Meeting the True Needs of Children Diagnosed as ADHD

Meeting the True Needs of Children Diagnosed as ‘ADHD’

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Expert Author Dan EdmundsHow should one look upon Attention Deficit Hyperactivity Disorder (ADHD) and what is the effective way to aid those who are given this diagnosis? There has been considerable debate as to whether or not ADHD is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an examination by Hartmann in 1993 felt that ADHD is actually normal variant of human behavior that doesn’t fit into cultural norms.

In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the TOVA (test of variables of attention), a test where the client must use a computer and hit a target at various points. This test is designed to measure the person’s response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the diagnosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of ADHD, he states, medications alone do not provide adequate or full treatment in this disorder.

Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for ADHD is that about 1% of these children will develop tics and or Tourette’s Syndrome. Hedaya asks the question,”One might wonder-, why use methylphenidate at all?” Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects include nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of ADHD lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of ADHD are lessened.

However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same effect in both those diagnosed as ADHD and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children’s Hospital of Philadelphia commented at the National Institutes of Mental Health Consensus Conference in 1998 that the behaviors exhibited by those considered ADHD were normal behavioral variations. A Multimodal Treatment Study was conducted by the National Institutes of Mental Health in 1999 in regards to ADHD. Psychiatrist Peter Breggin and the members of the International Center for the Study of Psychiatry and Psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the analysis conducted of behaviors in the classroom of those children studied showed no significant differences between those children receiving stimulant medications versus those who only were utilizing a behavioral management program (MTA Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no control group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication management group, they numbered only 144 of which Breggin finds to be enormously small.

Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a significant factor by the investigators. Breggin also believes that the study was flawed in that drug treatment continued for 14 months whereas behavioral management was utilized for a much shorter duration. Breggin argues that the behavioral management strategies, which involved mainly a token economy system, were ineffective as well and did not take into consideration family dynamics but regardless, the study still showed that there was no difference between the populations treated with drugs versus those undergoing behavioral management solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents.

The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of academic performance or social skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have almost identical adverse reactions and have the potential for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often become robotic and lethargic and that permanent neurological tics can result.

In his textbook, Attention Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of ADHD, notes that there is little improvement in academic performance with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can affect growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a diagnosis of ADHD.

Dr. Sidney Walker, III, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large number of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children actually become psychotic – the fact that many hyperactive children respond to Ritalin by becoming calmer doesn’t mean that the drug is treating a disease. Most people respond to cocaine by becoming more alert and focused, but that doesn’t mean they are suffering from a disease treated by cocaine. It is interesting to note Walker’s analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, EMP (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration produces a high similar to that of cocaine.   Walker (1998, pg. 14-15) that in addition to emotional struggles of children leading to ADHD-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette’s syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be considered ADHDEhowever Walker feels that these issues are most often overlooked and the person is considered to be ADHD.

F. Xavier Castellanos states at the 1998 Consensus Conference that those children with ADHD had smaller brain size than those of children who were considered to be normal. However, Castellanos reported as well that 93% of those children considered ADHD in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with ADHD since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse effect of this treatment.  Physician Warren Weinberg and colleagues stated, a large number of biologic studies have been undertaken to characterize ADHD as a disease entity, but results have been inconsistent and not reproducible because the symptoms of ADHD are merely the symptoms of a variety of disorders. The Food and Drug Administration has noted (Walker, 1998, pg. 27) that ee acknowledge that as of yet no distinct pathophysiology (for ADHD) has been delineated.

There has been concern as well about the addictive component of psychostimulants. The Drug Enforcement Administration (1995c) reports that it was found that methylphenidate’s pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse potential as these Schedule II stimulants.

Breggin states that psychiatrist Arthur Green in the Comprehensive Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be linked to abuse and/or neglect. Abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with limited attention span and hyperactivity. (Breggin, 1991, pg. 274)

Being that ADHD is a subjective diagnosis and that stimulant treatment has been shown to have risk as detailed above, what is the effective alternative to aiding those who have been diagnosed ADHD and what actually is underlying the difficulties that these individuals may be manifesting? Psychologist and educator Michael Valentine (1988) suggests that it is necessary to love your children, care about them, do as much as possible to have them grow and develop, teach them social skills, and teach them how to identify and express their feelings and to become uniquely human; but at the same time, care about them and love them enough to give them guidance, structure, limits, and control as they need it.

Valentine advocates a psychosocial approach to aiding children and adolescents who would be considered to be ADHD. Psychiatrist Peter Breggin also advocates this approach and feels that it is necessary for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is necessary to examine the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of ADHD itself). It is necessary to examine the experience of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an appropriate educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them.

Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, Epediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don’t like it as having attention deficit disorder or attention deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it’s better to use drugs than to try to apply their prestige and clout in the community to the real problem: improving our school s so that students find them enjoyable enough to pay attention and learn in an environment where drugs are not needed. This misguided psychiatric effort has created an epidemic of drug treated mental illnessEin the schools.

Breggin continues that it is also necessary to examine the environment the child lives in and the stressors around them. It is necessary to build relationship and collaboratively design structure and limits with the child or adolescent (Breggin, 1998, pg. 318) Breggin feels it is necessary to train parents in relationship building with their children and in working through situations of conflict. He states, parent management training has consistently proven successful in improving parent self-esteem, in reducing parent stress, and in ameliorating ADHD-like symptoms, especially negative attitudes toward parental authority and aggression.

Dr. David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as ADHD who Stein prefers to call highly misbehaving children. In this program, known as the Caregiver’s Skills program, Stein states it is necessary to treat your child as normal and not diseased. He states that the children should not be taking any medications, as they are risky for the child’s health and merely blunt behaviors. Stein argues, if the behaviors don’t occur, we can’t help (them) learn new habits.

The program encourages social reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The program encourages development of target behaviors and consistent encouragement and social reinforcement as well as consistent consequences for misbehavior. The program encourages the self-assessment and evaluation of the child of their own behaviors.

REFERENCES:

Barkley, Russell, Taking Charge of ADHD, Boys Town, NE, Boys Town Press, 1995)

Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, MA, 2000)

Breggin, Peter R., Talking Back to Ritalin,Common Courage Press, Monroe, ME, 1998)

Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)

DuPaul, Barkley, and Connor, Stimulants (article appearing in text Attention Deficit Hyperactivity Disorder, 1998).

Glasser, William, Psychiatry Can Be Hazardous to Your Mental Health, Harper Collins, New York, 2003)

Hedaya, Robert J., Understanding Biological Psychiatry, W.W. Norton, New York, 1996)

Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)

National Institutes of Mental Health Consensus Conference Statement, 1998

Stein, David, Unraveling the ADHD Fiasco, Andrews McMeel, Kansas City, 2001)

Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)

Weinberg, Warren et al., Attention Deficit Hyperactivity Disorder: A Disease or a Symptom Complex, Journal of Pediatrics, 130, 665-6

Dan L. Edmunds, Ed.D.
http://www.danedmunds.com

Article Source: http://EzineArticles.com/?expert=Dan_Edmunds

via Meeting the True Needs of Children Diagnosed as ADHD.

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14 August, 2011 23:16

 

How to Figure Out When Therapy Is Over

Published: October 30, 2007

If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.

A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.

“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”

What began with a simple case of writer’s block  turned into seven years of intensive therapy.

Over all, she found the therapy very helpful. She finished a second novel and felt that her relationship with her husband was stronger. When she broached the topic of ending treatment, her therapist strongly resisted, which upset the patient. “Why do I need therapy,” she wanted to know, “if I’m feeling good?”

Millions of Americans are in psychotherapy, and my friend’s experience brings up two related, perplexing questions. How do you know when you are healthy enough to say goodbye to your therapist? And how should a therapist handle it?

With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place — depression, anxiety, relationship problems, you name it — the common goal of treatment is to feel and function better independent of your therapist.

To put it bluntly, good therapy is supposed to come to an end.

But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?

The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal.  It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.

Still, even when patients feel that they have accomplished something important in therapy and feel “good enough,” it is not always easy to say goodbye to a therapist.

Not long ago, I evaluated a successful lawyer who had been in psychotherapy for nine years. He had entered therapy, he told me, because he lacked a sense of direction and had no intimate relationships. But for six or seven years, he had felt that he and his therapist were just wasting their time. Therapy had become a routine, like going to the gym.

“It’s not that anything bad has happened,” he said. “It’s that nothing is happening.”

This was no longer psychotherapy, but an expensive form of chatting. So why did he stay with it? In part, I think, because therapy is essentially an unequal relationship. Patients tend to be dependent on their therapists. Even if the therapy is problematic or unsatisfying, that might be preferable to giving it up altogether or starting all over again with an unknown therapist.

Beyond that, patients often become stuck in therapy for the very reason that they started it. For example, a dependent patient cannot leave his therapist; a masochistic patient suffers silently in treatment with a withholding therapist; a narcissistic patient eager to be liked fears challenging his therapist, and so on.

Of course, you may ask why therapists in such cases do not call a timeout and question whether the treatment is stalled or isn’t working. I can think of several reasons.

To start with, therapists are generally an enthusiastic bunch who can always identify new issues for you to work on. Then, of course, there is an unspoken motive: therapists have an inherent financial interest in keeping their patients in treatment.

And therapists have unmet emotional needs just like everyone else, which certain patients satisfy. Therapists may find some patients so interesting, exciting or fun that they have a hard time letting go of them.

So the best way to answer the question, “Am I done with therapy?” is to confront it head on. Periodically take stock of your progress and ask your therapist for direct feedback.

How close are you to reaching your goals? How much better do you feel? Are your relationships and work more satisfying? You can even ask close friends or your partner whether they see any change.

If you think you are better and are contemplating ending treatment but the therapist disagrees, it is time for an independent consultation. Indeed, after a consultation, my writer friend terminated her therapy and has no regrets about it.

The lawyer finally mustered the courage to tell his therapist that although he enjoyed talking with her, he really felt that the time had come to stop. To his surprise, she agreed.

If, unlike those two,  you still cannot decide to stay or leave, consider an experiment. Take a break from therapy for a few months and see what life is like without it.

That way, you’ll have a chance to gauge the effects of therapy without actually being in it (and paying for it). Remember, you can always go back.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.

http://www.nytimes.com/2007/10/30/health/views/30beha.html

visit my website: http://www.lkg4btrlife.webs.com

 

Applying Learning Principles to Thought: Cognitive Restructuring – Psychological Self-Tools – Online Self-Help Book

 

English: Arnold's appraisal theory of emotion
English: Arnold’s appraisal theory of emotion (Photo credit: Wikipedia)

 

Applying Learning Principles to Thought: Cognitive Restructuring – Psychological Self-Tools – Online Self-Help Book

 

Cognitive Restructuring (sometimes known as “reframing”) is essentially the core technique from cognitive behavioral therapy, a highly regarded, scientifically validated psychotherapy format. The technique is designed to help you alter your habitual appraisal habits so that they can become less biased in nature and you less moody. You alter your appraisal habits by becoming aware of them as they occur, and then criticizing and critiquing them. Usually there is no logical or rational basis for your appraisal bias. When you really examine your judgments carefully, looking for evidence to support them, you find that there is none. You are then in a position to form a new, more accurate appraisal.

 

Appraisal habits cannot be manipulated directly, but the thoughts that carry them can be. The first task in cognitive restructuring is thus self-monitoring; learning to become more aware of your thought behaviors. Habitual appraisal habits are not conscious things, and neither are the thoughts that carry them. In addition to the thoughts you are conscious of having, there are also all manner of unconscious automatic thoughts which flit through your mind without you noticing. Automatic thoughts are not inherently unconscious; they are just so common that you’ve habituated to them and no longer notice them.

 

You become more conscious of your automatic thoughts by self-monitoring. We don’t want to count thoughts, however, so much as we want to record them. A good way to do this is to write down all the thoughts that occur to you shortly after some event has occurred that causes you to feel bad.

 

Automatic thoughts are often situation specific instances of more core fixed beliefs about yourself and the world. While automatic thoughts reflects your reaction to a given event, core beliefs describes your general expectations and identity. For example, if you have recently done poorly on a test, your automatic thought will probably reflect your situation, “I’m so embarrassed! I should have done better!” , while your core belief might reflect a deeper fear: “I’m a stupid person!” Core beliefs influence appraisals, and thus are a major source of bias. They are not always obvious or conscious. The way to identify them is to examine multiple instances of your automatic thoughts over time for the repetitive themes that underlie them. You will likely be able to distill some of your core beliefs by examining your self-monitoring thought records, and by asking yourself the question, “Why am I reacting this way?”.

 

Writing down your automatic thoughts and core beliefs makes it easier for you to get a handle on them; to view them from an outsider’s perspective rather than your own. When you actually get to look at what you are thinking and believing, you may find that your thoughts and beliefs are inaccurate, incorrect or irrational, and that with a little work you can correct them so that they better reflect “reality”; the shared social consensus.