1. No category

IN THIS ISSUE
Frequently Asked Questions....P2
Peer Support Groups....P3
Multilingual Team....P3
Catching Reading Problems Early....P3
Personal Trainers for School....P4
I n the last several years, the words
Attention-Deficit/Hyperactivity Disorder
(ADHD) have rolled off the tongues of
professionals and laypeople alike.
Teachers are overwhelmed by their
difficulty keeping a few of their students
on task and in their seats. Parents wonder
whether their kids are just being
precocious—simply “boys being
boys”—or whether there is a true medical
or neurological problem at the root of
these behavioral challenges. Medical
professionals are being asked to come up
with answers and subsequently to make it
Spring/Summmer 2008
better.
ADHD seems like a reasonable option
—the behaviors fit and it responds to
medication. But what really is ADHD?
What causes it? What’s the best treatment
for it? Are there options aside from
medication? What about remediation
and accommodations? Is my kid the only
one? Because so many unanswered
questions exist, we at CPS felt that it was
necessary to provide some answers. As
such, we have dedicated our spring
newsletter to an exploration of ADHD and
have set out to answer the questions that
plague so many parents and teachers.
In the following pages, you will find a
myriad of information; however, inclusion
in this newsletter does not indicate CPS’s
endorsement of any specific medication or
alternative treatment modality. We simply
seek to provide you with as many
alternatives as possible. Before making
any decisions, it is imperative that parents
do their research and that they consult a
medical professional.
So join us as we embark on this journey to
learn more about ADHD.
activities, losing things, distractibility,
and/or forgetfulness.
2. 6 or more symptoms of
hyperactivity-impulsivity, including
fidgeting, difficulty remaining seated,
excessive running or climbing, difficulty
playing quietly, constant movement,
excessive talking, inappropriate blurting of
responses, difficulty waiting turn, and/or
interruptions.
B. Some of the above behaviors were
present and problematic before the age of
7.
C. Impairment in more than one setting.
D. Significant impairment in social,
academic, or occupational functioning.
E. Symptoms cannot be explained by any
other condition.
Based on the specific symptom picture, a
child can be diagnosed with one of three
subtypes of ADHD. If he/she is
inattentive, but not hyperactive, the
diagnosis is ADHD, Predominantly
Inattentive Type. If the reverse is true,
he/she will be diagnosed with ADHD,
Predominantly Hyperactive-Impulsive
Type. Finally, if the child is both
inattentive and hyperactive, a diagnosis of
ADHD, Combined Type also exists.
What is ADHD?
A ccording to the American Psychiatric
Association’s (2000) Diagnostic and
Statistical Manual of Mental Disorder,
Fourth Edition-Text Revision, ADHD is
defined by the following characteristics:
A. Either of the following “for at least 6
months and to a degree that is
maladaptive and inconsistent with
developmental level”:
1. 6 or more symptoms of inattention,
including careless mistakes, difficulty
maintaining attentional vigilance,
ostensibly poor listening, lack of follow
through on activities, poor organization,
resistance to mentally-challenging
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S
RECENT DEVELOPMENTS IN THE STUDY OF ADHD
everal studies published in the last year
have shed new light on the potential
underlying factors involved in ADHD.
One study, which was conducted by the
National Institute of Mental Health
(NIMH), suggested that the brains of
individuals with ADHD are not
fundamentally different; instead, they are
simply delayed in their development. The
frontal cortex is the area of the brain that is
primarily involved in planning, attention,
judgment, and foresight. As does the rest
of the brain, the frontal cortex goes
through a process of thickening in
childhood and then thinning out in
adolescence in order to promote maximum
efficiency. Based on the MRI’s of over 400
individuals with and without ADHD,
researchers found that this process
happens in both groups, but happens
several years later in the ADHD group.
Conversely, it seems that the motor cortex
develops more quickly in children with
ADHD than in those without, which serves
to explain the hyperactivity that is typically
witnessed by parents and teachers. These
findings support the common observation
of parents and teachers that children often
“outgrow” their symptoms.
Two other research projects implicated the
neurotransmitter dopamine, with one study
suggesting that individuals with ADHD
have decreased levels of the brain
chemical. Another study indicated that
20-25% of individuals with ADHD have a
variant on a dopamine receptor gene,
which seems to be related to decreased
tissue thickness in the areas of the brain
involved in maintaining attention. Because
dopamine seems to play an integral role in
the challenges associated with ADHD, it is
not surprising that the stimulant
medications often used to treat ADHD
work by increasing the levels of dopamine
in the brain, thereby decreasing
symptomatology. These findings have
important implications in that they give
further credence to the theory that ADHD
is a “real disease” with genetic
underpinnings.
Sources: 1. Reinberg, S. (August 2006).
Brain studies show ADHD is real disease.
HealthDay: News for Healthier Living.
Retrieved from
http://www.healthday.com/Article.asp?AID
=607086 on 02/15/2008; 2. Brain matures
a few years late in ADHD, but follows
normal pattern (NIMH Press Release,
November 12, 2007). Retrieved from
http://www.nimh.nih.gov/science-news/20
07/brain-matures-a-few-years-late-in-adhdbut-follows-normal-pattern.shtml on
02/15/2008.
PSYCHOPHARMACOLOGICAL TREATMENT OF ADHD
Because of the chemical nature of ADHD, medication therapy is often used to treat the disorder; however, the decision to use
medication is not one that should be entered into lightly. Understanding the mechanisms by which the medications work and
being aware of the potential side effects are vital to the decision-making process that each parent must undertake before
choosing whether to use medication to treat his/her child with ADHD.
How do the medicines work?
Physician and author Dr. Gabor Mate suggests that the prefrontal cortex, which is responsible for sorting through incoming
sensory information and deciding what is worth keeping and what should be discarded, is the area of the brain implicated in
ADHD. When there is decreased activity in this area of the brain, the sorting process is slowed and more information gets
through than would be ideal, thereby resulting in the lack of focus and difficulty maintaining attention that is characteristic of
ADHD. According to Dr. Mate, the medications help to increase brain activity in this area; thus, allowing the organization
process to function more effectively.
Types of Medications and Their Side Effects
Stimulant Medications
Stimulants are the most commonly used class of medication to treat ADHD. As implied by their name, their primary function is
to “stimulate” or activate the central nervous system. By increasing the amount of dopamine available in the brain (see article
on Theories of ADHD), stimulant medications decrease hyperactivity and impulsivity and improve the ability to maintain
attentional vigilance. Frequently used stimulants include Ritalin, Concerta, Meta date, Adderall, and Focalin. Some of the
stimulants are short-acting, which means they must be taken several times a day in order to achieve maximum efficacy
throughout the day, and others are long-acting, which means they must only be taken once per day.
The short-term side effects of stimulants can include any of the following: nervousness, difficulty sleeping, loss of appetite,
weight loss, headaches, upset stomach, nausea, dizziness, racing heartbeat, restlessness, agitation, irritability, mood swings,
lack of spontaneity, social withdrawal, depression, or tics. Furthermore, stimulants must be avoided by individuals with a
history of cardiac problems, as they can be lethal in combination with a heart condition. Out of those who take stimulants,
some people tolerate the medication fairly well, with minimal, if any, side effects, whereas others must discontinue use because
the side effects outweigh the original symptoms. Due to limited research in this area, little is known about the long-term effects
of these medications.
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P
ADJUNCT THERAPIES FOR ADHD
arents are often looking for help in
managing their children’s symptoms of
ADHD. Over the years, many different
strategies have been proposed, but few
have been supported by science, and none
have been as efficacious as medication
and therapy in addressing the impulsivity,
hyperactivity, and inattention that are part
and parcel in the disorder. Recently,
however, there has been increasing
support for complimentary strategies to
help control the behaviors. As an adjunct
to traditional treatment, the following
therapies may prove to be very effective in
managing ADHD symptomatology.
Neurofeedback has been shown to have
some positive results over time; however,
critics of this method suggest that the
research conducted to date has not been
rigorous enough to eliminate confounding
variables, such as the fact that the child is
spending individual time with the
practitioner, which in and of itself could
be responsible for the change.
Furthermore, it is expensive, with the
average course of treatment costing
anywhere from $2,000 to $5,000.
Neurofeedback
Simply stated, neurofeedback for ADHD
involves training one’s brain to control
behavior. It is based on the fact that
different states of mind (e.g., focused,
inattentive, etc.) result in the emission of
different brain waves. Through the use of
a cap wired with electrodes, the brain
waves are mapped and subsequently used
to create computer software/video games
in which the desired brain activity (i.e.,
focus) causes the characters in the game to
move and the undesirable brain waves
(i.e., those associated with day dreaming)
make the game stop. In essence, children
learn to create “short bursts of brain-wave
activity” in the formerly under-aroused
areas of the brain, which are implicated in
the symptoms of ADHD. The ultimate
goal of neurofeedback is to train the brain
to increase the child’s control over
on-task/focused behavior, thereby
decreasing inattention, hyperactivity, and
impulsivity.
Supplements, Nutrition, and Exercise
It is hard to listen to the news without
hearing about the latest research on food
and exercise and their effects on mood
and behavior. The same is true within the
ADHD literature, where some of the
current trends are to use supplements,
exercise, and a well-balanced diet as an
extra means of managing the challenges
associated with the disorder.
C ogmed is an intensive computer-based
Source: December/January 2008 edition of
ADDitude (www.additudemag.com)
For instance, omega-3 fatty acids (which
are not produced by the body, but can be
found in sardines, tuna, and salmon, or
can be taken in supplement form)
reportedly enhance mental focus.
Furthermore, results from a 2003 study
published by Nutritional Neuroscience
indicated that omega-3’s tend to break
down more rapidly in individuals with
ADHD (as cited in ADDitude,
December/January 2008). Subsequently,
some would argue that adding these
supplements to a well-balanced diet (or
eating more fish) will improve the ability
to maintain attention, particularly in cases
of ADHD, where levels of omega-3’s are
already somewhat depleted. They do not
seem to have a sizeable impact on
hyperactivity and impulsivity, however.
In addition to supplements, a
well-balanced meal plan, with plenty of
fruits, vegetables, whole grains, and
proteins, seems related to fewer shifts in
behavior and attention. According to Dr.
Edward Hallowell, who founded the
Hallowell Center for ADHD, each meal
should be one-half fruits and vegetables,
one-fourth protein, and one-fourth
carbohydrates (ADDitude,
December/January 2008).
Finally, the benefits of exercise are
multiple, but of primary importance to
individuals with ADHD is the resulting
release of neurotransmitters, including
endorphins, norepinephrine, serotonin,
and especially, dopamine. Because
ADHD patients seem to have diminished
levels of dopamine (see Recent
Developments article), activities that
increase this neurotransmitter are likely to
have positive effects on attention and
behavior. According to John Ratey, M.D.
of Harvard Medical School, “When you
increase dopamine levels, you increase
the attention system’s ability to be regular
and consistent, which has many good
effects” (ADDitude, December/January
2008).
Source: December/January 2008 edition of
ADDitude (www.additudemag.com)
WORKING MEMORY TRAINING - Judith Aronson-Ramos, MD
treatment intervention, for children and
adults. There are three versions of the
program: JM for 5-9 year olds, RM for 7
years old and up, and QM for adults. The
program is completed at home over a five
week period with coaching support from
trained staff members, who work under
the direction of a physician.
Cogmed is designed to improve Working
Memory, now known to be a key deficit in
many individuals with ADHD, learning
disorders, reading comprehension & math
difficulties, cognitive slowing, and other
problems. Working Memory is a function
of the brain that helps an individual
temporarily store and manage information
required to carry out complex thinking
tasks. In daily life, working memory is
used for things as diverse as remembering
instructions, solving problems, controlling
impulses, social skills, focus, and
attention.
The Cogmed Program was developed in
Stockholm at the prestigious Karolinska
Institute, known for cutting-edge medical
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CONTINUED....WORKING MEMORY TRAINING - Judith Aronson-Ramos, MD
treatments and research. The research on the
Cogmed Intervention Program, some of which has
already been published in leading scientific and
medical journals, shows clinically significant
improvements in the functioning of individuals
who complete the training program. Research is
ongoing in Sweden, as well as in the United States
at Notre Dame, Harvard, Stanford and NYU.
Information about the research is available on the
Cogmed website at www.cogmed.com
The actual treatment program involves at-home
computer-based training for 30-45 minutes daily, 5
days a week, for 5 weeks. The exercises are
similar to computer games, but the computer
adjusts the level of difficulty (through internet
synchronization with a large data base) so the
child or adult is always pushing him or herself.
The parent, or other caregiver, will be taught the
necessary techniques and strategies to be a
“training aide” to their child in order to obtain the
maximum benefits from the program.
Additionally, the Cogmed coach will be providing
weekly telephone contact to assist parents and will
be tracking daily progress by continuously
analyzing performance data. The program requires
a commitment to adhering to a consistent training
schedule in order to get the optimal results.
Improvement ranges from moderately good to
excellent, in terms of “real world” functioning. In
some cases, results are apparent as early as the
third or fourth week of training. In other cases,
however, results emerge slowly and begin to
become apparent only after training is completed.
One of the most exciting aspects of the training is
that results are long-lasting: over 80% of those
who improve either maintain their gains or
actually continue to improve over time at one-year
follow-up. For those who backslide a bit, a
3-week booster program is available.
In collaboration with Dr Aronson-Ramos,
Developmental and Behavioral Pediatrician, CPS
is now able to offer Cogmed Working Memory
Training. We have several specialized coaches
who work under the direction of Dr.
Aronson-Ramos in order to provide this adjunct
therapy for children with ADHD. For more
information, please see the article entitled
“Working Memory Training” or visit
www.cogmed.com.
RECOMMENDATIONS TO ASSIST WITH ADHD FEATURES
Beyond medication and remediation, various accommodations and modifications can be made in the classroom to address the challenges faced by
the student with ADHD. Below is a summary of recommendations for each of the major areas of difficulties commonly found in the classroom
setting.
Environmental Accommodations
For a student with ADHD, the classroom environment must be one that is free of distractions and absent of noise. The child should be seated close to
the teacher in order to provide for easier redirection and positive feedback; however, he/she should not be placed in situations where he/she is close
to other students in order to avoid pushing and bumping. Finally, cognitively-demanding tasks should take place early in the day, with time left at the
end of the day for activities that are enjoyable for the student.
Giving Instructions
When giving instructions, it is important to establish eye contact, speak clearly and succinctly, and ensure that the student has understood what is
being requested of him/her. Asking him/her to repeat the instructions is helpful, and allowing him/her to accomplish one step before moving on to
the next is critical.
Helping the Student Follow Through on Instructions
The delivery of instructions is important, but oftentimes students with ADHD have difficulty following through with even the best stated directives,
particularly when multiple steps are involved. In order to increase follow through on multi-step directions, teach the student to break down tasks into
manageable components and to use visual cues (e.g., write down spoken instructions, highlighting on worksheets, index cards, etc.) to serve as visual
reminders of the next step. Furthermore, have the student work with a buddy who can also serve as a reminder to stay on task.
Maintaining Routines, Departures from Routine
Routines and consistency are crucial. While there should be variety in the classroom, the more warning of major changes to routine that can be
given to the student, the better. If possible, plan in advance for major alterations to the regular structure in order to prevent problems that may arise as
a result of the change.
Teaching Approaches and Modifying Task Characteristics
The child with ADHD may also benefit from slight modifications to teaching strategies. Interactive and “hands on” should be the guiding principles
when creating lesson plans. Practicality is also important, in that the student (as are most people) is more likely to stay on task if he/she sees the value
in what he/she is doing. Activities should be short, engaging, and experiential; the more technology, the better. Furthermore, they should be
conducted at the student’s academic level and pace, as he/she will likely disengage if the activity is too hard or too easy.
Beginnings and Transitions
Because routines are so important to the student with ADHD, beginnings and transitions can be difficult times. Starting the day organized is
imperative; reminders to turn in homework and put unnecessary items away may be necessary. Informal transitions should be minimal. Finally,
ensuring that the student is ready to receive the instructions for the transition (i.e., sitting quietly and making eye contact) is important to minimizing
any fallout that may result from the shift itself.
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CONTINUED....RECOMMENDATIONS TO ASSIST WITH ADHD FEATURES
Increasing Attention and Time On Task
Maintaining attention and staying on tasks are the biggest challenges for students with ADHD. As such, it is important to keep distractions, including
talkative students and unnecessary items, as far from the student as possible. Movement helps to keep these children engaged, so it should be
incorporated into activities as appropriate. Praise and reinforcement as the child begins to increase time on task are also good ways of strengthening
this behavior. Additional reinforcement can be given by providing the student with a visual representation (e.g., a chart or graph) of increased
attention and time on task. Regular reminders to have the student check whether he is on task may be beneficial, so long as no unnecessary attention
is called to the child.
Task Completion
Staying on task is one challenge for the ADHD student, but actually completing the task and turning it in presents its own set of difficulties. Because
it is hard for him/her to maintain focused attention, time management and efficiency will also be compromised; consequently, modifying assignments
to show content mastery without excessive volume is recommended. Extended time may also be required to relieve the time pressure felt by the
student. When turned in, all assignments should be reviewed by the teacher and given back if incomplete. Work sent home should be minimal, but
for situations when it is inevitable, the student should have the phone numbers of several other students in the class so that he/she can contact them
should a question arise about an assignment outside of school hours.
Improving Academic Performance
While intellectual potential is not necessarily compromised by ADHD, academic performance often is. In order to address this, teachers must begin
by giving visual and oral instructions and should model difficult tasks for students. Notes should be provided in order to ensure that the student is
focusing on listening and not on writing. Organizational and study strategies should be taught.
Directing/Controlling Activity Level
Finally, hyperactivity in the classroom must be addressed. Breaks and movement are critical for students with ADHD. A “fidget toy” that is not
distracting to others may be very helpful. The student should have physical stability in his/her chair in order to avoid excessive fidgeting. Finally, if
redirection is necessary, it should be done in an unobtrusive manner in order to minimize the attention called to the student.
Source: Mather, N., & Jaffe, L. 2002. Woodcock-Johnson III: Reports, Recommendations, and Strategies. New York: John Wiley & Sons
FAMOUS PEOPLE WITH ADHD
Having ADHD is not necessarily a bad thing. In fact, if you have been diagnosed, you are in good company. Consider the following famous
people with ADHD:
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President Eisenhower
Beethoven
Stevie Wonder
Mariette Hartley
President Lincoln
“Magic” Johnson
Benjamin Franklin
William Butler Yeats
President Kennedy
George Burns
Milton Hershey
Galileo
Prince Charles
General Patton
Mozart
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Greg Louganis
Henry Winkler
Socrates
Eleanor Roosevelt
Albert Einstein
Harry Andersen
Jim Carrey
Sir Winston Churchill
Jason Kidd
Source: http://www.adhdrelief.com/famous.html
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ANNOUNCEMENTS
• We are pleased to announce the addition of Ralph Levinson, Ed.D. and Lauren Goldstein, Ph.D. to our staff. Dr. Levinson conducts individual and family
psychotherapy out of our Cooper City and Weston offices. Dr. Goldstein is also available to conduct psychotherapy, as well as psychological testing, but will
do so primarily out of our North Miami Beach office. Each of them comes to us with invaluable experience in the field, and we are thrilled to have them on
our team!
• It is with great excitement that we announce the launching of our Caribbean Regional Office in Nassau, Bahamas. With the help of our in-house native
Bahamian, Dr. Michelle Major-Sanabria, we have recently begun extending our services to children in the Bahamas without the inconvenience of having them
leave their country. Historically, these children would have to come to the United States to receive reputable treatment; however, we have implemented a
system whereby Dr. Major-Sanabria heads to the Island once a month to conduct psycho-educational/neuropsychological evaluations. Being right there
allows her easy access to parents and teachers, which in turn, facilitates the process of implementing services as quickly as possible.
• On the local level, we have joined forces with St. Andrew’s Catholic School (Coral Springs) and St. Timothy Parish School (in Miami) to create testing centers,
where students from each school, as well as neighboring parishes, can receive our services. Arrangements are also in progress with a third, more centrally
located school, in order to meet the needs of those students in North Dade and South Broward Counties. Each of our psychologists entering these testing
centers will have undergone the various screening methods and trainings put in place by the Archdiocese. Resident psychologists and interns will be available
to conduct evaluations on a sliding scale basis in order to ensure that as many children as possible will be able to receive the services they need.
• Finally, at CPS, we are constantly looking for ways to better serve the various communities in which we are located. We are pleased to announce the
launching of our new website, which we have created to present you with comprehensive information about the services we offer and the individuals who are
specially trained to provide those services. Please visit our website at www.childproviderspecialists.org in order to find out more about the exciting things
happening at CPS. Please take note that our web address has changed.
OUR LOCATIONS
WESTON
Miami Children’s Hospital
Dan Marino Center
2900 S. Commerce Parkway
Weston, FL 33331
For more information regarding our services or to
make an appointment, please call: (954) 577-3396
COOPER CITY
SHERIDAN PROFESSIONAL
CENTER
11011 Sheridan Street, Suite #303
Cooper City, FL 33026
NORTH MIAMI
BEACH/AVENTURA
1031 Ives Dairy Road, Suite #228
North Miami Beach, FL 33179
SOUTH MIAMI/KENDALL
St. Timothy Parish School
5400 SW 102 Avenue
Miami, FL 33165
BOCA RATON
Glades Medical Center
9325 Glades Road, Suite #208
Boca Raton, FL 33434
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