Thrive On the Autism Spectrum

Adult ADHD Group in Albany, California

The Center of Attention and Learning, in Albany, California, offers ADHD coaching, Executive Function support, and Educational Therapy. The Center, founded last year by Educational Therapist Linda Lawton, is now offering their first working group for adults with ADHD. The group will meet three times per month, and each month will focus on a different issue, starting with procrastination.

Group coaching is an excellent way to get both professional and peer support, and it is more cost effective than individual treatment. If you’re interested in more information, visit the Center’s website, or their Working Group information page.

And, for Middle School and High School Students, check out the Center’s Supervised Study Hall. Author's note: 2/13/12, the Supervised Study Hall is no longer offered, but I will be posting about a new program soon. 

Conference for Learning Differences

Ed Rev 2011 will be held on Saturday, April 16, 2011 at AT&T Park. Ed Rev 2011 is "a day of inspiration and resources for students with learning and attention difficulties, and their parents and educators." The day includes speakers, activities, and an art contest. Whether or not you can attend, it's worthwhile to check out the excellent list of exhibitors and resources. Check out the brochure.

Book Review: Buzz, A Year of Paying Attention

“Well written, compassionate, interesting” are all words I’d use to describe Buzz, A Year of Paying Attention, A Memoir by Katherine Ellison. But even though I enjoyed it, I struggled with the concept of the book and came away feeling vaguely unsettled.  Ellison describes her plan to devote a year in which she’d “put other work aside, making it my full-time job to seek the best path for a distracted parent intent on helping her distracted child.” I always appreciate well written books that combine information with a chance to really get to know the author’s experiences. Ellison, a Pulitzer Prize-winning journalist, has the ability and the connections to do just that. She meets experts such a Dr Russell Barkley, and authors like Dr Daniel Amen, and Blake Taylor. She quotes from Dr Ross Greene, Dr John Ratey and Dr. Edward Hallowell. (Greene and Hallowell even write blurbs for the for the book cover.)

It’s not surprising that an author who describes herself as having ADHD would take a creative and enthusiastic approach to exploring the different ways to manage ADHD. But it was also not surprising that this style resulted in a somewhat scattered attempt to solve a very challenging issue.  I kept wanting more depth and focus, and I kept hoping the author would stick with something long enough to really give it a chance. I kept looking for more scientific inquiry and less anecdotal evidence.

So often I hear from parents that they’re looking for a clear cut diagnosis, with a solid recommendation on what to do to help their child. Unfortunately, it’s just not that straightforward. Although a one size fits all diagnosis and treatment plan might be comforting, it’s never going to work as well as something tailored specifically. There is no one path, or one best treatment, and dabbling in different solutions over the course of a year is not going to result in the best outcome.

As for Buzz, I’d still recommend it, but I’d suggest thinking of the book as a chance to understand someone else’s experiences with a challenging child, not as a way to learn how to help your own child.

ADHD and Pesticides

Do pesticides cause ADHD? Should parents feed their kids only organic products? Should adults with ADHD eat only pesticide free foods? These questions are being asked frequently right now due to a recent study published in the June, 2010 issue of Pediatrics, showing a possible link between organophosphate pesticide use and increasing rates of ADHD. Of course, no one study can prove anything, and people need to use caution in making decisions regarding their own and their children’s health, but anyone concerned about ADHD should learn about this study.

If you’re looking for information, Medscape  published a good review. Regarding the study, Michael L. Goldstein, MD stated, “(The report) …. certainly got my attention when I read it; I was really impressed by it. I think it is a groundbreaking study.” Dr. Goldstein is a specialist in child neurology with Western Neurological Associates in Salt Lake City, Utah, and a faculty member of the American Academy of Neurology. Dr. Goldstein said the data on organophosphate pesticides and ADHD "look like the data we saw 30 to 40 years ago with lead exposure, and it may turn out to be the same thing — that even small exposures (to organophosphate pesticides) are very harmful to kids."

Dr. Andrew Weil, the founder and director of the Arizona Center for Integrative Medicine at the University of Arizona Health Sciences Center, also comments on this study in his article Pesticides and ADHD, saying that he’s not surprised by these results. 

Online Screening for Adult ADHD, Asperger’s, or Autism

Frequently, I get calls from adults thinking that they have ADD, ADHD, attention deficit, autism, Asperger’s, or some combination of these symptoms. Usually, they’ve never been formally diagnosed with anything, but they’ve researched online and they’re pretty sure about the pattern that fits them. So the question is: How good are online screening tools?

To start, how does a professional diagnose autism, Asperger’s, ADHD in adults? There is no easy blood test or brain scan to make these diagnoses. Generally, a professional will look at the patient’s history, especially problems and symptoms, administer some screening tests, and then use their clinical judgment to come up with a diagnosis. Unfortunately, the most frequently used screening measures are designed for children, so working with adults requires some adaptation. Clearly, testing is a bit more involved than just the online screening tests individuals take.

What about confidentiality? Many individuals are concerned about a diagnosis going on their record, getting back to their employer, or some other worry. This shouldn’t keep you from working with a professional. Before you see any professional, ask about confidentiality. Specifically, discuss how you’ll be paying for treatment, and what kind of confidentiality insurance plans or employee assistance programs offer.

What about online screening tests? For some people a doctor’s appointment may be too expensive, or intimidating, or complicated. Other people want to be informed before they talk to a professional, so online screening is a place to start. Taking an online screening test is not a bad starting point in understanding yourself, although it doesn’t substitute for professional help.

When looking for a screening tool, it’s probably best to go to larger organizations rather than individual’s websites. Often, the best known and most popular measures are not available online, and professionals have to purchase them, so although they may be well written and well researched, you’re not going to find them online. Also, I don’t like measures that merely repeat back a symptom list from the DSM. The DSM is written for professionals, and the symptoms may be tough to interpret without training and experience dealing with a large group of individuals having those symptoms. You can also find excellent self report measures in books. Again, look for the credentials of the author writing the book, or a forward by a well known professional.

A good general rule: books and websites written by individuals diagnosed with an issue can be interesting and informative, but they’re not the best way to diagnose yourself. Books written by actors, politicians or playboy bunnies may be enthusiastic, but they are not the best sources of science. Get professional information from professionals.

Some examples? For depression and anxiety, David Burns has written excellent books with self assessments in them. For ADHD, you can find self measures on both the CHADD and ADDA websites. For Autism and Asperger’s, check out Simon Baron-Cohen’s book or website. For alcoholism questions, The National Institute on Alcohol Abuse and Alcoholism has a clinician guide with questions.

The Alert Program

The Alert Program for self regulation is a wonderful tool for kids (and adults) who struggle with managing their own level of attention. Throughout the day, kids are expected to adjust to the school schedule. They have to jump into the morning bright and attentive, while still sitting quietly and listening to the teacher, then move into socializing at recess, then sit right back down, up and down, all day long. And the demands don’t end with the school day. Kids today have homework, classes, practices and activities. The pace alone can make it hard for any kid to manage, and it’s especially difficult for those kids with ADHD. (A lot of kids on the autism spectrum fall into this category as well, even if they don’t have an official ADHD diagnosis.

The Alert Program was developed by Mary Sue Williams, OTR/L and Sherry Shellenberger, OTR/L to bring together ideas from sensory integration and present them in a way that’s concrete and easy for children to utilize. It was developed for kids, but has been adapted for teens and adults, and I find it useful for almost any age client.

You can learn more about the Alert program from their website, or the book “How Does Your Engine Run?” : A Leader’s Guide to the Alert Program for Self-Regulation.

Book Review: Running on Ritalin, by Lawrence H. Diller, M. D.

Running on Ritalin is not just a book about ADHD or medications for children. Instead, it takes  a broader look at the issues involved in diagnosing, treating, and prescribing for our children. Although the book focuses on Ritalin and ADHD, much of the material is also applicable to other situations, such as those children with other diagnoses, such as autism, and those taking different medications.  Since Running on Ritalin (Bantam Books, New York) was published in 1998, it may be a bit dated as far as medicines and statistics, but the advice for parents and the general themes more than make up for this.

Dr. Diller is unusual in that he was not only trained as a Pediatrician, but also as a Family Therapist at the Mental Research Institute in Palo Alto, CA. Because of this unusual background, Dr. Diller is able to discuss treating his clients with both family therapy and medication. In his book, he takes a moderate, middle of the road stance, defining ADHD as stemming from both brain chemistry and environmental factors, such as school and parenting demands. The author looks into many of the factors involved, such as the impact of modern society and educational expectations, the strain on school resources from having so many children needing special services, the demands on parents, and the ethics of medicating children.

That moderate, balanced view, backed up by published research, is really the strength of this book. As far as treatment, Diller recommends a multimodal treatment, which may include medication, individual and family counseling, and special educations services, as appropriate. He backs this recommendation up with both published studies, (Unfortunately there are not a lot of those out there.) and anecdotes from his own patient experiences. As a therapist myself, I know that my clients may need a variety of different approaches in order to function at their best level. As a scientist, I always appreciate when authors back up their statements with data and published studies.

Dr. Diller is also balanced in his viewpoint of the diagnosis. “... I feel a bond with those who want society to appreciate and adapt to the range of diversity in children’s personalities. On the other hand, I recognize that the ADD child must learn to cope with socially approved expectations and responses, and that this may sometimes require the use of medication. It seems to me critical to raise questions about a society where several million children are taking Ritalin. In everyday terms, however, children and families must adapt to social norms, while we work on broader levels to make room for all kinds of people with all kinds of strengths and weaknesses.” (p. 217)

There’s also an interesting chapter on special accommodations for those with disabilities, both in school and the workplace. This has always been a tough issue, and it only grows more so as our school budgets get stretched tighter in this economy.

In general, this book probably raises as many questions as it gives answers, but they’re important questions, questions we all need to be asking.