[Moderator] CBN | Welcome! | This is a special night for the ADD Forum. Tonight, we have | appearing live Dr. Edward Hallowell, who's new book, "Driven | to Distraction" is taking the country by storm . [Moderator] CBN | As you all probably know now, this room is for "Watching" | only. I will be posting questions to Dr. H, using the | questions you submitted both in our forum threads and | tonight in CO5. If there is a small delay as questions are | gathered, please bear with us. Thanks! | Good evening, Dr. Hallowell! We are delighted | to have you here! Dr. Hallowell | I am AMAZED to be here. | I have no idea how this machine works, or this system works, | and if it weren't for Dave deBronkart literally sitting next | to me doing all the typing, holding my hand, I wouldn't be | able to be here at all! | And I am totally enthralled by your wacky, zany, completely | ADD forum, and I would love to meet this Cj at some point! | So... I'd be happy to try to answer your questions. [Moderator] CBN | LOL, Dr. (That's our online lingo for "laughing out loud") [Moderator] CBN | Here is the first question from a forum | member.. | How early (age) can ADD be diagnosed? HOW is | it diagnosed in the (very) young? Dr. Hallowell | Theoretically, ADD can be diagnosed at any age. In practice, | people differ as to when the earliest cutoff point is. I | myself do not diagnose it in children younger than 5. | This is because I think it's so hard to differentiate ADD | from normal toddler behavior. | The diagnosis in 5 year old, 6, 7 year olds, rests upon | history, as it does in all ages. But obviously the younger | the child, the more the diagnosis rests upon physical | behaviors. [Moderator] CBN | Here is another child related question... | A parent wonders if there are any "risks" to having a young | child diagnosed and "labeled" by the school bureacracy? | Should the school always be told? Dr. Hallowell | There are always risks, but I think the greater risk is in | the school NOT knowing. | We HOPE you live in an enlightened school district, but if | you do not, you take on the at times gargantuan task of | trying to educate the school about ADD. | You cannot do this by yourself! You need the help of forums | like this, books, professionals, and of a host of guardian | angels. [Moderator] CBN | That brings up a related question from another member... | What would you advise parents of ADD students in highly | stressed, low-wealth urban school districts? Dr. Hallowell | Um.... | That is a very difficult problem. Many urban areas are close | to teaching hospitals. And you can get the biggest bang for | your buck by getting a doctor in training - a "resident" - | at a teaching hospital to take on your case, be they in | pediatrics, neurology, or child psychiatry. | These young doctors tend to be very idealistic, highly | motivated, and indefatigable. Just the sort of staunch ally | a low-income urban ADD parent absolutely needs. [Moderator] CBN | Great suggestion! Thanks. As long as we are talking kids... | from a parent in a district with more choices comes the | question: | What attributes should I look for in my child's teachers? Dr. Hallowell | Flexibility... | a sense of humor, | and a willingness to learn. | I would say those are the 3 main ingredients to look for in | a teacher. You cannot expect your teacher to be expert in | ADD, but you can hope that he or she wants to learn as much | as possible about it. | Flexibility is key for obvious reasons. And a sense of humor | saves the ADD day more times than any of us can count. | Beware of teachers who tell you that they already know | everything about ADD that there is to know (because no one | does), and beware of teachers you can't get a laugh out of. [Moderator] CBN | Another parent asks.. | My school's clinicians don't beleve my son has ADD. What | can I do? What tests do you recommend? Dr. Hallowell | Tell them I'll duke it out at high noon.(g) | But seriously, this is a common situation. Once again, one | must "avoid the struggle" at all costs and appeal to the | persuasive power of knowledge. | Struggles almost invariably devolve into personal | hostilities, whereas an honest debate... [Moderator] CBN | Folks I am afraid we have temporarily lost our speaker.. | Bear with us please while he comes back and gets set up | again. (It must be those busy Boston phone lines ) [Moderator] CBN | While we are waiting, let me explain that I am using both | the questions that you submitted in advance and questions | you are posting in Room 5 tonight. We will not be able to | answer all. I wish we could! Questions of more general | interest, as opposed to more personal issues have a better | chance of being asked before our time runs out. Dr. Hallowell | Sorry! Whew! [Moderator] CBN | Hi there! Welcome back! Dr. Hallowell | I think we choked CompuServe. <===deB [Moderator] CBN | We gathered | Thank goodness you were able to get back in! Dr. Hallowell | Where did we leave off? | The struggles devolve into personal hostilities. One has to | hope that honest debate... [Moderator] CBN | Ready for our next question? [Moderator] CBN | We are switching subjects, slightly... go ahead. Sorry. Dr. Hallowell | will lead to the truth. Debate nourished by knowledge, not | rancor. [Moderator] CBN | Thanks. | Ok, we are moving onto the subject of medication for awhile, | in both kids and adults.. | What do you recommend for a child taking Ritalin who has | trouble sleeping? Dr. Hallowell | Let me say several things about sleep. | In answer to the specific question just asked, if a child is | taking Ritalin and is having trouble getting to sleep at | night, then the dose of Ritalin should be lowered, or the | time he takes the Ritalin should be moved back to earlier in | the day, or the med should be changed to another medication. | A more general point about sleep and ADD, particularly in | adolescents and young adults, is a pattern that I have seen | so often that I call it the ADD sleep pattern. The | individual has trouble getting to sleep at night, and | *tremendous* trouble waking up in the morning - in other | words, problems with deactivation and activation of the | brain. Usually, medication significantly ameliorates this | problem. However, when it does not, the problem can be | particularly disabling, particularly for college students | who chronically sleep through all their classes. [Moderator] CBN | I know a lot of us "sleepyheads" can relate to that terrible | wake-up problem! An ADDult asks for information about the | pros and cons of taking Ritalin as an adult. Dr. Hallowell | The pros and cons of taking Ritalin as an adult are the same | as the pros and cons of taking Ritalin as a child. | When it works it works very well; when it doesn't, you know | quickly, and can try an alternative medication. What it | does, mainly, when it works, is help the individual to | focus. It is not addicting, not habit forming, does not take | away creativity, and does not in any way sedate or "drug" | the patient. It works like a pair of eyeglasses. | Common side effects include appetite suppression and mild | headache early in the treatment. More severe side effects, | which warrant discontinuation of the medication, include | severe headeaches, elevated blood pressure, involuntary | muscle twitches, or palpitations. [Moderator] CBN | Another ADDult question.. | Is there connection b/w ADD and sexual dysfunction? Dr. Hallowell | Yes. | The two most common patterns of sexual dysfunction seen in | adults with ADD are #1, a tendency toward hyPERsexuality, | in which the individual unwittingly uses the excitement of | sexual attraction as a focusing or organizing device, almost | as a self-medication, much as one might use Ritalin. | The other most common sexual problem in ADD is the opposite | of the first, namely a tendency towart hyPOsexuality, | or even anorgasmia, not due to psychological problems, | but due to an inability to focus during sexual activity. [Moderator] CBN | From another ADDult who obviously read your book comes | the question: What can a couple, both ADD, do if one is | "high stim" about sex, and the other partner is the | opposite, distractible, type? Dr. Hallowell | Well.(g) | This is a difficult question. In all honesty, I would urge | such a couple to try to learn from each other - in other | words, let the hyPER teach the hyPO what is so exciting and | let the hyPO show the hyPER ways of dealing with libido and | other electrical energy other than through the sex act. [Moderator] CBN | Ok, from the room next door comes the question... | Do you see a decrease in ADHD symptoms during and after | puberty? Dr. Hallowell | Approximately 1/3 of children with ADD outgrow" their ADD | during puberty, apparently due to hormonal changes during | that phase of life. By the way, this same ADD-hormonal | sensitivity shows up in the fact that many women with ADD | find that their symptoms get much worse during the period | prior to menstruation. | 2/3 of children do NOT outgrow their ADD and they join our | wonderful, happy club of adults with attention deficit | disorder. [Moderator] CBN | | A frustrated parent asks.. | "Does she realize that her behavior is | wrong?... | Do ADD children have trouble determining | what is wrong & what is right?" Dr. Hallowell | Yes, they do. | But: do not take this to mean that they are bad children, | or bad people. Children and adults with ADD are poor self- | observers. They often need to be TOLD that what they are | doing is inappropriate, or unacceptable, or just plain | strange, because they often are unaware of that fact. Also, | impulsivity is lightning quick, and can outrun the slower | deliberations of morality. | In other words, by the time your brain can tell you it's | wrong to do it, you may already have taken a cookie from the | cookie jar. [Moderator] CBN | I am sure a whole lot of parents here related to that | answer! Returning to an ADDult concern.. | What should adults with ADD tell their employers? Dr. Hallowell | Very good question. | You have to know your employer in order to answer this | question wisely. If your employer is intelligent, | sympathetic, and flexible, then you should be able to | explain to him or her that you have ADD, and explain exactly | under what conditions you will work best. This may mean you | want your office moved underground, or into a treehouse, | this may mean you will only work where you can hear the | sound of water dripping or where you are suspended from the | ceiling. BUT: the enlightened employer will accommodate you | once he sees the fantastic improvement in productivity you | can deliver when you are working under the conditions you | know you work under best. | If on the other hand, you don't know your employer well, or | you fear that he or she is ignorant or narrow minded, | I would hold off on informing re your ADD. [Moderator] CBN | (LOL again) | From a parent with a BIG problem .. | If husband/wife both have ADD and both of their kids do too | what do you do? (Besides rent a zoo) Dr. Hallowell | In a family such as this, first of all let me congratulate | all members. I'm sure brilliant ideas emanate from your | house as much as flying objects do.(g) | I think a good coach could really help. This may be a | therapist, but need not be - someone with whom you can meet | who can act as a referee to set up the external structures | you will need. To use my metaphor, to build the walls of the | bobsled slide. [Moderator] CBN | Another frustrated parent asks.. | do ADD children have a greater tendency to be mean, | manipulative and "hateful"? Dr. Hallowell | No. | All children, and adults, with ADD carry with them a great | amount of frustration due to the ongoing struggle of their | daily lives to stay on task, be on time, sit still, respond | appropriately, decode social messages that they can barely | perceive, and make apologies for the times that they slip | up. In children, who have fewer social controls than adults, | all that frustration and inner sense of confusion can bubble | over at times and look like nasty or mean-spirited behavior. | It is not. | It is the unfortunate result of neural circuits not talking | to each other in synchrony. Such behavior needs to be | understood, not punished. Certainly limits need to be set, | but they need to be set with understanding, not vengeance. [Moderator] CBN | A related parenting question.. | some doctors just diagnose, write script and | send you home.. | what should we expect in an ongoing treatment | plan? Dr. Hallowell | Good question! | I divide treatment into five components. | First is the diagnosis. | That alone provides significant relief, and should remove | many of the negative labels (incorrect diagnoses, if you | will) such as lazy, stupid, or willful. | Second, education. | Education is key, for child, parent, and teacher alike. | (in order to manage the ADD successfully). | Third is structure. | External structure can compensate for internal chaos to an | amazingly significant degree. | #4 is coaching or psychotherapy. | The child needs to have someone on the sidelines of his or | her life, barking out encouragement, reminders, | instructions, just like a coach does on the sidelines of a | game. | Fifth and last is medication. | Medication is helpful but is only one part of this five-part | treatment plan. If your doctor is only writing script, ask | him where you should go for complete treatment! [Moderator] CBN | Another parent in the next room asks if you would discuss | the apparent coincidence of ADD and giftedness. Dr. Hallowell | One of my favorite topics! | I think in the future ADD will lend a great deal of | knowledge in our understanding of creativity. I think in | some ways the ADD mind is a living model of the creative | mind. | Take impulsivity, for example. What is creativity but | impulsivity gone right? Or, Look at distractibility. | Distractibility is simply a negative version of incessant | curiosity. Most of the qualities of ADD that are so | pathologized in some accounts of this syndrome have a bright | side to them. Associated with creativity, intuition, | flexibility, high energy, and an amazing degree of tolerance | for new ideas. | People with ADD tend not to be judgmental, but rather | receptive. They are always on the vanguard of what is new. | They are willing to look ridiculous for a while in search of | a new solution. Stodgy and proper we are not. Lively and | creative we most certainly are. [Moderator] CBN | From the questions submitted in advance... | A member wants to know why, since we have tracked biological | markers for ADD, we don't have a "litmus" test for it. Do | you think there will ever be such a test? Dr. Hallowell | Just a sec, please. | Yes, I think there will be. We just don't have it yet. | For now, the history is really a very reliable way of | diagnosing ADD, by an experienced evaluator. Just because | you're on CompuServe doesn't mean "high tech" is the only | way to truth. [Moderator] CBN | But high tech does have its benefits | Personally, I think *you* gave us a litmus test in your | book. The "cough drop sign" Dr. Hallowell | LOL! [Moderator] CBN | (Look at page 96 in his book, people) | That was a marvelous story! Dr. Hallowell | Thank you! [Moderator] CBN | But I wont ask you to repeat it.. Dr. Hallowell | And it was true! [Moderator] CBN | just tease our audience to go read it | OK, next question.. | How do you deal with skeptical family members who think that | all your kid needs is "more discipline"? Dr. Hallowell | Send those people off to the home for sufferers of Attention | Surplus Disorder. | But seriously: this is a common problem. And again, try to | combat their skepticism with knowledge. *Most* people, in my | experience, when given enough of the facts, enough case | examples, iow enough knowledge, are willing to revise their | opinion, *as long as you have not backed them into a corner* | such that they maintain their position simply to save face. [Moderator] CBN | Speaking of saving face ... | reminds me of another question submitted in advance... | it is said ADD is virtually never seen in Japan. Does this | suggest anything to you about cultural influences as a | factor? Dr. Hallowell | Another interesting question. | As Carla knows (and the readers of my book know), I think | there *is* a phenomenon in this country that I call "pseudo | ADD". This is not true ADD, but it is a syndrome that | *looks* just like ADD, and is induced by our fast-paced | culture. | Also, I think there is a genetic reason why the incidence of | ADD is higher in this country than in European or Eastern | countries. I think the American gene pool is loaded for ADD. | If you think of who colonized this country, it was precisely | the sort of person who could not sit still, who had trouble | staying within the rules, who was willing to take a big risk | in the name of a principle - men like Benjamin Franklin | seem to be to be classic ADD type. Who else would stand out | in a lightning storm with a kite and a key??? - Visitor | I believe our moderator has gone offline... Dr. Hallowell | Thanks, Jerrold! | We're getting the next question now. | There is a question about antioxidants. Particularly | vitamins A, C, and E. I have anecdotally observed them to | help, but not to take the place of other medications, but | rather to supplement and augment their effect. Have not | heard specifically of "pycnogenol." | I'm sorry to say it, but I have to catch a 6am flight to New | York. I have really enjoyed speaking to you all. Please | spread the word about my book "Driven to Distraction," | and I look forward to doing this again! Stan Davis | Thank You Dr H. Scott Patterson | (Clap clap clap clap) [Greeter] Wendy | Dr. Hallowell, thank you so much for being here with us | tonight. Dr. Hallowell | My special thanks to Dave deBronkart, without whose | assistance this evening would never have happened. And to | Carla Nelson, who ran the session so ably. | And with that, I'll say good night - best wishes to all! JOEL S. RUTLEDGE| (clap,clap,clap) Mary Jane Johnson| (clap, clap, clap) Wendy/Sysop | We look forward to having you back whenever you'd like. [Sysop] deB | Elvis has left the building. [Greeter] Cj | Thank you, Dr. Hallowell!