“First, there will never be a single solution for all children with learning and behavior problems. While some smaller number may benefit from short-term drug treatment, large-scale, long-term treatment for millions of children is not the answer.”

Who said there would be a single solution? No enlightened clinician offers medication as the single solution. We offer it as one tool that can help, but always as part of a comprehensive treatment plan which also includes other key elements like education of parent, child, and teacher; lifestyle modification, including sleep, diet, exercise, meditation and positive human interactions; coaching on how to better organize life; and ongoing follow up to monitor progress and offer encouragement and various specific tips on managing life with ADHD.
And what Dr. Sroufe cites as “some smaller number” is about 80% of individuals with ADHD who try medication. When these medications work, they do not solve the problem, any more than eyeglasses solve the problem of myopia. But they sure do help!

“Second, the large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them.”

It is a statement cited so endlessly as to become an accepted truth that we live in a society that believes all of life’s problems can be solved with a pill. But have you ever met anyone who actually does believe that? I haven’t. Furthermore, 19 out of 20 people who come to me for help for themselves or their child adamantly oppose the use of medication. Only when they fully understand the medical facts do many of them change their minds. Far being predisposed to the use of medication, the people who come to see me are predisposed in precisely the opposite direction.

Furthermore, no enlightened clinician prescribes the medication and leaves it at that, allowing the parent and child to imagine they have “something inherently defective in them.” I go to great lengths not only to present the medical facts but also to create a framework of understanding that describes ADHD in strength-based terms.  I tell the child that he is lucky in that he has a race car for a brain, a Ferrari engine. I tell him he has the potential to grow into a champion. I tell him (assuming it is a he, but he could just as easily be a she) that with effort he can achieve greatness in his life, and then I tell him about the billionaires, CEO’s, Pulitzer Prize winners and professional athletes with ADHD I’ve treated over the years. But I also tell him he does face one major problem. While he has a race car for a brain, he has bicycle brakes. I tell him I am a brake specialist, and one of the many tools I can use to strengthen his brakes is medication. I remind him he will have to do much more than take the medication to strengthen his brakes, but, if we’re lucky, the medication will help him in that effort.

The child and parents leave my office full of hope. Far from feeling defective, the child feels like a champion in the making. Which he most certainly can be!

“Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone — politicians, scientists, teachers and parents — off the hook. Everyone except the children, that is.”

Once again, Dr. Sroufe assumes the clinician, parent, and society at large all buy the notion that “children’s behavior problems can be cured with drugs,” and that such a belief gets us “off the hook,” as if we politicians, scientists, teachers, parents, and heaven knows who all else were so sweetly deluded and so uncaring that we welcome any excuse to get us out of doing the deep probing into the “complex solutions” one is left to presume only Dr. Sroufe and his exemplary colleagues can or will attempt.

No clinician worth his or her salt believes that all problems can be cured with drugs. But neither does a responsible clinician deny the good that medications can do. When people ask me, “Do you believe in Ritalin?” I reply that Ritalin is not a religious principle. Ritalin, like all medications, can be useful when used properly and dangerous when used improperly. Why is it so difficult for so many people to hold to that middle ground?

And yet difficult it is. Ritalin continues to be a political football, a hot-button issue almost on a par with abortion or capital punishment. One is pushed to be for it or against it, while the right and good position is to be for whatever will help a child lead a better life, as long as it is safe and it is legal.

Used properly, Ritalin is safe, safer than aspirin. And it is legal, albeit highly regulated. As to its long-term use, apply common sense. Use it as long as it is helpful and causes no side effects. That may be for a day, or it may be for many years.
Of course we need to address the complex issues that contribute to behavioral, emotional, and learning problems in children. I’ve written extensively about what I call “pseudo-ADHD,” children who look as if they had ADHD but in fact have an environmentally-induced syndrome caused by too much time spent on electronic connections and not enough time spent on human connections, i.e., family dinner, bedtime stories, walks in the park, playing outdoors with friends or relatives, time with pets, buddies, extended family, and other forms of non-electronic connection. Pseudo-ADHD is a real problem; the last thing a child with pseudo-ADHD needs is Ritalin.

But that is not to say that no child needs Ritalin, nor that those who prescribe it are dimwits hoodwinked by drug companies to medicate children who do not need it. Sure, some doctors over-medicate, while other doctors never medicate because they “don’t believe in ADHD” and “don’t believe in Ritalin.”

Above all, children need a loving, safe, and richly connected childhood. The long-term study that Dr. Sroufe cited in his opinion piece does indeed show that over time, medication becomes a less important force in a child’s improvement and that human connections become ever more powerful. It is good and heartening to know that human connection–i.e., love–works wonders over time. Love is our most powerful and under-prescribed “medication.” It’s free and infinite in supply, and doctors most definitely ought to prescribe it more!

But that is not to say, as Dr. Sroufe does, that Ritalin has “gone wrong.” We may go wrong in how we use it, when we over-prescribe it, or when we use it as a substitute for love, guidance, and the human connection.

But as long as we use it properly, it remains one of our most valuable–and tested–medications. Going all the way back to the first use of stimulants to treat what we now call ADHD in 1937, stimulants have served us well as one tool–not the tool–for helping children and adults learn how to strengthen the brakes of their race car brains and become the champions they can be.

To help people start the process of learning about ADHD and its potential affects on them, Dr. Hallowell created the  Dr. Hallowell’s ADHD Self-Assessment Quiz. The iPhone app is available on iTunes and the Smartphone version is now available in the Goggle App Store.

 Visit our apps page for more information.   

If your “significant other” has ADHD and/or  you’re more distant from your spouse than you’d like to be, Dr. Hallowell recommends the following books:

Married to Distraction: Restoring Intimacy and Strengthening Your Marriage in an Age of Interruption by Edward Hallowell, MD and Sue George Hallowell, LICSW, with Melissa Orlov.

The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in 6 Steps by Melissa Orlov.

Do you think you or someone close to you may suffer from ADHD? If so,  check out Dr. Hallowell’s ADHD Self-Assessment Quiz app available for iPhone and Android.

iLs is a multi-sensory program used in Hallowell Centers, clinics, schools and homes for children and adults with ADHD and sensory processing difficulties.  For more information go to: http://www.integratedlistening.com/

BOOK FORUM:  Deepak Prabhakar, M.D., M.P.H.

Superparenting for ADD: An Innovative Approach to Raising Your Distracted Child.  By Edward M. Hallowell and Peter S. Jensen. New York, NY: Ballantine Books, 2008. 212 pp, $25.00 (hardcover).

Diagnosing attention-deficit/hyperactivity disorder (ADHD) is traditionally rooted in identifying deficits. In an effort to diagnose patients accurately in a time-efficient manner, providers are often dissuaded from identifying strengths and positives that children with ADHD possess. The strength-based approach of this book is like a breath of fresh air in a process of diagnosis and management that primarily relies on exposing weaknesses.

Renowned experts in the field, Edward Hallowell and Peter Jensen have synthesized their combined wisdom into a succinct format. At times it seems that the authors are responding to a worried parent’s questions about effective management of a child with ADHD. Their consultation is as intriguing as it is practical and informative. The authors make a conscious effort to keep the text reader-friendly, particularly for parents of these children. For instance, they use the term attention-deficit disorder (ADD) in place of ADHD due to its wider recognition with the general public.

The authors set the enduring positive tone of this book in the Introduction. The discussion on unconditional love and its attributes is a welcome change. Readers are reminded that love helps us accept children for what they are rather than what we want them to be. So often in dealing with children who have ADD, this message is overlooked.

For years, the focus of treatment in ADD has been correcting the deficits. This approach can be frustrating right from the start. The authors urge readers to go a step beyond and look at ADD with a positive mindset. The diagnosis of ADD is accompanied by negative terms such as inattention, hyperactivity, and impulsivity. However, children with ADD have certain strengths that are often overlooked: creativity, tenacity, energy, curiosity, and imagination. Referring to these strengths has the potential to kindle hope rather than pessimism at the time of diagnosis. The authors offer various positive attributes that go hand-in-hand with associated deficits, for example, curious with distractible, creative with impulsive, and eager with intrusive. Concentrating on deficits while ignoring strengths can potentially contribute to the stigma associated with ADD. Hallowell and Jensen’s approach can help us turn the tide against stigma associated with ADD, because parents and children will be more willing to discuss ADD if the discussion focuses on positives rather than negatives.

The authors offer a practical plan to discover the strengths and hidden talents of children with ADD. While discussing the “cycle of excellence” (p. ), the authors rely on the unifying theme of love. They underscore the importance of love in making the child feel connected to himself and to his environment. Once the child feels connected and loved, he is more able to participate in and master those activities that enlighten the imaginative process in a developing brain. The authors encourage readers to recognize any amount of progress rather than wait for the child to win major awards in a competitive field. This can go a long way toward boosting self-confidence in children who are accustomed to rejection by their peers, schools, and families. The discussion around conative strengths is enlightening and the conative model, if implemented in a tactful manner, can go a long way toward increasing productivity while enhancing the self-esteem of children with ADD. The authors offer several helpful pearls of wisdom for effective management of children with ADD in a school setting.

They discuss several successful school models being implemented across the United States. The readers will find this section helpful and informative, because few parents know how to interact with schools to obtain appropriate services for their children.
Empathy, an ingredient to any successful parent–child relationship, is discussed in a sensitive way. The authors take us through the life experiences of a fictional individual with ADD. This captivating narrative is based on experiences the authors have had with children they have treated. After reading this interesting piece, readers will feel a heightened appreciation for the challenges that these children face in their daily lives. Parents may ultimately feel empowered by their new understanding of their child’s feelings.
This book does not include detailed sections on diagnostic techniques, comprehensive reviews of medications, therapies and alternative treatments, genetics, or classroom management of ADD. The authors reference their previous work and suggest numerous resources on these related topics wherever necessary. However, this book does a great job in discussing the most important intervention of all, love. Just when you thought that you have read every possible book on ADD, you will be surprised that a text on “love” and “strengths” can be so refreshing and effective.

Use of the term superparenting in the title seems appropriate. In our contemporary hectic Western lifestyle, with negligible social supports for families, an extraordinary effort is a prerequisite for rearing any child, with or without ADD. This book leads its readers on an exciting expedition of discovery by offering a strength-based model that will help parents and other caregivers uncover several of these children’s previously unrecognized talents.

Superparenting for ADD is an informative and fascinating text. This book makes an honest attempt to educate its readers about virtues of children with ADD. This approach has the potential to change the way parents, peers, and society in general interacts with these children. I strongly recommend this book to parents, teachers, and providers who are involved in taking care of children with ADD. Ultimately, I hope Hallowell and Jensen have found an effective tool to address the stigma associated with ADD.

Deepak Prabhakar, M.D., M.P.H.
Wayne State University, Detroit, MI

Disclosure: Dr. Prager reports no biomedical financial interests or potential conflicts of interest. Dr. Storrs reports no biomedical financial interests or potential conflicts of interest. Dr. Miller reports no biomedical financial interests or potential conflicts of interest. Dr. Prabhakar reports no biomedical financial interests or potential conflicts of interest.

I am always looking for new, non-medication treatments for both ADHD and reading problems, and I believe this is one of the best.  It is actually not new, in that it has been in use clinically for 30 years.  However, some of the science behind it is new.  It is based upon the principle of stimulating the cerebellum, a region at the back of the brain that has connections to the front parts of the brain, which is where the symptoms involved in ADHD and reading problems originate.

By stimulating the cerebellum through physical exercises, like standing on a balance board, juggling, standing on one leg with your eyes closed, and a variety of others, you can actually bring about improvement in concentration and reading fluency, by taking advantage of the connections from the cerebellum to the front parts of the brain.  

The beauty of the Learning Breakthrough Program is that it makes this therapy affordable, convenient, and actually fun.  You order the kit and do the exercises at home.  You can demonstrate for yourself that it is working by doing the before and after comparisons the kit shows you how to do.  So, you get immediate positive reinforcement, which is a powerful motivator to keep you, or your child, doing the exercises.

One of my sons and my wife benefitted enormously from cerebellar stimulation exercises, my son with a reading problem, and my wife with a coordination problem (yes, these exercises also improve coordination and athleticism!).

LBP can–and should–be used as part of a comprehensive treatment program that also includes education, coaching, tutoring, perhaps medication, and perhaps additional complementary treatments.

I am so enthusiastic about LBP that I have leant my name to endorse the product.  I have become a consultant to the company, and while they do pay me for my time, I would never endorse a product I did not totally believe in.  While we do need more research to prove the efficacy of LBP, I have seen enough anecdotally for me to be a big-time fan of this effective, convenient, and affordable treatment.

 I think LBP is one of the most exciting innovations in the treatment of ADHD and reading problems since the advent of stimulant medication in 1937.  And it carries the possibility of going one better than medications, in that it addresses underlying causes.

The only drawback to LBP is that not enough people know about it.  I hope to help in the effort to change that soon!

To learn more, go to the LBP web site, learningbreakthrough.com

There is no one key.  Watch out for simplistic solutions and the people who offer them.  There is no one best remedy, there is no one best system, there is no one best medication or nutritional supplement.  And what works for one person will not necessarily work for you or your child.

However, having treated ADD in children and adults for over 25 years now, and having ADD as well as dyslexia myself, I can say with absolute certainty that while there is no one key, we do have a marvelous assortment of keys that open many of the doors untreated ADD can seem to close.  The doors to success, personal fulfillment, joy, health, and lifelong satisfaction.

“The key” is to find the various keys that work for you. The best way to do this is to work with a doctor who knows that vast array of available keys.  Sadly, such doctors can be hard to find.  If that’s the case for you, start with my books.  Start with Delivered from Distraction and SuperParenting for ADD.  Those books will show you many keys that might work for you or your child.  As you read, you will start to smile and fill up with knowledge and knowledge’s sibling, hope.

I can tell you for sure that there is always a realistic chance for major improvement.  So don’t settle for mediocre results.  People with ADD are champions in the making.  I want you to know this just as surely as I know it.  You, or your child, are champions in the making.  Let me help you get there, either through my books, or through a personal conversation.  I have started offering telephone appointments for people who can’t come to see me in person.  If you are interested in booking such an appointment, just contact my assistant, Dianne, at hallowellevents@drhallowell.com

The great mistake people make as they work with their ADD or their child’s is settling for less than the best outcome.  Please don’t make that mistake yourself.