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Making the Noise Go Away.

Is it really ADHD? If so, what’s the best treatment?

This article originally appeared in Tulsa Kids Magazine

by Liz Walker

From the outside, they are bright and busy. They may fidget, squirm, twirl…never stop moving. They are disorganized, easily distracted. Their rooms are utter chaos. They shift from one uncompleted task to another. They have difficulty following instructions or sustaining attention. They are daydreamers. Sometimes they are quick to anger and have difficulty making or keeping friends. This is how children with ADHD appear to parents, teachers and other children.

From the inside, as one fifteen year old girl describes, "It’s like having a million thoughts go through my head all at once."

Description and Diagnosis

Attention Deficit Hyperactivity Disorder (ADHD) has three subtypes, 1) ADHD-Predominantly Inattentive Type, 2) ADHD-Predominantly Hyperactive Impulsive Type 3) ADHD -Combined Type (The most common). They are all called ADHD these days, even if the hyperactive component is missing.

Dr. Richard Irwin, Developmental Pediatrician with Tulsa Developmental Pediatrics and Center for Family Psychology, says, "It’s important for people to understand that the core characteristics of ADHD are difficulty with concentration and attention, easy distractibility, excessive impulsivity and varying degrees of hyperactivity. The NON-hyperactive ADHD child tends to be less impulsive in nature and may struggle the most with concentration, distractibility, disorganization and forgetfulness."

Dr. Irwin also says that these traits are most evident when a child is involved in an activity they find boring, like school work. But that they are able to sustain attention for long periods of time when they are doing something they enjoy like playing video games.

A diagnosis of ADHD can be made by a General Pediatrician, Developmental Pediatrician, Child and Adolescent Psychiatrist or Psychologist. All can prescribe medication if necessary, except for the Psychologist.

Traditional Treatments

According to Dr. Irwin, "The current gold stand treatment is a combination of medication therapy, supportive parenting guidance and counseling and behavior modification strategies (as indicated), specific accommodations in the classroom, special education interventions and tutoring for any areas of specific educational weakness.. Social sills group training and instruction in study skills also are used."

The office for Tulsa Developmental Pediatrics is located at: 4520 S. Harvard. Their number is 743-2334.

Two Non-Traditional Therapies.

Neurotherapy

Neurofeedback involves teaching a person to modify his or her brain wave activity. Some people have too little or too much of certain types of brain wave activity in different areas of the brain. Neurofeedback teaches them how to maintain a healthier balance.

Neurofeedback research began in the UCLA Medical School labs in 1965. Since then it has been used to help people overcome a variety of problems including addiction, anxiety, depression and migraines. It’s even been used by the military and by NASA.

Some children with ADHD can benefit from Neurofeedback by "learning to attend to the activity at hand," says Dan Corley of Neurosystems. "It’s not really a matter of controlling brain waves."

Corley does not normally diagnose, but sees patients after they have been diagnosed by one of the specialists mentioned above. In hour long sessions, the child is trained to increase and decrease brain waves in the correct frequencies.

Corley says parents and teachers often notice changes after 7 -10 sessions. About the same time, the children report they are sleeping better, remembering more dreams (REM sleep) and they can often reduce medications or sometimes stop taking it all together. Dr. Corley can be reached 748-9213. His office is at 2424 E. 21st. St. For additional information about ADHD and Neurofeedback, he recommends reading, "Getting rid of Ritalin. How Neurofeedback can successfully treat Attention Deficit Disorder with Drugs." by Robert W. Hill, Ph. D. and Eduardo Castro, M.D.

Chiropractic Care

"My son tells me it takes the noise out of his head," says Brandon’s mother. "He knows when he needs to go in to the doctor and he tells me."

Brandon (not his real name) is a patient of Dr. Robert Brooks of Brooks Spinal Care of Tulsa.

Dr. Brooks says, "Some cases of ADHD can be caused by structural mis-alignment in the spine. The misalignment can affect the cranial vault or the spinal column and create stress in the central nervous system."

Dr. Brooks says these alignments can often be corrected with no more than a gentle touch on the side of the neck. He takes x-rays both before and after to determine whether the misalignment is completely corrected or only reduced. "Many spines are corrected with just one adjustment," he says.

Brandon’s mother says it definitely calms her son. She also says he is still taking medication…for now. But she believes his care is a balancing act and wants to consider all options that will help her son.

Brooks Spinal Care is located at 1722 S. Carson, Suite 3100. The number is 587-7111. Website: http://www.brookspinalcare.com

Misdiagnosis?

"Environmental factors such as child abuse or neglect, peer conflicts, or other social-emotional factors can cause the appearance of inattention, distractibility and hyperactivity", says Irwin. "Some medical conditions have been know to produce ADHD-like behaviors including hyper or hypo- thyroidism, iron-deficiency anemia, lead intoxication, and specific abnormalities of the brain. Although these are more rare, they need to be ruled out in a complete evaluation. Other psychiatric conditions can also produce symptoms suggestive of ADHD, such as anxiety or depressive conditions and obsessive compulsive disorder. True ADHD is a neurologically based condition. It is usually inherited and hard wired into the nervous system."

Two other medical conditions that parents may want to take into account are visual and sleeping problems.

It’s in the eyes.

Dr. Monte Harrel is a developmental optometrist at Oklahoma Vision Development Center. He specializes in the diagnosis and treatment of vision problems that interfere with reading and learning.

One of his young patients, Chelsea Colvard, talked about seeing in 3D. Her story was so compelling it was told in the November 11, 2001 issue of the Tulsa World. Dr. Harrel says, "What she called 3D was actually seeing double, a condition that can cause many of the same symptoms of ADHD." Chelsea had originally been diagnosed with ADHD but was able to go off her medication once she had vision therapy.

Why does this go undiagnosed? Partly because school vision tests only check for 20/20 vision. "But the problem," says Harrel, "is the way the brain controls the eyes. The typical vision test doesn’t screen for eye teaming (both eyes focusing on the same object at the same time), focusing flexibility and eye tracking. " Children could be experiencing vision problems and not realize what it is, as in Chelsea’s case.

Dr. Harrel uses a combination of office visits and home activities that teach how to use vision correctly.

His office is in the Harvard Professional Building, 3315 E. 47th Place, Suite 100. 745-9662. www.oklahomavision.com

Breathe easier.

Sleep apnea is a disorder that causes children (and adults) to frequently stop breathing while sleeping. As a result, they do not get the oxygen their bodies need, and may fail to get a restful night’s sleep.

A study conducted in Texas last year and funded by the National Institutes of Health, National Heart, Lung, and Blood Institutes, found that sleep apnea can have a significant impact on a child’s cognition, school performance and behavior. The profile of some of these children looks very much like ADHD. Although according to one of the authors of the study, Dr. Michael Stewart, Director of Residency Education at Baylor College of Medicine in Houston, Texas, none of the children in the study had been diagnosed with ADHD before the study, their symptoms were typical of that diagnosis.

"Children with sleep breathing disturbance had significant problems with concentration and behavior. After the upper airway obstruction had been cleared with tonsillectomy and adenoidectomy, the children’s behavior and concentration improved dramatically," he says.

Dr. Stewart was unaware of any studies in Tulsa directly related to his research. However, St. Francis in Broken Arrow has a Sleep Disorders Clinic. If you think your child should be evaluated for a sleep disorder, the main number for St.Francis BA is 455-3535. Their address is 3000 S. Elm. Their website can be found at http://www.sfh-tulsa.com/services/sleeplab/

The girl mentioned at the beginning of the article who had a million things going through her mind at one time has found some success with Adderall a medication for ADHD. "It helps me think more clearly and focus in on one thing."

Since going on the medication, her grades have improved. Her mother says, "We’re still taking it one day at a time and trying to figure out the best way to quiet all the noise."

SIDE BAR 1

ADHD checklist.

Does your child have these behaviors?

Fidgets with hands or feet

Squirms in seat

Has difficulty remaining seated

Easily distracted

Difficulty awaiting turn in games or group situations

Gives answers to questions before they are completed

Difficulty following instructions

Difficulty sustaining attention in tasks or play activities

Shifts from one uncompleted task to another

Difficulty playing quietly

Talks excessively

Interrupts others

Does not seem to listen

Loses things

Engages in physically dangerous activities with out considering the consequences

SIDE BAR 2

Sleep Disorders check list

Does your child have these behaviors?

Snoring

Stops breathing during sleep

Feels sleepy during the day

Restless sleeper

Sweat excessively at night

Wake up with frequent headaches

SIDE BAR 3

Visual Problem checklist.

Performance Clues:

Avoidance of near work

Frequent loss of place

Omits, inserts, or rereads letters/word

Confuses similar looking words

Failure to recognize the same word in the next sentence

Poor reading comprehension

Letter or word reversals after first grade

Difficulty copying from the chalkboard

Poor handwriting, misaligns numbers

Book held too close to eyes

Inconsistent or poor sports performance

Secondary symptoms:

Smart in everything but school

Low self-esteem, poor self image

Temper flare-ups, aggressiveness

Frequent crying

Short attention span

Fatigue, frustration, stress

Irritability

Day dreaming

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