ADD - Help

Aido c

I am trying to understand where the treatment of ADD fits, it is primarily a learning disorder, and yet all the information I have seems to suggest you go see your local GP.

It is a disorder where drugs seem to play a very minor role in the treatment, and yet if you need to keep that option open you need to choose a doctor (in rural areas) / psychiatrist.

Because then the therapy is so hit and miss this would seem to suggest many trips to a doctor who frankly will care little about what amounts to lifestyle difficulties.

Am I reading this all wrong, can psychologists prescribe Ritalin?

I know one guy who can get his vet to prescribe it for the greyhounds to help them focus on chasing the hare, should we be going to a vet for learning difficulties?

Gibs

Aido c wrote:

I am trying to understand where the treatment of ADD fits, it is primarily a learning disorder, and yet all the information I have seems to suggest you go see your local GP.

It is a disorder where drugs seem to play a very minor role in the treatment, and yet if you need to keep that option open you need to choose a doctor (in rural areas) / psychiatrist.

Because then the therapy is so hit and miss this would seem to suggest many trips to a doctor who frankly will care little about what amounts to lifestyle difficulties.

Am I reading this all wrong, can psychologists prescribe Ritalin?

I know one guy who can get his vet to prescribe it for the greyhounds to help them focus on chasing the hare, should we be going to a vet for learning difficulties?

I would respectfully suggest that there are some inaccuracies in what you have written above.

First, with regard to treatment, only three treatments have been validated as being effective, short-term treatments for ADHD: 1. Central nervous system stimulant medication (for any child with ADHD), 2. Behaviour modification (for any child with ADHD i.e. parent training, classroom interventions, peer interventions) and 3. the combination of stimulant medication and behaviour modification (for any child with ADHD)

Psychologists cannot prescribe Ritalin in Ireland (though they can in certain states in the US), which is why typically you need to have the involvement of a psychiatrist or a GP. Conversely, psychiatrists and GP´s generally do not do behaviour modification programmes, whcih is why you should ideally have the involvement of a psychologist (or another mental health professional suitably trained). Often in Ireland you have a multi-disciplinary mental health team involved, but the waiting lists are terrible. There is a push, particularly in the States toward having ADD/ADHD treated at primary care level (i.e. by your GP and other health professionals working in the community) as a chronic disorder.

I have attached two documents that explain much of the theory and practice of add assessment and treatment much more lucidly than I can.
(There is another really good article I have but it´s too big to attach to the forum. PM me if you need a copy)

(Mods - I hope that is allowed: both documents are in the public domain and can be found at [EMAIL="www.nichq.org/resources/toolkit/"]www.nichq.org/resources/toolkit/[/EMAIL]

It's funny that you mention dogs in relation to ritalin and add/adhd, as there was a famous full-page ad taken out by the American Psychiatric Association when the prospect of prescribing psychologists looked like becoming a reality. You can see it for yourself here. I don't think it requires much further comment....:rolleyes:

cathy01

The medication given for ADD is to allow the child focus long enough to learn.
Its very difficult to learn when you cant remember whats been said.
Drs here can assess for ADD/ADHD , and medicate, however, thats only if they think they can.
To access educational services a psychological assessment is needed.You would see a specialist if you needed a full DSM5 assessment.
For behaviour management, there are very few programmes for children,
Gental teaching is one.
The parents plus for parents of ADD/ADHD children is useful for parents of younger children.
Best options for threatment are
Medication, support in school, education/Support for the parents.
HTH,
Cathy

Aido c

Gibs wrote:

I would respectfully suggest that there are some inaccuracies in what you have written above.

Yes, respectfully accepted, here is one

aido c wrote:

Because then the therapy is so hit and miss this would

Was supposed to read ''Because then the medication is so hit and miss..." Sorry for the confusion.

I work with 3rd level students and have a plan to come to terms with at least one learning disability each summer, last summer was Dyslexia, I got no where with that, its a hard one to fathom, but this Summer I have had an enjoyable summer with three books by Dr. Ned Hallowell; Driven to distraction , Answers to distraction & Delivered from distraction.

Much of the resources were American so I was trying to establish my own Irish ones and all I seem to get is that a Psychologist will for €400 do an assessment, but cannot treat it, but can get you a cert for your teacher. Assuming the teacher (me) accepts there is a problem in the first instance, is that not a waste of €400.

I think we can do better than that, and then when I heard about the Vet, I was forced to leave a rant here which I apologize for, but am glad you took the time to break it out step by step.

But back to doing better, Hallowell suggests the best way to achieve the best results with medication is through trial and error, that is potentially a lot of doctor visits, again massive cost. Hallowell himself hit on no successful medication after all that. Again I am dealing with third level students and I have to look at cost. Often when you say to a student go over here and spend €400, and then go over there and spend whatever, its a little like saying you are on your own...

I take it you disagree with Psychologists prescribing these drugs, which would have been my first suggestion, I find it hard to obtain a single point responsibility otherwise, but you seem happy enough that the Medication and Behaviour Modification can live together but apart. I am not a medical professional so I do accept your take on it. That was I suppose the central question I needed to ask, so again I thank you for the time you took.

ps. I hit on a very stimulating online discussion on how America prescribes it's drugs, its at the end of this link, and if you like you can Right click on the 'Click to listen' button and download a MP3 which you can listen to anytime (these programmes are an hour long so the flexibility is nice).

cathy01

can I suggest
www.adhd.ie

Gibs

Aido c wrote:

all I seem to get is that a Psychologist will for €400 do an assessment, but cannot treat it, but can get you a cert for your teacher. Assuming the teacher (me) accepts there is a problem in the first instance, is that not a waste of €400.

Your frustration is understandable but it's important to distinguish between the diagnosis/treatment of ADHD and the requirements for a psychological assessment of adhd set out by the department of education. Having a psychological assessment and a report, is a way of accessing accommodations from the department in both everyday classroom activities (getting access to learning support teaching, having a special needs assistant made available, getting technological accommodations like laptops etc.) and in exam situations. ADHD can be diagnosed by numerous professionals, but the department of education will only accept a report from a psychologist or a psychiatrist as being valid for the purpose of providing offically sanctioned extra help for students in an educational setting.

The cost is certainly an issue but it is possible to obtain a diagnosis and treatment through your local HSE for free. You may have to wait for a long time to see theh appropriate person, but they are out there.

As I pointed out earlier, a psychologist can treat ADHD, just not with medication.

Aido c wrote:

But back to doing better, Hallowell suggests the best way to achieve the best results with medication is through trial and error, that is potentially a lot of doctor visits, again massive cost. Hallowell himself hit on no successful medication after all that. Again I am dealing with third level students and I have to look at cost. Often when you say to a student go over here and spend €400, and then go over there and spend whatever, its a little like saying you are on your own...

You mentioned that you are dealing with 3rd level students but I'm not clear as to what exactly the difficulty is. Is it the case that you suspect a lot of them have undiagnosed ADHD and you would like to obtain a diagnosis for them? Do they have difficulties coping with the 3rd level curricula? While I would accept that there are some people who make it all the way to adulthood having an undiagnosed ADHD, in order for a diagnosis to be given, the symptoms must have been apparent before age 7 and must have interfered significantly with functioning. Do you have a lot of students with ADHD like symptoms who don't have a diagnosis? You could access the ADHD adult screen questionnaire here as a place to start. If your students score above the cutoffs in the scale, you might at least have a good reason to pursue a more complete assessment.

Aido c wrote:

I take it you disagree with Psychologists prescribing these drugs, which would have been my first suggestion, I find it hard to obtain a single point responsibility otherwise, but you seem happy enough that the Medication and Behaviour Modification can live together but apart. I am not a medical professional so I do accept your take on it. That was I suppose the central question I needed to ask, so again I thank you for the time you took.

On the contrary, I didin't say I necessarily disagreed with psychologists prescribing these medications. I merely pointed out that in Ireland psychologists can't prescribe them. The ad I referenced above is an indication of how strongly Psychiatrists in the US feel about psychologists prescribing meds. Personally I think the ideal way to treat ADHD is to provide both medication and behaviour modification options as part of a comprehensive package delivered by a multidisciplinary team that is tailored to each individual. Here's a debate between two high profile UK psychologists about whether ADHD should be treated with meds or not. Here's another issue of the Psychologist that outlines the whole prescription debate within Psychology.

Aido c

Thank you again Gibs for the time you are taking with this...and those links are excellent. Thanks for the link Cathy.

I don’t have difficulties per se, I actually feel very well supported by a learning support unit of which I sit on the committee representing my dept. And I believe firmly in the division of labour, I will never cross the line between teaching and diagnosis, the students I have in mind rarely make it to third level anyway, as you said there are probably a few, but we rarely get close enough to them to remember names, let alone make pseudo diagnosis.

I think I would actually welcome some because apparently their innate impulsivity leads them to ask more questions, and I would certainly welcome more of that. Again I have only come to understand this disorder during this summer and I will let you know through out the year if I think there are symptoms of it apparent.

A cousin of mine once flew to the US and had a reoccurrence of an old injury which resulted in a collapsed lung mid flight, I remember one of the US doctors ranting abut Irish medicine, and this was years ago, he said ''socialist medicine - they only ever fix you up till you are as bad as the next fellow on the list'', Now I will not get into politics or the mess that is US health care (Pot and Kettle anyone) but I do accept his point that there is a focus only on the worst cases.

A multidisciplinary team is perfect for worst case scenarios, but I think that for every worst case there are quite a few up along the scale that could also benefit from help, affordable help that is less an intervention more assistance. I am thinking of the daydreamers, the quite students who never make it to third level, or when they do they fall apart with the loss of structure. It would be nice if there was a one-stop psychologist, don't even call them that - learning specialist who can provide the whole package. There is a stigma associated with seeing a psychologist that should not apply to learning disorders. The cost benefit ratios are great. A learning coach at the right time; transition year - it could change a lot of lives.

I ranted when I saw that the support seem to be there for your greyhound, for humans its more complicated - It should be and care must be taken around drugs but I am never the less glad I started this thread.

cathy01

well, just to let you know.
AT LAST
A clinic is been set up, in Balbriggan, which can dignise and threat
ADD/ADHD,ASD,AS,PDD-NOS, PDD etc.
It will see both Adults and children, private.
But the cost forMedical and CLINICAL psychological report is under €1000, I am not 100% sure of the fee.But its not much concidering you could go HSE and wait forever.
The impact of finding out you have ADHD is huge.Its like opening your eyes for the first time ever.
It makes things clear .
It doesnt cure anything.
Parents understand their children better and can work at ways of supporting them.
THe psyc report is done for children and will be supported by DEPT of ED, IE, NEPS approved.

PM me for the details as its only just , as in next week, opening.
Cathy

N8

http://www.newstarget.com/ADHD.html

taztastic

All I can say "Good on you" to anyone who manages to get to 3rd level with ADD/ADHD, diagnosed or otherwise.
I'd be more familiar with assessing cases at the younger end of the spectrum. One thing that has really struck me is the number of cases that sound like a clear cut ADD/ADHD issue but when you see them there's no two of them alike and the vast majority are actually emotional or behaviour in nature. I have to wonder if more universal, preventive approaches to support the emotional and social development of children in schools would remove an awful lot of these frustrating cases where parents and teachers wait months only to be told that the child don't meet criteria.

cathy01

would that not be like, almost getting the teacher to make a dignoise as to if the childs needs to be seen.
Its hard enought to get a teacher to accept such a thing even exsits.
I do beleive that knowing how to parent a child with ADHD would make a difference.
Not just parent plus, which is aimed at behaviour but ADHD , which is often behaviout that cant be controlled.

There as a few, programmes, but none that are ADHD specific,that I know of anyway.
I think a guy from the mater is working on one, but its needed.
Not just manageing the childs behaciour but
Their self esteem etc.
And yes well done to that person for making it, I know how difficult it can be.
On the adhd web site a reporter is looking for people to do a peice on how they manage at school.It would be noce if someone came accross as the success and not the drop out,
Cathy

taztastic

would that not be like, almost getting the teacher to make a dignoise as to if the childs needs to be seen.

I think I know what you mean but forgive me if I've missed the point. It would be getting the teacher to support the diagnostic process by differentially ruling out the possibility of social or emotional problems that would give ADD/ADHD-like symptoms. I think far too many children's difficulties relating to concentration and behaviour are put down to some "condition" and not so not to be dealt with in school. Teachers know far more about their students then most people so I think they should play a bigger role in the diagnositic process.

As for parenting programs I would definitely recomend them, if only to protect the parents' sanity! As far as I know some evaluations have been done on Incredible Years with the parents of ADHD children are promising and its well established that it works well for conduct disorders so it would be especially good for children with co-morbid ADHD and conduct which co-occur at an exceptionally high rate and can really compound problems for parents and children.

Aido c

One of the things that stood out from the books I read is how many of the symptoms look like Laziness or lack of will.

The many stories of students who came up against new teachers, year on year, and essentially began a battle of wills with the teachers, are what were disturbing. I think we all know those students, and we all know those teachers.

I see the teachers role as raising a flag, at the end of one of those battle's of will (or what ever its modern equivalent is), and saying we tried everything, this child has problems. So the whole thing does not begin again in the New Year. I should not wonder in an area of such a dubious diagnosis, with such a myriad of complicated treatment routes, I think the tendency would be to leave the student on to the next year, make him the next teacher’s problem. It seems such a waste, especially since much of what that Teacher now knows could be used to form a diagnosis.

kerrbrand

Are we not acting too quickly to drug our children or taking the easy road out.