Center of Attention
Newsletter of CHADD of Northern California
Also at: http://www.chaddnorcal.org/newsletter
3 February 2002

CHADD Works to Improve the Lives of People with
Attention-Deficit/Hyperactivity Disorder through Education, Advocacy,
and Support

===== In This Issue =====

About the Newsletter
Calendar of Events
Feature Article: Myths about ADHD
This Week: Adderall vs Methylphenidate in the treatment of ADHD
Please Tell Us

===== About the Newsletter =====

The Center of Attention is CHADD of Northern California's bi-weekly
newsletter. The newsletter is designed to keep you up to date with
CHADD of Northern California's activities and updates in the field.
It's a step toward bringing the members closer together.

======== Calendar of Events ==========

2/6/2002, Wed. 7 - 9 pm - Sonoma
Julian Isaacs, Ph.D. - Advances in Brain Research: Identifying
co-morbidities and co-existing conditions with greater accuracy. ,
Bipolar Disorder, Tourette Syndrome and Asperger Syndrome share many
of the same symptoms with AD/HD. Dr. Isaacs will share insights into
how subtle changes in the brain can cause many different symptoms,
and how mapping these changes can give the health practitioner keys
to more accurate diagnoses and treatments. Dr. Isaacs is clinical
director of the ADD Clinic of the North Bay and Marin Neurodiagnostic
Imaging.
Kaiser Hospital Building, Santa Rosa - Contact: Thora Lares: 707-765-4863
============================
2/6/2002, Wed. 7:30pm - San Francisco
Women's ADD Support Group, Please Call Lynn to confirm times and
locations before attending.
CPMC Davies Campus, San Francisco - Contact: Lynn: 415-621-1078
============================
2/9/2002, Sat. 9am - 3pm - San Francisco
Paying Attention to Attention Deficit Disorder: a Saturday program
for parents, teachers, and counselors presented by University of
California, Berkeley Extension. ,
*Assessing ADD/ADHD
*Cooperative roles of behavior modification and drug therapy
*Teaching and learning strategies
*Classroom management techniques

Speakers Include: Dr. Stephen Hinshaw, Ph.D., Department of
Psychology, UC Berkeley and Dr. Glen Elliott, M.D., Ph.D., Director
of Child and Adolescent Psychiatry at UCSF. For Information: please
call (510) 643-2456 To Register: please call (510) 642-4111 and
enroll in EDP 203430. Cost = $35.00
Richardson Hall Auditorium; 55 Laguna Street, San Francisco -
Contact: University of California, Berkeley Extension: (510) 643-2456
============================
2/12/2002, Tues. 7-9pm - Marin
Parenting a Child with ADHD - Mark Edwards, MFT, Come get some
practical suggestions for improving your parenting skills. Also learn
about PCIT, the new Parent Child Interactive Therapy. Mark works at
Family Services Agency in Terra Linda and has a private practice in
San Rafael. 415-499-6231.
Town Center Corte Madera Community Room, Corte Madera - Contact:
Beverlee: 415-789-9464
============================
2/13/2002, Wed. 1:30 p.m. to 4:30 p.m. - Sacramento
Public Hearing on "Children's Mental Health Care" , Joint Hearing
Health and Human Services, Business and Professions, Committees and
Select Committee on Developmental Disabilities and Mental Health;
Ortiz, Figueroa, and Chesbro, Chairs. See our Public Policy page at
http://www.chaddnorcal.org/VAN/
State Capitol, Sacramento - Contact: Lew Mills: 510-291-2950
============================
2/13/2002, Wed. 7 - 9 pm - Alameda
Tri-Valley Parent Support Meeting,
Thomas J. Hart Middle School, Pleasanton - Contact: JoAnn Matone: 925-484-2173
============================
2/19/2002, Tues. 7-9pm - Marin
Drop in Support Group, for Adults and Teens with ADHD and Significant Others
Marin Community Mental Health, Greenbrae - Contact: Beverlee: 415-789-9464
============================
2/20/2002, Wed. Reg: 7pm, Meet 7:30pm - Santa Clara
Silicon Valley Adult, Parent and Spouse Support Groups, Separate
peer-facilitated groups let you share struggles and strategies with
each other. Includes video.
Friends Meeting House, Palo Alto - Contact: Silicon Valley Warmline:
650-949-5472
============================
2/21/2002, Thu. 6-8:00 PM PST - Online
Sandra Rief, MA - Success at School,
CHADD Online Chat, Internet - Contact: Message Line: 510-291-2950
============================
2/27/2002, Wed. 7-9pm - San Francisco
Frances Straussman, from "More Than Order" , All that I have Learned
through Coaching and Organizing ADDers.
CPMC Pacific Campus, San Francisco - Contact: San Francisco Warmline:
415-442-1944
============================
2/27/2002, Wed. 9:30-11:30am - Marin
Support Group for Parents of Children / Teens with ADHD, Share your
concerns with a parent who really understands.
30 Catalpa Ave., Mill Valley - Contact: Victoria Vogel: 415-383-6048
============================
2/27/2002, Wed. 7:15 p.m. - 9:30 p.m. - Santa Clara
Kitty Petty ADD/LD Institute Meeting, Discussion of and sharing
successful ADHD/LD strategies and coping skills with other like
ADDults
Friends Meeting House, Palo Alto - Contact: Kitty Petty ADD/LD
Institute: 650-329-9443
============================
===== Feature Article ======

Myths about ADHD

Contributed by: M.A.A.A.N. Members (Michigan Adolescent and Adult ADD
Network for Professionals)
(Posted on 9/2/2000 on addconsults.com
(http://addconsults.com/articles/) and used with kind permission.)

by Becky Booth, Wilma Fellman, LPC, Judy Greenbaum, Ph.D., Terry
Matlen, ACSW, Geraldine Markel, Ph.D., Howard Morris, Arthur L.
Robin, Ph.D., Angela Tzelepis, Ph.D.

The following myths - and factual responses - have been collected
from rebuttals to recent media articles about ADD/ADHD. The rebuttals
were written by MAAAN (Metro Area Adult ADHD Network, based in the
Detroit area).

Myth #1: ADHD is a "phantom disorder".

FACT: The existence of a neurobiological disorder is not an issue to
be decided by the media through public debate, but rather as a matter
of scientific research. Scientific studies spanning 95 years
summarized in the professional writings of Dr. Russell Barkley, Dr.
Sam Goldstein, and others have consistently identified a group of
individuals who have trouble with concentration, impulse control, and
in some cases, hyperactivity. Although the name given to this group
of individuals, our understanding of them, and the estimated
prevalence of this group has changed a number of times over the past
six decades, the symptoms have consistently been found to cluster
together. Currently called Attention Deficit Hyperactivity Disorder,
this syndrome has been recognized as a disability by the courts, the
United States Department of Education, the Office for Civil Rights,
the United States Congress, the National Institutes of Health, and
all major professional medical, psychiatric, psychological, and
educational associations.

Myth #2: Ritalin is like cocaine, and the failure to give youngsters
drug holidays from Ritalin causes them to develop psychosis.

FACT: Methylphenidate (Ritalin) is a medically prescribed stimulant
medication that is chemically different from cocaine. The therapeutic
use of methylphenidate does NOT CAUSE addiction or dependence, and
does not lead to psychosis. Some children have such severe ADD
symptoms that it can be dangerous for them to have a medication
holiday, for example a child who is so hyper and impulsive he'll run
into traffic without stopping to look first. Hallucinations are an
extremely rare side-effect of methylphenidate, and their occurrence
has nothing to do with the presence or absence of medication
holidays. Individuals with ADHD who are properly treated with
stimulant medication such as Ritalin have a lower risk of developing
problems with alcohol and other drugs than the general population.
More importantly, fifty years of research has repeatedly shown that
children, adolescents, and adults with ADHD safely benefit from
treatment with methylphenidate.

Myth #3: No study has ever demonstrated that taking stimulant
medications can cause any lasting behavioral or educational benefit
to ADHD children.

FACT: Research has repeatedly shown that children, adolescents, and
adults with ADHD benefit from therapeutic treatment with stimulant
medications, which has been used safely and studied for more than 50
years. For example, The New York Times reviewed a recent study from
Sweden showing positive long- term effects of stimulant medication
therapy on children with ADHD. Readers interested in more studies on
the effectiveness of medication with ADHD should consult the
professional writings of Dr. Russell Barkley, Drs. Gabrielle Weiss
and Lily Hechtman, and Dr. Joseph Biederman.

Myth #4: ADHD kids are learning to make excuses, rather than take
responsibility for their actions.

FACT: Therapists, educators, and physicians routinely teach children
that ADHD is a challenge, not an excuse. Medication corrects their
underlying chemical imbalance, giving them a fair chance of facing
the challenges of growing up to become productive citizens.
Accommodations for the disabled, as mandated by federal and state
laws, are not ways of excusing them from meeting society's
responsibilities, but rather make it possible for them to compete on
a leveled playing field.

Myth #5: ADHD is basically due to bad parenting and lack of
discipline, and all that ADHD children really need is old-fashioned
discipline, not any of these phony therapies.

FACT: There are still some parent-bashers around who believe the
century-old anachronism that child misbehavior is always a moral
problem of the "bad child." Under this model, the treatment has been
to "beat the Devil out of the child." Fortunately, most of us are
more enlightened today. A body of family interaction research
conducted by Dr. Russell Barkley and others has unequivocally
demonstrated that simply providing more discipline without any other
interventions worsens rather than improves the behavior of children
with ADHD. One can't make a paraplegic walk by applying discipline.
Similarly, one can't make a child with a biologically-based lack of
self-control act better by simply applying discipline alone.

Myth #6: Ritalin is unsafe, causing serious weight loss, mood swings,
Tourette's syndrome, and sudden, unexplained deaths.

FACT: Research has repeatedly shown that children, adolescents, and
adults with ADHD benefit from treatment with Ritalin (also known as
methylphenidate), which has been safely used for approximately 50
years. There are NO published cases of deaths from overdoses of
Ritalin; if you take too much Ritalin, you will feel terrible and act
strange for a few hours, but you will not die. This cannot be said
about many other medications. The unexplained deaths cited in some
articles are from a combination of Ritalin and other drugs, not from
Ritalin alone. Further investigation of those cases has revealed that
most of the children had unusual medical problems which contributed
to their deaths. It is true that many children experience appetite
loss, and some moodiness or "rebound effect" when Ritalin wears off.
A very small number of children may show some temporary tics, but
these do not become permanent. Ritalin does not permanently alter
growth, and usually does not result in weight loss. Ritalin does not
cause Tourette's syndrome, rather many youngsters with Tourette's
also have ADHD. In some cases, Ritalin even leads to an improvement
of the of tics in children who have ADHD and Tourette's.

Myth #7: Teachers around the country routinely push pills on any
students who are even a little inattentive or overactive.

FACT: Teachers are well-meaning individuals who have the best
interests of their students in mind. When they see students who are
struggling to pay attention and concentrate, it is their
responsibility to bring this to parents' attention, so parents can
take appropriate action. The majority of teachers do not simply push
pills- they provide information so that parents can seek out
appropriate diagnostic help. We do agree with the position that
teachers should not diagnose ADHD. However, being on the front lines
with children, they collect information, raise the suspicion of ADHD,
and bring the information to the attention of parents, who then need
to have a full evaluation conducted outside the school. The symptoms
of ADHD must be present in school and at home before a diagnosis is
made; teachers do not have access to sufficient information about the
child's functioning to make a diagnosis of ADHD or for that matter to
make any kind of medical diagnosis.

Myth #8: Efforts by teachers to help children who have attentional
problems can make more of a difference than medications such as
Ritalin.

FACT: It would be nice if this were true, but recent scientific
evidence from the multi-modal treatment trials sponsored by the
National Institute of Mental Health suggests it is a myth. In these
studies, stimulant medication alone was compared to stimulant
medication plus a multi-modal psychological and educational
treatment, as treatments for children with ADHD. The scientists found
that the multi-modal treatment plus the medication was not much
better than the medication alone. Teachers and therapists need to
continue to do everything they can to help individuals with ADHD, but
we need to realize that if we don't also alter the biological factors
that affect ADHD, we won't see much change.

Myth #9: CHADD. is supported by drug companies, and along with many
professionals, are simply in this field to make a quick buck on ADHD.

FACT: Thousands of parents and professionals volunteer countless
hours daily to over 600 chapters of CHADD. around the U.S. and Canada
on behalf of individuals with ADHD. CHADD. is very open about
disclosing any contributions from drug companies. These contributions
only support the organization's national conference, which consists
of a series of educational presentations, 95% of which are on topics
other than medications. None of the local chapters receive any of
this money. It is a disgrace to impugn the honesty and efforts of all
of these dedicated volunteers. CHADD. supports all known effective
treatments for ADHD, including medication, and takes positions
against unproven and costly remedies.

Myth #10: It is not possible to accurately diagnose ADD or ADHD in
children or adults.

FACT: Although scientists have not yet developed a single medical
test for diagnosing ADHD, clear-cut clinical diagnostic criteria have
been developed, researched, and refined over several decades. The
current generally accepted diagnostic criteria for ADHD are listed in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
published by the American Psychiatric Association (1995). Using these
criteria and multiple methods to collect comprehensive information
from multiple informants, ADHD can be reliably diagnosed in children
and adults.

Myth #11: Children outgrow ADD or ADHD.

FACT: ADHD is not found just in children. We have learned from a
number of excellent follow-up studies conducted over the past few
decades that ADHD often lasts a lifetime. Over 70% of children
diagnosed as having ADHD will continue to manifest the full clinical
syndrome in adolescence, and 15-50% will continue to manifest the
full clinical syndrome in adulthood. If untreated, individuals with
ADHD may develop a variety of secondary problems as they move through
life, including depression, anxiety, substance abuse, academic
failure, vocational problems, marital discord, and emotional
distress. If properly treated, most individuals with ADHD live
productive lives and cope reasonably well with their symptoms.

Myth #12: Methylphenidate prescriptions in the U.S. have increased 600%.

FACT: The production quotas for methylphenidate increased 6-fold;
however that DEA production quota is a gross estimate based on a
number of factors, including FDA estimates of need, drug inventories
at hand, EXPORTS, and industry sales expectations. One cannot
conclude that a 6-fold increase in production quotas translates to a
6-fold increase in the use of methylphenidate among U.S. children any
more than one should conclude that Americans eat 6 times more bread
because U.S. wheat production increased 6-fold even though much of
the grain is stored for future use and export to countries that have
no wheat production. Further, of the approximately 3.5 million
children who meet the criteria for ADHD, only about 50% of them are
diagnosed and have stimulant medication included in their treatment
plan. The estimated number of children taking methylphenidate for ADD
suggested in some media stories fails to note that methylphenidate is
also prescribed for adults who have ADHD, people with narcolepsy, and
geriatric patients who receive considerable benefit from it for
certain conditions associated with old age such as memory
functioning. (see Pediatrics, December 1996, Vol. 98, No. 6)

======== This Week ==========

Contributed by: ADHD Research Update: http://www.helpforadd.com
(Posted on 8/5/2000 on addconsults.com
(http://addconsults.com/articles/) and used with kind permission. )

During the past year there have been two studies published in which
Adderall - a relatively new medication used for treating ADHD - has
compared favorably to methylphenidate (i.e. the generic form of
Ritalin) for reducing the symptoms of ADHD. In these studies,
Adderall was found to yield a comparable - or even more favorable
response - than methylphenidate for most children, and children
required less frequent dosing with Adderall.

There were several important limitations of these prior studies,
however, that mitigate the conclusions one can make about the
superiority of Adderall. First, both studies compared certain fixed
doses of Adderall to fixed doses of methylphenidate. What this means
is that an individualized procedure to determine the optimum dose of
medication for each child - based on feedback received about the
child's performance on different doses - was not employed. This is
important because such a procedure helps to insure that a child is
getting the maximum possible benefits from medication. This is also
closer to what should happen in actual clinical practice. Second,
children in these studies were not randomly assigned to receive
either Adderall or methylphenidate, but received one or the other -
or both - based on a variety of considerations. Random assignment
(i.e. it is strictly chance whether a child gets placed on one
medication or the other), however, is the best procedure to use for
trying to determine whether one medication tends to produce a
superior effect to the other.

A study published last month in the Journal of the American Academy
of Child and Adolescent Psychiatry (JAACP) takes an important step in
addressing the limitations of prior work (Plizka, S.R. et al.,
(2000). A double-blind, placebo- controlled study of Adderall and
methylphenidate in the treatment of ADHD. JAACP, 39, 619-626.) The
focus of this study was to provide the most thorough evaluation to
date of the relative efficacy of Adderall vs. methylphenidate for the
treatment of ADHD in elementary school children.

Participants in this study were 58 children diagnosed with ADHD, the
majority of whom had received no prior medication treatment. The
average age of children was approximately 8 years old and both boys
and girls were included. (Unfortunately, the breakdown of girls and
boys in the sample was not provided). To participate in this study,
parents had to provide consent for their child to be randomly
assigned to receive either methylphenidate, Adderall, or a placebo
(i.e. a placebo is something that looks like real medication but is
really not) for a 3-week trial. (The child received only one of these
3 possibilities during the entire 3-week trial.) Neither the child,
the child's parents, nor the child's teacher were aware of what the
child was receiving during the trial.

Prior to commencing the trial, baseline ratings of children's
behavior were obtained from both parents and teachers. During the
initial week of the trial, teachers completed behavior rating forms
twice per day, each day - once to report on the child's behavior and
academic performance during the morning and once to report on
behavior and school work during the afternoon. In addition, at the
end of the week, parents were interviewed over the phone about their
child's behavior during the after-school hours for that week. Parents
were also asked to rate the severity of a variety of possible side
effects that they may have observed during the week. These teacher
and parent ratings were then reviewed by a psychiatrist who was also
blind to the child's medication status. Based on the ratings, this
psychiatrist decided whether an adjustment to the child's medication
needed to be made for the second week (e.g. increasing the dose,
adding a second dose during the school day and/or after school).

So, for example, some children on Adderall may have done so well
during the initial week that no adjustment to dosage was made after
reviewing the first week's ratings. Other children in Adderall, in
contrast, may have had their dosage increased. The same would be true
for the children on methylphenidate. Even for children on placebo, a
recommendation for adjustment could be made (recall that the
psychiatrist making the recommendation did no know whether the child
was on a placebo), although this would result in nothing more than
the placebo being administered for another week.

A similar procedure was followed during the second week, at the end
of which another adjustment was made if warranted. This procedure
thus provided the opportunity to adjust the child's dosage for 2
successive weeks using carefully collected data from parents and
teachers. Finally, parent and teacher behavior ratings and parent
side effect ratings were then collected once again at the end of the
final week. In addition, a psychiatrist who was blind to the child's
medication status provided an overall rating of the child's
improvement using a standardized scale designed to assess treatment
improvement. This rating was made based on an individual interview
with the child and his/her parents, as well as reviewing the rating
scale data collected during the trial.

In theory, this procedure for adjusting dosage after the first 2
weeks based on the behavior rating and side effects data should have
resulted in the child being placed during the 3rd week on a dosage
regime that was best suited for him or her. Thus, this should allow
for a "fair" comparison of the relative efficacy of Adderall vs.
methylphenidate for treating ADHD symptoms in school-age children.

RESULTS

For each source of outcome data (i.e. teachers, parents, and
psychiatrist) analyses were conducted that compared children in the 3
groups (i.e. Adderall, methylphenidate, and placebo). The results of
these comparisons are summarized below.

TEACHERS

Teacher behavior ratings showed - as expected - that children
receiving either Adderall or methylphenidate did better than children
on placebo. This, of course, has been documented in numerous prior
studies and the magnitude of the difference were comparable to what
has been found before.

Of more interest, however, is that children receiving Adderall fared
significantly better according to teachers than children receiving
methylphenidate. This was true for ratings of ADHD symptoms
specifically and for ratings of aggressive/ disruptive behavior.

PARENTS

In contrast to the results for teachers, no significant difference
was found when parents ratings were analyzed. In other words, neither
Adderall nor methylphenidate were found to be superior to placebo
when parent ratings of children's behavior during the evening were
analyzed.

This can not be explained by the fact that children were not
receiving medication to cover the after-school hours when parents
would have the opportunity to observe them. The reason why this is
not a viable explanation is that when parent ratings during week 1 or
2 indicated that problems related to ADHD were clearly evident during
evening hours, an adjustment would have been made to provide the
child with the additional dose needed to cover the after-school
period. Instead, the authors suggest that the reason no significant
effect was found for the parent ratings is that there was such a
large placebo effect for parents. In other words, even parents whose
children were receiving placebo reported substantial improvements
relative to the initial ratings taken at baseline. Because so much
improvement was reported by parents for children receiving a placebo,
it was difficult for the medication to look significantly better.

PSYCHIATRIST

As noted above, a psychiatrist also provided an overall rating of
each child's improvement based on an interview conducted with the
child and family, and reviewing the behavior rating scale data.
Children were considered to have shown a positive response (i.e.
significant improvement) during the trial based on the score they
received on this rating.

Using this criterion, 90% of the children in the Adderall group were
judged to be responders. This compares to 65% of children receiving
methylphenidate and 27% of children who received placebo. This
difference in response rate between Adderall and methylphenidate was
statistically significant, as was the difference between
methylphenidate and placebo. (The fact that over 25% of children
receiving placebo were rated as showing significant improvement
highlights the need of conducting placebo-controlled trials to
determine medication response. Otherwise, children who get no real
benefit from medication above and beyond a placebo response may be
maintained on the meds for a sustained period of time.)

FINAL DOSING REGIMEN

In addition to looking at how the behavioral outcomes compared for
children on Adderall and methylphenidate, it is also instructive to
look at the dosing regimens that children were on at the end of the
trial. Seventy percent of the children receiving Adderall required
only a single dose per day to cover the entire day, while 30%
required a second dose after school to cover the evening hours. None
of the children on Adderall were judged to have needed a second dose
during the school day - an important finding in that taking
medication at school can be a source of concern for some children and
parents.

For the children on methylphenidate, 85% received 2 or more doses per
day. Of the 13 who were judged to be positive responders according to
the psychiatrists ratings, 6 required a second dose during the school
day. Thus, about half the children judged to have responded favorably
to methylphenidate needed to take the medicine during school.

In terms of the total daily dose, children in the Adderall group
received an average of 12.5 mg/day compared to 25.2 mg/day for
children receiving methylphenidate.

SIDE EFFECTS

After each week of the trial, parents provided ratings of the most
commonly reported side effects of stimulant medications. For each of
11 side effects, the percentage of parents reporting that the adverse
effect was either moderate or severe was a minority. Although there
was no significant difference in the number of children for whom
parents reported moderate to severe side effects, there was a
tendency for children receiving Adderall to show more stomach
problems and mood changes (i.e. sadness and/or irritability).
Approximately 25% of children receiving Adderall were reported by
parents to show such effects.

It was interesting to note the parent reports of the side effect
"Gets wild when medication wears off", a relatively common complaint
of parents whose children take stimulant medication. Thirty-five
percent of parents whose child received Adderall reported this
concern as did 40% of parents whose child received methylphenidate.
This would seem like a real problem. For children receiving placebo,
however, this same concern was reported by 44% of their parents.
Thus, this also illustrates one of the potentially important benefits
of conducting placebo-controlled medication trials: such trials can
help to determine whether an apparent side effect of medication is
really just a placebo effect.

SUMMARY AND IMPLICATIONS

The results of this study suggest that Adderall may be a better
initial choice of medication for children with ADHD relative to
methylphenidate. In this study, the behavioral effects of Adderall
were generally greater than those produced by methylphenidate, and
they also lasted longer. This means that most children treated with
Adderall required less medication and fewer doses to achieve better
results. In particular, none of the children treated with Adderall
needed to take a dose during the school day during this trial,
something required by a number of children treated with
methylphenidate. One potential concern is the possibility that
Adderall may possibly be more likely to lead to stomach aches and
mood changes than methylphenidate. Thus, these potential side effects
would need to be monitored carefully.

These results should not be interpreted to mean that any particular
child will do better on Adderall than methylphenidate, as this is
clearly not the case. Many children will do equally well on both
types of medication, some will do equally poorly on both, and some
will do better on methylphenidate than Adderall. Instead, the data
should be interpreted to suggest that if a child is going to be
started on medication to treat ADHD - and this is an entirely
separate decision - then Adderall is probably a good medication to
begin with. Replicating these results with a larger sample would lend
even greater confidence to this recommendation. It would also be nice
if a study was done that directly compared Adderall to Ritalin, as
there have been some reports that Ritalin may be superior to its
generic form (i.e. methylphenidate).

If your child is currently on methylphenidate or Ritalin and is doing
well, I would not take these data to mean that you should switch to
Adderall. For a child on a stable medication regimen and doing well,
the only reason I am aware of to do this would be if the child needed
to take medication during the school day, and this was a source of
concern. In this case, it appears that Adderall will often eliminate
the need for this in school dosing. Thus, should this be your
circumstance, it may be an option worth discussing with your child's
physician. Remember, though, there is no guarantee that Adderall will
prove to be as effective for your child, so one would need to
carefully and systematically monitor how a child responded to the
switch.

===== Please Tell Us! =====

In the last few weeks we have received some very positive feedback
from readers. It is very encouraging and gratifying to the editors.
We thank members for their responses. Please continue to help us make
this newsletter more beneficial to you all.

You can e-mail your comments to us at CHADD_Dimples@....
Simply replying to this e-mail will also send your message to the
right place. If you would like to publish experiences in the
newsletter, please include your permission to do so. Articles and
experiences can be shared anonymously in the newsletter.