Are children with ADHD at higher risk for substance abuse? The answer to this question depends on a number of factors.  The very nature of ADHD does make one more likely to smoke cigarettes, have conduct problems, and abuse substances, as shown by a new study published in the Journal of the American Academy of Child & Adolescent Psychology. But not every child with ADHD is guaranteed to have a substance abuse problem. I also believe that this risk can be avoided with proper treatment and parental involvement.

The new findings on ADHD and substance abuse are based on data from two early studies.  The average age of the participants was 10 years old at the start of the study, and their development was followed for the next 10 years. The participants with ADHD were 1.5 times more likely to smoke, use alcohol, and do recreational drugs after 10 years. Among those who no longer had the ADHD diagnosis, only 1/4^th of the participants had similar problems.

The study mentioned above is said to be the largest study on the issue to date, and shows strong support for the relationship between ADHD and substance abuse confirmed by early studies. Initially, it was suspected that the substance abuse problem was linked to co-existing factors like a family history of alcoholism or other psychiatric conditions.  However, these factors didn’t play a role in the substance abuse risk. The researchers did observe that participants with behavioral problems did increase the risk three times.

In my experience, children who learn to manage their symptoms early in life are less likely to have conduct problems and substance abuse problems when they reach their teens.  By nature, ADHD kids are impulsive and don’t learn from their mistakes. Until they are able control their symptoms, they will continue to act on their desires without considering the consequences.  Parents play a crucial role in behavior modification and need to be proactive in giving rewards and consequences.

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Many ADHD teens also self-medicate with alcohol or marijuana to compensate for their shortcomings at school or to sort out their inner turmoil.  Watch your child carefully for signs of depression or drug use, and let him or her know that you’re around to provide whatever help he or she needs.

When an ADHD child can’t finish chores or homework due to lack of focus, yet can spend hours playing video games or watching TV, many parents get confused. How can these kids completely lose themselves in one task and have so much difficulty applying that same concentration on others?  Although ADHD is often the cause, a New York Times article reveals that it has less to do with an attention deficit and more about brain chemistry.

When a child enters the world of a fast-paced video game or an action-packed movie, the brain releases neurotransmitters like dopamine, which provides positive reinforcement and feelings of reward.  This not only makes a child hunger for the stimulation that causes it; it also makes mundane tasks like homework a lot less boring.  In other words, screen time for ADHD kids is a way of self-medicating. This theory was backed up by a study that discovered that ADHD kids spend less time on video games when medications like Ritalin increased their dopamine activity.

Additionally, the ADHD brain needs neurochemical rewards in order to keep it focused and on task.  This is why children seek out risky activities or visual stimulation.  However, screen time can also contribute to ADHD and makes symptoms worse. If a child – especially a young child – gets used to the breakneck pace and heightened alertness needed to respond and win at video games, the child might find the real world under-stimulating and underwhelming.

However, not all children with ADHD fall into the cycle of ADHD-video games-ADHD. And in small, healthy doses, video games can boost the self-esteem of a child. To promote a healthy balance, I suggest encouraging your child to get involved in a sport like swimming or martial arts. Physical activity provides the brain with the stimulation it needs, not to mention that these sports will also instill values like discipline and hard work.  Limit your child’s time in front of the TV and computer, and do not place these devices in your child’s bedroom. Pay attention to the games and shows your child watches, especially if they are violent.  It also helps to have some quality time with the whole family, doing something away from a television screen.

Maybe it’s the diet we have today, or perhaps it’s the chemicals present in our food and in the air. Whatever it is, more and more people are getting diagnosed with ADHD today.  Or are they really suffering from the disorder? Amid claims of a growing epidemic of ADHD among adults, a new report published in The Clinical Neuropsychologist reveals a surprising fact. Nearly one in four adults who seek medical treatment for the disorder might be faking their ADHD symptoms.

According to the authors of the report, there are many reasons why adults would exaggerate their symptoms. Some people do have ADHD, but just want to be sure that their doctor diagnoses them properly, while others thought they had ADHD but turned out to be depressed or stressed.  In many cases, however, adults faked ADHD to get their hands on medications like Ritalin and Adderall.

As you’re probably aware by now, ADHD medications work as stimulants – that is, they boost the production of dopamine and norepinephrine, neurotransmitters deficit among people who have ADHD. When someone with the disorder takes these drugs, they become calmer and are able to stay focused. But among healthy people, ADHD medications make great performance enhancers. College students, office workers, and journalists are known to take these drugs to improve their attention, memory, and learning.

This is why the UnRitalin Solution makes use of a complex testing protocol when we evaluate a new patient for ADHD. The typical ADHD test only looks at the symptoms, which does not provide enough information for an accurate diagnosis and appropriate treatment. In fact, diagnosing a disorder based on the symptoms alone is what makes it so easy to fake ADHD.

Last year, psychologists from the University of Kentucky discovered just how easy it was to fake the symptoms of the disorder.  Their study, which was published in the June 2010 issue of Psychological Assessment, asked a group of college students to try to fake ADHD symptoms while they take tests. The college students were made up of three groups – one had ADHD and stopped taking medications temporarily, one didn’t have ADHD and weren’t asked to fake symptoms, and one who also didn’t have ADHD but were offered $45 if they could trick the assessor into thinking otherwise. The last group had five minutes to read ADHD information taken from Google.

ADHD tests generally fall into two categories. First is the self-report, where a patient describes symptoms using a scale or structured questions. The second is the neuropsychological test, a game-like test where mistakes are used as a measure for inattention, impulsivity, and other ADHD symptoms. The study revealed that the self-report tests couldn’t tell the real ADHD patients from the frauds, and the computer tests were hardly more effective.

It’s easy to see why adults get tempted into faking ADHD symptoms for a performance boost. Who wouldn’t want to get ahead by simply taking a pill? However, ADHD medications have side effects that can aggravate existing psychological and cardiac problems. Serious side effects sustained from frequent misuse of these drugs is a surefire way to ruin one’s performance and health.

Children age 12 and below need at least 10 hours of sleep each night, especially if they have ADHD.  Studies have shown that when ADHD children don’t get enough sleep, they become more hyperactive, inattentive, and irritable the following day. But what qualifies as “not enough sleep” and how bad do ADHD symptoms get? A new study in the scientific journal Sleep reveals that as little as one less hour of sleep is enough to make the academic performance of ADHD students deteriorate.

The study involved the participation of 43 children with a mean age of 9 years. Eleven of them have ADHD while 32 are controls. After monitoring their baseline sleep for six evenings, the children were asked to remove an hour of sleep by going to bed later for six consecutive nights. An actigraph (a watch-like device) was used to monitor their sleeping hours during the baseline and experiment period.

After the baseline period and the experimental period, the children’s neurobehavioral function was measured using a Continuous Performance Test, a computer-based diagnostic test used to evaluate ADHD. The test takes 15 minutes to complete and involves responding to specific signals. Results revealed that after a mean 34 minutes of nightly sleep loss, the performance of children with ADHD deteriorated by four of six measures in the inattention scale. They also had slower reaction time. While the children without ADHD also had poorer performance, those with the disorder made more mistakes.

It’s worth pointing out that the reduction of sleep done in the study is quite modest compared to the actual sleep deprivation children experience today. The slightest changes in a child’s routine, such as eating dinner later or staying up to study (or play video games), is enough to push sleep back and cause poorer neurobehavioral functioning the following day.

Preventing sleep deprivation is an important part of a holistic ADHD treatment. After all, it takes time to see the effects of long-term solutions for ADHD, and your child needs to deal with the symptoms today.   Here are five solutions to sleep problems, which we talked about a few weeks ago, as well as a few more resources on sleep and ADHD.

With every published study that comes out, we develop a deeper understanding of ADHD and find new ways to treat or diagnose this mysterious disorder.  Two new studies on “mirror movements” reveals some interesting clues about childhood ADHD symptoms that may pave the way for a new way of testing for ADHD.

The two studies, which were published in the February 2011 issue of the medical journal Neurology, looked at children’s ability to control impulsive hand movements.  The first study involved the participation of 25 children with ADHD and 25 more without the disorder. All children were right-handed. Each child was asked to tap each finger of one hand to its thumb; during the exercise, any unintentional “mirror” movements in the other hand were recorded.  The researchers noted that those with ADHD had twice as many mirrored hand movements than the other children when the finger-tapping test was done on the left hand. The difference was more evident among boys with ADHD, who showed almost four times as many mirrored hand movements as those without ADHD.

The second study looked at the brain activity of a different set of kids – 49 children with ADHD and 49 children without. A technology called transcranial magnetic stimulation (TMS) was applied to the motor control region, enabling the researchers to activate the brain cells using magnetic pulses.  The researchers observed that a “braking mechanism” called short-interval cortical inhibition (SICI) is 40% lower in children with ADHD than those without the disorder. This means that they are less able to control movement and impulses. It was also noted that this reduced inhibition in the motor region was linked to the severity of ADHD symptosm.

These findings bring us one step closer to understanding how ADHD interferes with communication between the brain and body. They also reveal just how much children with ADHD struggle to keep unwanted behavior and actions under control, even at an unconscious level.  If developed properly, these findings can be used as an ADHD test, specifically to evaluate the disorder and examine how well the treatment is progression.

Despite these optimistic outcomes, please don’t use the motor movements test to identify ADHD in your child.  More work has to be done in order to make this test a feasible one. Parents hoping to use this method will only invite frustration and worry to an already confusing situation. If you suspect that your child has ADHD, have him or her evaluated by a licensed professional.

To most parents of kids with ADHD, the disorder can be nothing but a constant source of frustration.  When their kids have a hard time making friends or staying out of trouble in school, it’s difficult to find the silver lining of this condition. Yet there is an upside to ADHD that was recently confirmed by a new study – ADHD makes people more creative.

The link between ADHD and creativity was often seen as something parents clung on to console themselves.  Yet there’s no denying the studies that have found that those with ADHD have great “divergent” thinking yet problems with “convergent” thinking. Divergent thinking is the thought process where original solutions and ideas are generated spontaneously and unexpectedly. Convergent thinking, on the other hand, is the kind of thinking used for standardized tests – the ability to logically deduce a single correct answer.   Since the hallmark symptoms of ADHD include a lack of intellectual and behavioral constraint, it’s easy to see why a hyperactive child is more likely to come up with an out-of-the-box idea than one without ADHD.

Dr. Holly White from the University of Memphis sought to examine if there really is a link between ADHD and creativity or creative problem solving. The study involved the participation of 60 undergraduate students from the University of Memphis, 50% of which have an ADHD diagnosis. Using the Creative Achievement Questionnaire (CAQ), which asks about accomplishments in 10 creative domains like writing and drama, Dr. White discovered that those with ADHD are more likely to be better at certain creative domains than others.  It was interesting to note that the subjects with ADHD excelled most at those that require a lack of inhibition, such as the performing arts.

The other test used on the participants is called the FourSight Thinking Profile.  Like the CAQ, this is a self-reported test that measures creative problem solving in four phases – the Clarifier (“Let’s look at the problem”), the Ideator (brainstorming), the Developer (developing the idea), and Implementer (implementing the solution). Here, the researchers discovered that those with ADHD make great Ideators and Developers, while those without ADHD are better Clarifiers. Both groups were just as proficient at implementing the solutions.

While this study brings a ray of hope for parents, there are two important things to keep in mind.  First, Dr. White’s subjects may not be representative of young adults with ADHD. These are students who have graduated from high school, study at a university, and are motivated enough to be part of a study.  ADHD presents a number of challenges to school-age children, and it will take a great deal of support from family and teachers to get through high school.

Secondly, the creative potential of ADHD cannot be harnessed while the destructive aspects of ADHD are still dominant. ADHD symptoms need to be kept under control before we can start working on developing the strengths that come with ADHD.   At the UnRitalin Solution, we show families that ADHD does not always have to be a curse. There are ways to transform ADHD into powerful gifts so that the child can develop his or her fullest potential.    But of course, treating the immediate problems caused by the disorder remains our first priority.

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Many parents I’ve spoken to make the same observation about their ADHD children’s sleep habits: they have a hard time falling asleep, staying asleep, or waking up in the morning.  When they don’t get enough sleep the previous night, they spend the rest of the day in an ADHD funk with their symptoms in overdrive. These observations are hardly surprising – sleep problems and ADHD are closely related because the regions of the brain responsible for attention also regulate sleep. While there’s not much you can do to change your child’s biology, there are a few things that can be done to help your child get enough sleep.

Establish a bedtime

Doctors recommend that school-age children get at least 10 hours of sleep every night.  Determine your child’s bedtime by subtracting ten hours from the time he or she has to get up at school (e.g. children who have to be up by 7 am should be sound asleep by 9 pm the previous evening).  Enforce this bedtime consistently, even on weekends. Allowing your child to stay up late on Fridays and Saturdays will disrupt the body clock; by Monday, he or she will experience something like jet lag.

Create a bedtime routine

While enforcing a strict bedtime may be enough for the average child, kids with ADHD may need more than this, especially for those who end up tossing and turning well after midnight.  An hour before going to bed, create e a routine filled with calming and relaxing activities.  Read a book, listen to music, or do yoga together. The important thing is that these activities slow your child’s brain down and help ease any anxieties he or she might have about sleeping at night.

Keep the bedroom dark

Darkness is not only the perfect cue for bedtime; it also gets rid of any visual distractions that keep your child from falling asleep. For instance, if your child has no light to read, she’s less likely to stay up reading all night.  If your child is afraid of the dark and needs a light to calm his fears, provide a very dim light and shut it off once your child is asleep.

Use white noise

If the slightest sound stirs your child from sleep, try using white noise – a type of noise made up of different sound frequencies, enabling it to mask disruptive sounds without interrupting a person’s sleep.   White noise is normally emitted by household appliances – the whirring of an electric fan or the hum of an air-conditioner count as white noise.  You can also find white noise in CD recordings or in white noise machines.

Consider melatonin

Is your child still tossing and turning all night? Consider giving a melatonin supplement before bedtime.   Melatonin, a hormone secreted by the pineal gland, is responsible for maintaining our body’s internal clock; studies suggest that children with ADHD may have problems with melatonin secretion. Supplements are available in health food stores – try giving your child a small dose an hour before going to bed to induce sleepiness.

As a parent of a child with ADHD, you’ve probably noticed something I observe among my patients: kids with ADHD don’t do well in the winter.  As fall turns to winter and a blanket of snow covers the streets, kids with ADHD tend to:

• Become more hyperactive or impulsive as they grow increasingly restless. In the winter, they have fewer opportunities to burn excess energy or do activities they enjoy outside of school or at home.
• Become more argumentative and oppositional due to the inability to use their regular coping skills, such as outdoor activities or sports, to help them vent their feelings and burn off excess energy.
• Become more distracted and inattentive, resulting in difficulties doing homework or completing errands and chores.
• Experience more disciplinary or legal trouble as their frustration, restlessness, impulsivity, and hyperactivity increases.

Does this sound like your child?

Like everyone else, children with ADHD develop habits, skills, or behaviors that enable them to cope with their feelings, highs, lows, and the obstacles caused by their symptoms. Perhaps you’ve helped your child develop some of these healthy habits.  While the average child can easily cope with the changes caused by the seasons, most of those with ADHD do not handle change well.  They overreact to these disruptions because they perceive a threat underneath the change. Because of their symptoms, their reactions to change tend to involve the behaviors described above.

What can you do to help your ADHD child cope with the winter blues?

• Keep the house as well-lit and cheerful as possible. In the daytime, draw back the curtains and bring in as much natural light as you can. At night, use lamps or light up the room with a string of Christmas lights. Dark, dreary environments can aggravate ADHD symptoms or trigger seasonal affective disorder.
• Enroll your child in a gym or a winter camp. These programs will provide your child with enough activities to keep him or her occupied, happy, and fit.
• Turn a spare bedroom or garage into a homemade gym for days when your child has no choice but to stay indoors.  You don’t have to buy state-of-the-art exercise equipment for this; your homemade gym have a hula hoop, exercise balls, a tension band, a trampoline if there’s enough space, or a television with a Wii sports console.
• Spend some quality time with your child. Ask about how your child’s day went and what he or she is feeling.  Make it a real bonding session by sharing similar stories from your childhood.

Most children with ADHD will show significant improvements with these interventions but if your child’s symptoms continue to persist, check with your health care provider immediately.  Kids and teens with ADHD are more likely to experience depression during the cold winter months.

If your child’s kindergarten teacher brings up the possibility that your child might have ADHD, don’t panic just yet.  A new study suggests that one in five kids may be misdiagnosed with ADHD simply because they are the youngest in their class.

Researchers from North Carolina State University and the University of Minnesota spent an entire year examining the birth dates of 60,000 children in kindergarten up to twelfth grade. After cross-referencing this information with ADHD diagnoses, they discovered that children with ADHD were most likely to be the youngest in their class.  They are also more likely to be misdiagnosed with ADHD.

Start dates for schools vary from state to state, and make a huge difference to the performance of incoming students.  Let’s say that a school’s kindergarten program only accepts children who are 5 years old by September 3, the first day of school. If your child’s fifth birthday falls on September 4, he will be too young to attend school his year and will wait until next year to start kindergarten. When he starts, he will be among the oldest in class. But if your child turns five on September 2, then he makes the cutoff and is among the youngest in class.  There is a huge difference between the school performance of a six-year-old and a five-year-old. The young five-year-olds might have made the cut-off date, but they might not be ready for school just yet;  as a consequence, they may fall behind or have a hard time adjusting to a structured classroom setting. On the other hand, six-year-old kindergarteners are more mature and will clearly do better in terms of academics and athletics.

In addition to these findings, Todd Elder from Michigan State University examined the differences in ADHD diagnoses and use of stimulant medication among the youngest and oldest students in kindergarten. He discovered that the youngest students are 60% more likely to receive an ADHD diagnosis than the oldest students.  When they reached the fifth and eighth grades, the youngest students are also twice as likely to take stimulants for ADHD.

What this study demonstrates is that there are probably a million children misdiagnosed for ADHD and taking medications they don’t need, when the reality is that they may simply be too young for school. So how do you avoid an ADHD misdiagnosis? How can you tell the difference between a true case of ADHD or a child acting his or her age?

Observe your child’s behavior

For an ADHD diagnosis to be made, the child has to show the following ADHD symptoms in at least two settings.  If the teacher complains that your child keeps acting up at school, watch out for signs of this behavior at home and at other places.  Is your child very energetic? Talkative? Do these behaviors disrupt family life, or is this what your child’s personality is really like?

Get a comprehensive ADHD test

Identifying ADHD involves more than checking off a grocery list of symptoms. As this study’s findings have shown, hyperactive behavior and poor concentration have many possible causes, like simply being too young to attend kindergarten.  At the UnRitalin Solution, we start our ADHD testing protocol with a comprehensive interview with the parents and child. By doing so, we make sure that there are no other explanations that can account for a child’s ADHD-like symptoms.

Get a second opinion

If you feel that a doctor was too hasty about diagnosing your child and prescribing stimulants to treat ADHD, seek a second opinion. While an ADHD diagnosis is important for children who do need help, a misdiagnosis can be dangerous and even fatal. Stimulant medications are the most popular treatment for ADHD, but they have harmful side-effects like appetite loss, insomnia, headaches, and heightened aggression. Long-term use of stimulants can cause heart complications and death, even among children without a history of heart disease.

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If children with ADHD are more likely to get injured in the playground, are ADHD teens of driving age at higher risk for motor vehicle accidents as well?  It seems that the answer is yes.  Teenage bravado coupled with distractibility, impulsivity, and difficulty with self-regulation can make the ADHD driver a force to reckon with on the road.  Even though a teenager with ADHD may have good knowledge of driving rules, applying these rules may be challenging, especially if he or she gets easily overwhelmed by new stimuli, increased responsibility, and distractions from gadgets.

Studies have also confirmed that teenage drivers with ADHD are indeed more accident-prone than peers without. According to the research of psychologist Russell Barkley, people with ADHD speed four times more often than those without the disorder.  ADHD drivers are also two or three times more likely to get into an accident, three times more likely to have their licenses revoked in their first five to eight years of driving, and five times more likely to get a parking ticket. The latest research on the subject comes from Central Michigan University, where PhD candidate Michele Oliver was able to compare the driving skills of young motorists with ADHD and without.

Oliver’s research is currently being done in cooperation with Professor Richard Backs, director of the Driving Evaluation Education and Research Center.  The Center is equipped with an AAA Michigan driving simulator, which allows driving instructors and researchers to test people’s driving abilities without endangering the driver and motorists on the road. Oliver has been able to test two groups of young drivers using the simulator – one with ADHD and one without. Both groups had displayed the same awareness of driving rules and possessed the same skills.  However, those in the ADHD group ran more stop signs, stop signals, and had more crashes and multiple crashes in the simulator.  Oliver is still determining the reasons for these outcomes and hopes to confirm these by the end of fall.

These grim facts don’t necessarily mean that your teenage ADHD driver will get into an accident. For one thing, the risk is greatly reduced once your child has managed to control his or her symptoms. There are also several things you can do to keep your child safe on the road.

Prolong driver education

The conventional practice is to delay driving education only until a he or she is old enough to get a license at sixteen.  However, the opposite approach might work better for those with ADHD. As young as 14, start explaining driving rules, demonstrating driving skills, and establishing safe driving habits. Depending on your child’s ADHD symptoms, it may be wise to delay licensure until he or she turns 18, when your child is more mature and careful.

Practice driving together

Use practice driving time as an incentive for good behavior.  Spend at least 30 minutes each time driving and use this as an opportunity to address the challenges faced by your child.  Ask your child if there’s anything that distracts him and find a way to overcome these distractions.   When your child gets a learner’s permit, don’t sign it unless you agree upon certain rules, such as no cellphone use while driving or limit music sources to just one CD or tape.

Restrict your child’s driving

Once your child gets his or her license, draw up driving restrictions or conditions where your child receives driving privileges in increments.  Here are some examples of rules you can enforce:

• Plan every trip ahead of time and inform a parent in advance.
• Driving is only restricted to necessarily trips, such as school, after-school jobs, or team events.
• Keep your cellphone on silent mode to avoid getting distracted by text messages or calls.
• For the first three to six months, no passengers are allowed except for parents.
• For the first six months, no night driving is allowed without a parent on board.

Remember, driving is a privilege, not a right.  Evaluate your child’s overall behavior and determine if your child really is ready to drive.  If he or she consistently throws temper tantrums or breaks rules, there’s a chance that your child is not mature enough to get behind the wheel.