COMMANDING ATTENTION: A PARENT AND PATIENT GUIDE TO MORE ADHD TREATMENT

322 Pages·2013·2.09 MB·English

by  Tess Messer

COMMANDING ATTENTION

A PARENT AND PATIENT GUIDE TO MORE ADHD TREATMENT

BY

TESS MESSER, MPH
Copyright 2012 Tess Messer
Table of Contents
COPYRIGHT, LEGAL NOTICE, AND DISCLAIMER INFORMATION
DEDICATION
PREFACE
INTRODUCTION
SECTION 1: ADHD TODAY
THE LIMITATIONS OF RESEARCH
IT BEGINS WITH AN ADHD DIAGNOSIS
ADHD SYMPTOMS
THE CAUSE OF ADHD
THE ADHD MEDICAL EVALUATION
DIAGNOSTIC STUDIES FOR ADHD
ADHD TYPES
ADHD DRUG TREATMENT
PRESCRIPTION DRUG TREATMENT
THE STIMULANTS
ATOMOXETINE (STRATTERA)
GUANFACINE
THE ANTIDEPRESSANTS
ADHD MEDICATION COMBINATIONS
SECTION II: THE LIFESTYLE INTERVENTIONS
EXERCISE
DIET
SLEEP
STRESS CONTROL
MEDITATION AND MINDFULNESS
SECTION III: TOOLS OF THE MIND AND BRAIN
PART 1: THE BEHAVIORAL THERAPIES
PARENT-TRAINING PROGRAMS
ADHD BEHAVIORAL COACHING
CLASSROOM BEHAVIOR MANAGEMENT
SOCIAL SKILLS TRAINING
COGNITIVE-BEHAVIORAL THERAPY
PART 2A: THE NEUROLOGICAL THERAPIES
EXECUTIVE FUNCTION TRAINING PROGRAMS
WORKING MEMORY TRAINING
NEUROFEEDBACK
PART 2B: TRAINING THE SENSES
CENTRAL AUDITORY PROCESSING TRAINING
CEREBELLAR TRAINING
VISUAL PROCESSING TRAINING
SECTION IV-VITAMINS, NUTRIENTS, AND DEFICIENCIES
PART 1: BUILDING BLOCK AND ANTIOXIDANT VITAMINS
PART 2: SUPPLEMENTING NUTRITIONAL DEFICIENCIES
OMEGA-3 FATTY ACIDS
IRON
ZINC
ACETYL LCARNITINE (ALC, LCARNITINE)
MAGNESIUM
SECTION V: THE HERBAL TREATMENTS
CAFFEINE
PYCNOGENOL
BACOPA MONNIERI
SIBERIAN GINGSENG—RHODIOLA
SUPPLEMENTS FOR CONDITIONS THAT COEXIST WITH ADHD
MELATONIN
ST JOHN’S WORT
SECTION VI: EMERGING THERAPIES
INDIVIDUALIZED DIAGNOSIS AND TREATMENT
NEW MEDICATIONS
BRAIN STIMULATION
NEW DIAGNOSTIC TOOLS
SO WHAT DO I DO NOW?
TREATMENT EFFECT SIZE AND DECISION TREES
AFTERWARD
ABOUT THE AUTHOR
ENDNOTES
COPYRIGHT, LEGAL NOTICE, AND DISCLAIMER
INFORMATION
The right of Tess Messer to be identified as author of this Work has been
asserted by her in accordance with sections 77 and 78 of the Copyright, Designs
and Patents Act 1988. All rights reserved. No part of this publication may be
reproduced, stored in retrieval system, copied in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise transmitted
without written permission from the publisher. You must not circulate this book
in any format.
This book is based on personal experience and anecdotal evidence and is for
your personal enjoyment only. Although the author and publisher have made
every reasonable attempt to achieve complete accuracy of the content in this
guide, they assume no responsibility for errors. You should use the information
in this book only under the guidance of your own health care provider and at
your own risk. Your particular situation may not be exactly suited to the
examples illustrated here; in fact, it is likely they will not be the same. You
should adjust your use of the information and recommendations accordingly.
Any trademarks, service marks, product names, or named features are the
property of their respective owners, and are to be used for reference only. The
author has no formal endorsement arrangement with any of these products or
services. The author does allow the Google Adsense program to place
advertisements on her blog. Google decides what ads will be placed. The author
has no endorsement arrangement with any of the companies chosen by Google.
This eBook may not be resold or given away to other people. If you would like
to share this book with another person, please purchase an additional copy for
each recipient. If you’re reading this book and did not purchase it, or it was not
purchased for your use only, then you are reading a pirated copy; please return
the book and purchase your own copy. Thank you for respecting the hard work
of this author.
Finally, use your common sense. Nothing in this guide is intended to negate your
need to obtain legal, medical, or other professional advice. This guide is
intended to inform and entertain the reader; it is not to be used for any other
purpose. It is the author’s hope that you enjoy this material and find it useful.
DEDICATION
For my children, who teach me something new every single day. For Pascale,
who makes every part of my life easier. For my siblings and Terry, who have
always said that I should write a book and most importantly, for my mother, who
believed in my talents long before there was any obvious indication that I had
any.
PREFACE
In 2009, I started writing a blog about the inattentive subtype of Attention-
Deficit/Hyperactivity Disorder (ADHD-PI). My elder son had just been
diagnosed with ADHD-PI, and though I had been a primary care physician
assistant for over ten years, I had never heard of this medical problem. I, like
most people, thought ADHD was a disorder of children who could not sit still.
I went to the medical library and began to read everything that I could find about
inattentive ADHD. It did not take much reading to come to the conclusion that I
too had ADHD-PI and that this was the reason that I had done so poorly in
school.
I was evaluated by physicians, and even specialists, as a child. My IQ was
normal, but my grades were barely passing. I was never placed on medication
and continued to academically struggle until I was in my twenties. It was then
that I started drinking a couple of shots of good Cuban coffee every morning and
found that my motivation, focus, and ability to learn improved.
By the time my second son was in second grade, he too had been diagnosed with
ADHD. He was hyperactive, impulsive, loud, and combative. He was diagnosed
by our pediatrician as having combined-type ADHD. Both my sons were started
on stimulant medication, and while my younger son has done well on the
medicine, my elder became depressed and withdrawn and his teachers suggested
that we look into other treatments. So began my exploration into other therapies
for ADHD.
Both my sons have some of the co-conditions that often accompany a diagnosis
of ADHD. My elder son has Sleep Onset Insomnia, and he has been treated for
visual convergence problems, and my younger son has struggled with
depression, anxiety, and auditory processing problems.
My boys go to a fantastic school, a regular school that knows how to reach and
teach children with ADHD, and this has really helped them grow and progress as
students and people. Many people with ADHD struggle socially, and my sons
are no exception. In Commanding Attention, I discuss treatments that help
people with ADHD succeed not only academically, but also with other life skills
that are, as I will discuss, as important as academic skills to achieving happiness
and success.
I believe that my own ADHD symptoms are mostly controlled. I still drink
several cups of coffee daily, exercise regularly, and use technological tools to
keep myself organized. Many people remind me that I am, in fact, medicated
with caffeine. I agree. There are biological and physiological reasons why
caffeine helps my son and me. Caffeine will not help everyone. In Europe thirty
years ago, coffee was regularly recommended by psychiatrists for symptoms of
ADHD, but you rarely read about coffee as a possible treatment for ADHD
today. This was one of the many reasons why I decided to write this book.
Neurologists have found that any activity that allows people with ADHD to
practice their attentiveness and focusing strengthens our moldable brains. This
book has required a lot of focus and attention, and I am happy to report that
since I began it over a year ago, my cell phone has been filed away in my
dishwasher only once.
INTRODUCTION
“Life is not about waiting for the storms to pass...
It’s about learning how to dance in the rain.”

Vivian Greene

Commanding Attention is a book about Attention-Deficit/Hyperactivity Disorder
(ADHD) treatments that you may have never heard of. In this book, I discuss
what scientific research has taught us about the benefits, costs, and limitations of
these treatments. I also discuss what the research findings from human and
animal studies have reported about the biology of these treatments. The
treatments in Commanding Attention offer parents, clinicians, and patients more
tools to treat ADHD. These tools can be used in combination with drug therapy,
or sometimes alone, to help ADHD.
The reason that you may not have heard much about other ADHD therapies has
as much to do with pharmaceutical marketing and a physician’s familiarity with
drug treatment as it has to do with the fact that patients and parents are often in
need of a quick fix for troublesome ADHD symptoms and for the majority of
patients, the stimulant drugs improve symptoms immediately. When you
compare the ease of starting drug treatment to the ease of starting other
treatments such as dietary changes, neurofeedback, working memory training, or
aerobic exercise for example, medication wins hands down. The only easier
treatment might be a vaccine that immunized you against ADHD, but that
treatment does not exist. For many patients, drug therapy is:
Affordable
Quick
Easy
Effective
Safe
Given all the benefits of drug therapy, you might ask why I bothered to write a
200-page book on other therapies. There are two reasons. The first reason is that
drug treatments are not necessarily the best treatment for ADHD. Other
treatments may, in the long term, better address the complex neurological
processes that result in ADHD symptoms. The second reason is that not
everyone can or will take medication for their ADHD symptoms. Explaining the
benefits that other treatments may provide is what Commanding Attention is
about.
Commanding Attention is not an anti-drug therapy book. The debate in the
ADHD community for and against drug therapies can be contentious and
divisive. As you will learn in the executive function skills section of this book,
flexible thinking does not come easily to people with ADHD and many of them
see drug treatment as a black-and-white issue. This is a shame.
It is my belief as a parent of children with ADHD and as a clinician, that for
many patients prescription therapy is necessary. Many patients, because of their
age, their environment, their genetics, or their particular symptoms, will get the
greatest, the most immediate and most appropriate symptom improvement from
drug therapy. Other patients, for a variety of reasons, may find that drug therapy
is not the best answer for their symptoms.
The people who take medication are not right. The people who do not take
medication are not wrong. ADHD is a medical condition that affects everyone in
a unique way. Not everyone can control their blood pressure by taking ACE
inhibitors or by taking beta blockers: some require both. Some people have side
effects when they take either drug. Some have side effects no matter what drugs
they take. Just like not everyone will be able to control their blood pressure with
the same treatment plan, not everyone will be able to control their ADHD
symptoms with a “one size fits all” treatment plan. Some patients may find that
their symptoms improve with therapies that are not prescription drugs. For the
majority of patients, a combination of treatments is the best solution.
Patients who have improved with drug therapy will find additional therapies in
Commanding Attention that may enable them to further improve their symptoms.
Other patients will find that these other ADHD treatments provide enough
symptom improvement to allow them to decrease the dose or eliminate their
prescription medication.
The majority of patients with a diagnosis of ADHD are not on any treatment. Of
the patients prescribed medication, two-thirds of them, despite debilitating
ADHD symptoms, will no longer be taking their prescription medication a year
after it is prescribed. Some will stop because of side effects; for some, the