Head in the Clouds

Handelman on Alternative Treatments for ADD

If you're wondering how much research has gone into alternative treatments for ADD/ADHD, check out this short video by psychiatrist Kenny Handelman (it's video number 3). In 12 minutes, he gives a nice overview of three treatments that have some basis in research: fish oil, dietary changes, and neurofeedback.

I thought video number 2 was interesting as well. Handelman goes over why doctors aren't always keen on alternative treatments, and he makes suggestions on how to evaluate alternatives. This video is 10 minutes long.

By the way, one of these days, I'll post about my own neurofeedback experience. I've had a post about that almost ready for, um, a few years ...

Parenting and Self-Parenting with ADD/ADHD

As usual, Ned Hallowell is the voice of reason, balance, and love in a beautiful blog post called "Their Beautiful Minds." It's about taking a strength-based approach with children who have ADD/ADHD or learning disabilities. The post touched me as a parent, and I highly recommend it.

But Hallowell's advice is not just for kids—or it doesn't have to be. We adults with ADD can apply his advice to ourselves as well. I'll do just that with a few passages from his post:

One of the great myths many parents buy into is that school performance predicts performance in adult life. It does not.

Hallowell is certainly right in my case. I was a high performer in school, all the way through two master’s degrees, but I’ve had trouble putting together major aspects of my life outside of school. Here’s my latest thought, though: Maybe our performance as young adults or even middle-aged or older adults with ADD—especially with undiagnosed ADD—doesn’t have to predict our performance in the future.

By far, the most dangerous learning disabilities, what truly holds people back in life, are not ADD or dyslexia. The dangerous disabilities are fear, shame, loss of hope, broken confidence, shattered dreams, and a feeling of being less-than.

Check, check, check ... OK, I've just diagnosed myself with all of those dangerous disabilities. I think that’s pretty typical for a person with long-undiagnosed ADD. But I've actually come a long way, thanks to therapy, support, and education.

Ironically, knowing about my ADD has been a good antidote to fear, shame, and the rest. It’s hard to deal with the dreadful feeling that you’ll never be able to get your life together in the most basic of ways like everyone else seems to be able to do, never mind following through on dreams. On the other hand, you can deal with ADD. You can look it up and read about it and get treatment and support for it and celebrate the positives of it.

The model I advocate is a model that identifies talents and strengths first and foremost, and only then looks at what is getting in the way of developing those talents and strengths.

Strengths first. Then look at what gets in the way. I think I've been doing this backward a lot of the time. Not too late to try it the other way!

Be sure you are working with a professional and a school who can help you develop the talent, not just address the problems and struggles. You need to do both simultaneously–develop talent and address shortcomings–but in an atmosphere that is free of shame and fear and full of hope and positive energy.

I've been thinking it would be helpful to me to work with an ADD coach. The above passage pretty much defines what I'd be looking for. It's good for people to identify their talents, even as grown-ups. And hope and positive energy are as healthy for us as they are for our kids.

Today we have more ways of unwrapping these kids' gifts than we have ever had before. From medications, to exercise-based treatments, to neurofeedback, to nutritional remedies, to specialized coaching and tutoring, to mindfulness training, we have a vast and potent armamentarium from which to draw.

I've been struggling some lately and have realized I need to make use of more resources, as opposed to beating myself up (which is not effective) or just trying harder (not effective either). Besides coaching, I'm thinking neurofeedback booster sessions and a stepped-up meditation practice.

The most potent treatment of all, bar none, is love.

We love our kids with ADD despite their foibles. It's important to love ourselves, too—our beautiful minds and our lives in all their imperfection. Consider it part of the treatment plan.

Again, I strongly recommend Hallowell's post, which expresses so much more than I've excerpted here. 

Meditation for Kids

Parents and teachers tell kids 100 times a day to pay attention. … But we never teach them how.

—Stanford researcher Philippe R. Goldin, quoted in the New York Times

Goldin has a good point. How do you pay attention? Can you teach someone how? Can you teach children how?

Some educators and researchers are trying to teach school kids how to pay better attention by teaching them meditation. My last blog post was about meditation and ADD. Research suggests that meditation can help with symptoms of ADD, at least in adults. But what about in children?

A little  bit of research plus some experience in schools suggests that meditation might help kids as well—on a wide variety of issues, as with adults, and perhaps directly with attentional issues. A 2007 New York Times article and a 2009 SharpBrains post are good places to start reading about this.

Much of the research on meditation is on a type called mindfulness meditation. Mindfulness might help both with primary ADD symptoms and with the type of fallout that can go along with ADD. According to the New York Times article,

Dr. [Amy] Saltzman, co-director of [a] mindfulness study at Stanford, said the initial findings showed increased control of attention and “less negative internal chatter—what one girl described as ‘the gossip inside my head: I’m stupid, I’m fat or I’m going to fail math.’”

Chances are you've heard of Transcendental Meditation as well. A piece in Medical News Today covers a small study suggesting that that type of meditation might also be helpful to children with ADD.

Further research on kids and meditation looks like it'll be worth paying attention to!

The website of the Association for Mindfulness in Education looks like a good place learn more about the topic and watch for research updates.

Stanford researcher Amy Saltzman’s website offers a few guided mindfulness videos for kids, including one on finding the “still, quiet place,” one with simple movements, and one on the “flashlight of attention.” (I love the metaphor!)

Paying Attention to Paying Attention

There’s something hard for me about making the switch from a lively, even cluttered, brain to a quiet brain. Some fear of emptiness or boredom. It’s one reason I’ve gone years at a time without meditating, even though I thought it would be helpful to me. And even though I knew from experience that I enjoy what it feels like to meditate—once I actually get started.

Over the years, as I didn’t meditate, I kept reading about the benefits of meditation. Research suggests it might help prevent heart disease, reduce anxiety, ease arthritis pain, and even diminish perimenopause symptoms—all pertinent for me. I listened to people, too, and heard all about how meditation helped them be more patient, more understanding, more peaceful. 

Then I read about a study out of UCLA. It’s small, but it suggests that meditation might help with the core issues of ADD itself. A type of meditation called mindfulness meditation “improves your ability to control your attention,” says psychiatrist Lidia Zylowska in an interview with ADDitude magazine. “In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so they won’t react impulsively.”

I also read a summary of the UCLA study on the blog SharpBrains, which I highly recommend. “Mindfulness meditation,” writes psychologist David Rabiner, “can be thought of as a type of attention/cognitive exercise program that is focused on improving self-regulation.”

All this made sense to me. “Now,” I was thinking, “I really have to start meditating.” But how do you meditate if you have ADD? If you have trouble sitting still or reining in your thoughts or fitting in a shower once in a while?

Finally, though, I am meditating regularly. It’s not some pure, perfect, time-consuming practice. But it’s a practice. Here’s what’s helped:

• I’ve set my goal really small: meditate at least three minutes a day most days. I usually end up doing more. In fact, the more I practice, the longer I can meditate. (I hear that's why they call it a meditation practice.)
• I track meditation along with the other exercises I do—from hiking to thumb bends—filling in one square in a table with green and the number of minutes every time I meditate.
• I’ve been using online guided meditations to create structure for myself. When a voice guides me, I’m able to stay focused in a way that’s hard for me on my own.

I’ve set up a page on this blog with links to short online guided meditations, a bunch of them, all free. If you’re challenged when it comes to quieting mind or body but want to meditate, check them out. Bookmark the page if you find it helpful. I’ve also put a link to the page on the right-hand sidebar of this blog.

One more thing I’ve realized—I tend to get tired of the same old same old, and guided meditations are no exception. I’ll keep adding to the list, and please feel free to share your own finds by commenting at the bottom of the list. Thanks!

What helps you meditate? Feel free to comment below.

My next post will be about teaching meditation to children.

For more on the UCLA research, visit UCLA’s Mindful Awareness Research Center.

One more study: Researchers at the University of Pennsylvania examined “how meditation may modify the three subcomponents of attention, including the ability to prioritize and manage tasks and goals, the ability to voluntarily focus on specific information and the ability to stay alert to the environment,” according to a summary of the study in Science Daily. “Researchers found that even for those new to the practice, meditation enhanced performance and the ability to focus attention. Performance-based measures of cognitive function demonstrated improvements in a matter of weeks.” 

It's Complicated Redux

What are the potential consequences of taking ADD medications over the long run, from childhood into adulthood? Might taking meds facilitate the normal development of the cerebral cortex in children with ADD? But might those same meds also make people more susceptible to depression, anxiety, and cognitive deficits? Psychiatrist Edmund S. Higgins explores the research in a July 2009 article in Scientific American Mind.

On the one hand, says Higgins,

the pills can improve attention, concentration and productivity and also suppress impulsive behavior, producing significant improvements in some people's lives. Severe inattention and impulsivity put individuals at risk for substance abuse, unemployment, crime and car accidents. Thus, appropriate medication might keep a person out of prison, away from addictive drugs or in a job.

On the other hand, says Higgins, the benefits of the meds—from staying out of prison to being able to focus on schoolwork—could come at a cost: 

With the expanded and extended use of stimulants comes mounting concern that the drugs might take a toll on the brain over the long run. Indeed, a smattering of recent studies, most of them involving animals, hint that stimulants could alter the structure and function of the brain in ways that may depress mood, boost anxiety and, contrary to their short-term effects, lead to cognitive deficits.

Don't let the opening anecdote of the article stop you; I'm not sure it really illustrates what Higgins is talking about. I started wondering, Don’t tests like the ones he may have performed yield a fair number of false negatives? And did Higgins listen—really listen—to the boy and his mother about the boy’s difficulties? (Of course, he may well have.)

I also wondered if using the term “relaxation of official criteria” dismisses the possibility that diagnostic criteria could evolve over time to be more helpful. Such “relaxation” might reflect an increased understanding of real differences in how ADD presents—for example, in girls, women, and adults.

Higgins also refers to a “lower tolerance in society for mild behavioral or cognitive problems.” But what about when you thwart and frustrate yourself, never mind what society thinks? When some of your ADD traits keep you from achieving your own goals? I’m not arguing that meds are the answer, just that it’s important not to minimize people’s individual struggles, even if those people aren’t causing big problems for society.

Despite my quibbles about some of Higgins’s wording, his article is a great overview of the possible risks and benefits of long-term medication for ADD, with summaries of interesting studies. It’s well worth the read.

For more on the complexity of medication for ADD, see a previous post, "It’s Complicated.”

Back to Basics

"Some time ago," a friend e-mailed me, "I read an article on ADD, but I can't find it." How appropriate!

"However," she continued, "I took some notes." Those notes were so succinct and at the same time so all-encompassing that I got her permission to reprint them here. In her words:

[The article] said ADD people need

1. Structure.
2. Meditation.
3. Aerobic exercise.
4. Diet—less carbos.
5. Follow your heart—need passion and interest.
6. Neurotransmitter activity—need stimulation.
7. Recognize there is struggle to shift gears.

That about sums it up! Seven good reminders for us all ...

It's Complicated

As always, the medication issue is way more complicated than a lot of people think. And this Washington Post article—"Debate over Drugs for ADHD Reignites"—illustrates that. Do ADD meds offer long-term benefits for children? Even the researchers collaborating on a major study are squabbling about it. There's a lot to learn from their debate as laid out in the article.

Psychologist John M. Grohol brings up an interesting point in a related blog post at PsychCentral: Maybe medication decisions shouldn't be so much about whether to use meds, but also about how to sequence different treatments—possibly including meds—in the best way.

And Grohol links to a post on health-care finance expert Maggie Mahar's blog about the big picture of research, money, politics, and ADD meds, with an interesting look at the issue from an international standpoint. It's a balanced and informed piece.

I've added another post on the complexity of medication, "It's Complicated Redux."

Circadian Rhythm and ADD

What does your internal clock have to do with ADD? Check out this interesting piece in Science Daily.