The First Description of ADHD - the Lancet 1904

The Story of Fidgety Philip


"Let me see if Philip can
Be a little gentleman;
Let me see if he is able
To sit still for once at the table."
Thus Papa bade Phil behave;
And Mama looked very grave.
But Fidgety Phil,
He won't sit still;
He wriggles,
And giggles,
And then, I declare,
Swings backwards and forwards,
And tilts up his chair,
Just like any rocking horse--
"Philip! I am getting cross!"
See the naughty, restless child
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, plates, knives, forks and all.
How Mama did fret and frown,
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace . . .

my food thief and self control

Our son is constantly in search of his next sugar high.  I know this sounds like a problem most of us struggle with....however, he takes it to the next level.  If we have sugar in any form in our home he will find it and devour it all in one sitting.  We have bargained with him in all shapes in forms.  We've used sugar as a behavior reward and we've also rewarded him for using self control.  No matter what we do he is constantly seeking and negotiating for his next sugar high.  When we are exhausted by the negotiations we just physically place locks on the cabinets.  Don't think this deterred him.  Kaya merely saw this as a new challenge and woke up a few hours earlier to figure out how to get past the locks and sneak the cookies.

I was reminded of our "sugar dilemma" when I heard about a report that suggested that lack of self control predicts your future health, wealth and potential criminal behavior.  I had to laugh out loud because ever since my son was little and using his houdini tricks to get to the cookies I found myself telling him "use your powers for good".  He goes through such planning and effort to get cookies that it's hard not to think about how successful he could be if he just applied his skills to a more productive task. I've always felt that one day he'll either use his "powers" to become the next ruler of the world or with his lock picking skills he'll end up in jail.  Little did I know that research would validate my argument. 

An article published in the Proceedings of the National Academy of Science in January states that "The need to delay gratification, control impulses, and modulate emotional expression is the earliest and most ubiquitous demand that societies place on their children, and success at many life tasks depends critically on children’s mastery of such self-control."  This is very similar to the results of the original Stanford marshmellow test (which is quite entertaining to watch). 

In the study they followed 1000 children from birth to adulthood and looked at certain measures of self-control including parent, teacher, and self reports of impulsive aggression, hyperactivity, lack of persistence, inattention, and impulsivity (otherwise known as ADHD!) and how these affected health, wealth and happiness. At the age of 32, children with poor self-control were struggling financially, they were less likely to save and had acquired fewer financial building blocks for the future (e.g., home ownership, investment funds, retirement plans). They reported more money-management difficulties and had accumulated more credit problems. Poor self-control in childhood was a stronger predictor of these financial difficulties despite social class origins and IQ.  Children with poor self-control were also more likely to be convicted of a criminal offense.  Adolescents with low self-control made mistakes, such as starting smoking, leaving high school, and having an unplanned baby, that could ensnare them in lifestyles with lasting ill effects. 


It sounds like the children with the lowest levels of exhibited self-control would likely meet diagnostic criteria for ADHD.  I wonder if any of the children in the study who demonstrated low levels of self control early on were treated with medications or behavioral plans?  Did this change any of their outcomes?  


For now I'm still left with the conundrum that I somehow have to help my son master self control - at the moment I'll stick to shopping for a better lock to keep him out of the cabinets and I won't be leaving any marshmellows out unsupervised for awhile. 

Jessie

To find a service dog like Jessie or help fund dogs for other children go to: www.neads.org

Jessie

By Kaya Suner

Jessie is my dog.  She is a yellow lab.  They love kids.  Some people call them Labrador retrievers.  There are all kinds of labs – yellow labs, black labs and chocolate labs.  Jessie’s nickname is Calm Canine and sometimes Mutant Mutt.  Jessie loves to swim.  Some people get mixed up with human years and dog years.  In dog years Jessie is three and in human years she is twenty one.  I have had Jessie for about ten months.  We got Jessie in March.

Labs are bred to catch fish in the ocean.   They collect the net with the fish in it and bring it to the boat.  They have webbed feet to swim and can swim very fast.  When Jessie gets out of the water she smells gross.  Well, she always smells gross.  Jessie loves to lick me but sometimes I don’t like it because her breath smells.

Jessie is an assistance dog.  An assistance dog is a dog that helps people.  You have to have a special need to have an assistance dog.  Jessie is from Virginia I don’t know where in Virginia, but we got Jessie at a place called N.E.A.D.S in Mass.  Assistance dogs are more calm than most dogs.  I think Jessie is the most calm dog.  Jessie was trained in prison.

An assistance dog will not bite, claw, bark or chew the sofa apart.  It is hard to have an assistance dog.  You have to let them play every morning and night for 45 minutes, let them go to the bathroom every morning and night, and feed them every morning and night.  Assistance dogs are trained to do a log commands like sit, stay, down, heel and fetch.  Those are only basic commands.

Since Jessie is an assistance dog she can go anywhere, like planes.  She sits right under our feet.  Jessie has to wear a special vest when she goes places with us.  On the plane she has to wear a big puffy vest.

Dan is the name of the guy who gave us Jessie.  We had to do a lot with him.  We  had to go to the mall we had to go to restaurants we had to go to stores and Jessie was there with us.  We also had to do commands with her at N.E.A.D.S before we got to take her home.

It was about a week before we took Jessie home.  It was hard work.  When we took Jessie home we were all excited but she was sniffing the whole house for about two days. Jessie really likes our house. 

When we go to hockey and Jessie comes, she is scared of the buzzer.  Jessie is scared of a lot of things.  She is scared of smoke alarms and fish. 

Jessie can be a loon sometimes.  Jessie loves to play with her friends at the park.  Jessie has played with a pig and a sheep.  Jessie loves to chase me.  I like Jessie a lot. 

Our service dog Jessie

Jessie

By Kaya Suner

Jessie is my dog.  She is a yellow lab.  They love kids.  Some people call them Labrador retrievers.  There are all kinds of labs – yellow labs, black labs and chocolate labs.  Jessie’s nickname is Calm Canine and sometimes Mutant Mutt.  Jessie loves to swim.  Some people get mixed up with human years and dog years.  In dog years Jessie is three and in human years she is twenty one.  I have had Jessie for about ten months.  We got Jessie in March.

Labs are bred to catch fish in the ocean.   They collect the net with the fish in it and bring it to the boat.  They have webbed feet to swim and can swim very fast.  When Jessie gets out of the water she smells gross.  Well, she always smells gross.  Jessie loves to lick me but sometimes I don’t like it because her breath smells.

Jessie is an assistance dog.  An assistance dog is a dog that helps people.  You have to have a special need to have an assistance dog.  Jessie is from Virginia I don’t know where in Virginia, but we got Jessie at a place called N.E.A.D.S in Mass.  Assistance dogs are more calm than most dogs.  I think Jessie is the most calm dog.  Jessie was trained in prison.

An assistance dog will not bite, claw, bark or chew the sofa apart.  It is hard to have an assistance dog.  You have to let them play every morning and night for 45 minutes, let them go to the bathroom every morning and night, and feed them every morning and night.  Assistance dogs are trained to do a log commands like sit, stay, down, heel and fetch.  Those are only basic commands.

Since Jessie is an assistance dog she can go anywhere, like planes.  She sits right under our feet.  Jessie has to wear a special vest when she goes places with us.  On the plane she has to wear a big puffy vest.

Dan is the name of the guy who gave us Jessie.  We had to do a lot with him.  We  had to go to the mall we had to go to restaurants we had to go to stores and Jessie was there with us.  We also had to do commands with her at N.E.A.D.S before we got to take her home.

It was about a week before we took Jessie home.  It was hard work.  When we took Jessie home we were all excited but she was sniffing the whole house for about two days. Jessie really likes our house. 

When we go to hockey and Jessie comes, she is scared of the buzzer.  Jessie is scared of a lot of things.  She is scared of smoke alarms and fish. 

Jessie can be a loon sometimes.  Jessie loves to play with her friends at the park.  Jessie has played with a pig and a sheep.  Jessie loves to chase me.  I like Jessie a lot. 

can we train our kids like pavlov?

Pavlov makes it seem easy.  Ring a bell and the dog drools.


In my personal experience trying to condition my son's behavior has been nothing but easy. 
We've tried paper behavior charts, different size rewards from little toys to trips to disney.  We've tried whiteboards and picture charts, and lastly this week we tried an online version of a behavior system...adhdnanny.com.  Of all the chart systems we've tried this one seemed to have the largest appeal to our son because it is in a "club penguin" type setup where he can cash in points for rewards online.   However, 2 weeks in we are already slacking...are we lazy? or does the novelty or effect wear off?  Sometimes I wonder who needs the training him or me?


So why do we keep on trying?  Most of the research about how best to manage ADHD suggests that "multimodal" treatment -  a combination of medication management and behavioral therapy is most effective (although this is controversial at this point).   Most of this data comes from the National Institute of Mental Health Multimodal Treatment Study of ADHD (MTA).  In the initial study a combination of behavioral therapy and medication outperformed medication alone on several behavioral rating scales. However, on follow up studies the advantage of behavioral therapy is less clear -  the picture is confused by the difficult of keeping up with the behavioral therapy. Even when state of the art behavioral treatment was provided to families at NO CHARGE, almost 40% of families were unable and/or unwilling to fully take advantage of it.  In the study the behavioral treatment included parent training, child-focused treatment, and a school-based intervention. 


Parent training involved 27 group sessions and 8 individual sessions per family. The focus was on teaching parents specific behavioral strategies to deal with the challenges that children with ADHD often present. The child-focused treatment was a summer treatment program that children attended for 8 weeks, 5 days a week, during the summer. This program employed intensive behavioral interventions that were administered by counselors/aides who were supervised by the therapists conducting the parent training. The basic model was one in which children were able to earn various rewards based on their ability to follow well- defined rules and meet certain behavioral expectations. Social skills training and specialized academic instruction was also provided.


The school-based treatment had 2 components: 10 to 16 sessions of biweekly teacher consultation focused on classroom behavior management strategies, and 12 weeks of a part-time paraprofessional aide who worked directly in the classroom with the child. Throughout the school year, a Daily Report Card was used to link the child's behavior at school to consequences at home. The Daily Report Card was a 1-page teacher-completed ratings of the the child's success on specific behaviors. This was brought home daily by the child to be reviewed by parents with rewards for a successful day provided as indicated.


Whoaa!  Who on earth could implement or sustain that type of behavioral program?  Our longest stretch with a simple behavioral chart has lasted 2 weeks tops.   Some days I wonder why keep trying, we will never come close to the ideal behavioral plan outlined by the MTA study.   However, every time we start and stop we do see short term improvements  so I will continue to look for the nirvana of behavioral plans/charts/chips we can stick to.... if anyone out there has the answer please post below :)

ADHD Tweeters

Enjoy this List of ADHD tweeters!  Here is the list if the link doesn't work:

1. @CHADDING (CHADD-Children and Adults with Attention Deficit/Hyperactivity Disorder) Here is where you will find the nation's leading non-profit organization serving individuals with AD/HD and their families on Twitter.

2. @ADDitudeMag ADDitude is a magazine, website and community for families touched by Attention Deficit Disorder. You will find their editors and bloggers tweeting here.

3. @ADDclasses ADDclasses.com offers virtual support and educational resources for those whose lives are affected by ADD. You'll find them tweeting information, resources and connecting you to others in the ADD/ADHD community.

4. @TerryMatlen helping moms and women survive living with ADHD at www.momswithadhd.com, she tweets from here.

5. @livingwithadd this is Tara McGillicudy, ADD/ADHD support mentor and founder of ADDclasses.com.

6. @simpleadhdexpert find the tweets of Ben Glenn, speaker, author, artist and ADHD advocate, also a contributing blogger at ADDitudeMag.com.

7. @nickmortensen tweeting here: Nick Mortensen, comedian turned speaker and ADHD advocate extraordinaire.

8. @TotallyADD community manager for TotallyADD.com, Aerin Guy, tweets from this account providing humor and important information for the adult ADHD community.

9. @adhdmomma Penny Williams, creator, author and editor of A Mom's View of ADHD tweets from this account, sharing real life as a mom of a child with ADHD.

10. @CoachforADHD Laura Rolands tweets and shares her knowledge as a coach for students, adults and families dealing with ADD/ADHD.

+1 For good measure: @petequily another adult ADHD coach and blogger, who knows what it's like himself. Thought provoking and expressive, you may find him tweeting politics now and then.

Best episode of parenthood yet!

I just watched  the February 1st episode of Parenthood on NBC and it was right on!  I would love to know who is writing for the show because it's depiction of parenting a child with a "syndrome" disorder feels very real to me.  On this episode Max's grandfather decides he is going to take him on an overnight camping trip because it's a Braverman tradition.  Max's has Asperger's syndrome so his mom puts together a manual on how to handle Max while they are away.  His grandfather of course thinks she is capital C crazy and over the top neurotic.  Well those of us who have been there know how this goes....by the end of the camping trip it becomes clear why there is a manual (see my previous post "I'm a little burnt out).  Watch the episode for free online, trust me you won't feel alone anymore.  If you click this link you can find autism experts discussing the episodes.

Do moms get a snow day?

Do you remember the pure unadulterated joy of seeing (or did we hear it on the radio back then?) your schools name go up for cancellation on a snow day?  That serene "I have no responsibilities today" feeling that would come over you.  I can't remember the last time I felt that way and now my son's snow days are a reminder of how infrequently we get to feel that way.  Imagine a day where you could eliminate all of your responsibilities and worries and just play.   What would that feel like?

Boys will be boys

I can't even begin to count the number of times I've been told "boys will be boys" when I describe some of my kids behaviors.  Although my son's academic struggles are clearly more complicated, I was fascinated by this TED talk, Gaming to re-engage boys in learning, which explains how elementary education is doing a disservice to boys as a whole.