Questions and Answers-cont.

A:    A single approach to the management of ADHD is never completely satisfactory, despite the dramatic early benefits of stimulant therapy.   In addition to medications, important therapeutic regimens include the following:

• Psychological and psychosocial intervention
• Parent and family counseling
• Behavior modification and/or child counseling
• Remedial education and learning accommodations

      The optimal order of introduction of these various methods of management is somewhat controversial.   Some psychologists favor initial psychosocial intervention and behavior modification management, whereas physicians prefer to introduce medication early as an essential aid to education and academic success.

A:      The psychologist provides testing, diagnosis and/or counseling in group or individual sessions, and advises and monitors but does not generally perscribe medications.   The psychiatrist diagnosis and treats with medications and psychotherapy.   Some university based psychiatrists are psychopharmacologists, specializing in the research and trials of medications for ADHD and comorbid disorders.

      Psychologists specialize as educational or clinical psychologists, providing testing and/or therapy.   Some are trained to provide both types of services.   A parent may consult a psychologist about symptoms of ADHD or a learning problem as a first resort or on the advice of the physician or teacher.   At some point, a child who is having learning or behavioral problems will need the services of a psychologist.   These may be provided through the school or mental health system or privately.   The psychological effects of a handicapped child on family functioning and methods of counselling and training for families of children with ADHD, including peer relationships, are described by Barkley RA (1990, 1997) and Millichap MG (1984).

A:   Parents often ask why their child can focus on an activity such as Nintendo or a favorite television program while exhibiting distractibility and inattentiveness in school.   The answer is related to the nature of attention and the influence of environmental demands and distractions.

      The learning process has been classified in four categories: 1) goal-awareness, 2) vigilance, 3) selectivity, and 4) tenacity.   The child with ADHD is usually hypervigilant, but has deficits in selection and sustaining attention (Rosenberger PB, 1991).   The discrimination of essential from unessential stimuli is impaired.   Attention can be redirected by situational demands and goal-awareness or motivation.

      Parents can encourage the child to pursue appropriate interests by finding motivational activities adn providing support and praise.   Biograhies of famous people who have overcome adversity to succeed in their chosen field of endeavor are excellent motivational tools.

      Winston Spencer Churchill, who saved England from the tyranny of Hitler's Germany by his superior leadership and oratory, and later wrote a best-selling History of the British Empire, had symptoms of ADHD, a speech impediment and learning disability as a child (Churchill WS, 1930).   In his autobiography, My Early Life, Churchill wrote: "I was on the considerably discouraged by my school days."  "It is not pleasant to feel oneself so completely outclassed and left behind at the very beginning of the race."   He was surprised on leaving school to hear his teacher predict, "with a confidence for which I could see no foundation, that I should be able to make my way all right."   "I have always been very grateful to him for this remark."

      A simple word of praise or note of confidence from a teacher makes its mark for life in a child with academic problems.   Churchill did indeed make his way alright.   He bacame Prime Minister of Great Britain and a World leader.   Like Churchill, several famous people have been reported to suffer from learning disabilities during childhood.   Thomas Edison, Albert Einstein, President Woodrow Wilson, and Governor Nelson Rockefeller are among those listed as dyslexic, yet their names are indelibly written in the papers of history.

      Nancy Millichap, in her book on Dyslexia (1986), refers to articles on the childhood of Thomas Edison and other historical figures.   Thomas Edison, inventor, was diagnosed as mentally ill by his teacher, his father thought he was stupid, he never learned to spell, and up to the time of his manhood his grammar was appalling.   Albert Einstein, physicist and Nobel prize winner, did not talk until he was four nor read until nine.   He was considered backward by his teachers and his father.   Woodrow Wilson, President of the United States, did not learn his letters until he was nine or learn to read until he was eleven.   Nelson A. Rockefeller, the former governor of New York State and vice-president of the United States, in an article written in the TV Guide, 1976, entitled "Don't Accept Anyone's Verdict That You are Lazy, Stupid, or Retarded," recalled his difficulties as a dyslexic boy before there were special schools and teachers for reading-disabled children.   Nowadays, with our current understanding of dyslexia and other learning disabilities, the burden of a child's academic problems should be lighter and prospects brighter.