LINKS
If you have a website and are looking for links. I am happy to add
a reciprocal link to The ADHD (UK) Website. Take a look at my
site at http://www.gailmiller.clara.net and email me to swap links

**************************************************
SEE YA NEXT TIME ~ Gail Miller 1999
theadhdgazette@fr