Another expert opinion on ADHD

There are a lot of experts out there on ADHD.  I don't think any one person has all of the answers, so I like to read lots of different options and opinions. 

Dr. Sam Goldstein is an expert on ADHD from the University of Utah School of Medicine.  He'll be speaking tonight in Calgary.  Unfortunately, I can't drop everything and fly half way across the country, so I'll have to settle for a little light reading - again.  I did find this article which features an interview with Dr. Goldstein in The Calgary Herald, and I thought I'd share it with here.  Enjoy!

Rhonda

An Interview with Dr. Sam Goldstein

Dr. Goldstein is a doctoral psychologist with areas of specialization in school psychology, child development and neuropsychology and sees about 300 patients a year. He’s also editor in chief of the Journal of Attention Disorders, a filmmaker and the author of many books including Raising a Self-Disciplined Child.

The Herald grabbed a few minutes with Goldstein prior to his visit.

Q: What, exactly, is attention deficit hyperactivity disorder?

A: Simply put, it’s a delay in a child’s ability to keep pace with their developing self-discipline relative to their peers.

They tend to have trouble regulating their emotions and their behaviours, which interferes with performance situations like school, social situations like on the playground or in family situations like at the dinner table.

It’s been portrayed as a psychiatric condition, but it really is a developmental difference or delay. The brain’s executive function is slower to develop.

Q: It seems to be everywhere, but how widespread is it really?

A: The problem is they’ve so liberalized the definition of it that now every other child is described as having ADD, which is unfortunate because if you look at the outcome of the two or three or four per cent of children who are at the bottom of the bell curve at the rate at which they mature in this area, they struggle.

They struggle in school, with substances, with interpersonal relationships. They struggle to transition into functional adult life. They are also more likely to kill themselves in a car, more likely to contract a sexually transmitted disease.

Q: Is ADHD something kids can outgrow as the executive part of their brain matures?

A: Do you outgrow ADHD? No. Can you reach a point in your life where you compensate sufficiently or where your brain has matured to where you don’t meet the diagnostic definition because you do not have significant impairment? Absolutely, yes.

What we see is that if you take a group of children with ADHD and follow them into adulthood, about one-third have very poor outcomes. One-third are in the middle and one-third do pretty well. What percentage still meet the diagnosis? Probably 80 per cent.

Q: Can you predict who will be OK and who won’t?

A: We began looking at children with conditions like ADD who transitioned to adulthood and managed to find some normalcy in their lives, who managed to get through school and have a family and jobs and not be burdened by substance abuse and other adversities.

We discovered that there’s this “ordinary magic”: universal qualities that insulate children over time. Treatment — medication, counselling, educational support, parent support — has only a very small prediction in outcome.

The larger prediction of who will thrive is predicted by universal factors . . . things like developing self-discipline, resiliency and learning to deal with mistakes. Being connected to people. Developing empathy. Learning how to problem-solve. Developing an island of competence — something that gives you a sense of identity and purpose, even in the face of other challenges and adversities. Having a charismatic person in your life [an adult from whom you gather strength], who loves and cares for you, even when they’re angry at you.

These seem like fairly ordinary phenomena, but when you study the outcomes of children broadly — not just those with disabilities — you find they’re very powerful predictors over time of life satisfaction, of normalcy in adult years.

Q: Do people with ADHD have any unique strengths?

A: They have the same strengths as anybody in the general population. I don’t think the condition comes with any assets or benefits. Out of the thousands of studies that have been done, there’s not a single one to demonstrate that people with ADHD perform better.

There’s a movement to glorify people with ADHD, to describe them as “hunters in a farmers’ world,” [a reference to author Thom Hartmann’s books about ADD]. Really, people with ADHD learn to live with it, to adapt and make it part of their successes. There’s never been any empirical support for the folklore that having ADHD will make a person a better jet fighter or stockbroker.

Q: Are there learning environments that children with ADHD function better in?

A: Yes, when they can talk, move and question. When the material is not boring and repetitive and effortful and the payoff is something they value. It isn’t that they can’t pay attention, it’s that they don’t regulate attention unless the stakes are higher. They need a higher level of stimulation and motivation to bring that kind of self-discipline to the table.

It’s not that they can’t do it, it’s that they don’t do it in a consistent, predictable, independent way. That’s what parents have to understand: It’s not “I have to teach you how to do it”; it’s more like “I have to help you develop the self-discipline to do what you already know.”

Q: What other advice do you have for parents?

A: [Raising a child with ADHD] is a challenge. Treatments like medication take you just so far. Emerging literature shows that communicating and interacting with your child every day, giving them opportunities to become stress-hearty and really appreciating their assets along with their liabilities sets a foundation for a parent to make a difference.

How you shape their lives will determine what happens to them over time, help them be more consistent, predictable and independent in what they already know how to do. Be proud, patient and persistent. It’s like teaching a poorly coordinated child to ride a bicycle. You need to be patient, understanding and appreciate that the child’s disability makes it harder for them to accomplish the task, but if they stick with it, they get it.

Read more: http://www.calgaryherald.com/health/Understanding+ADHD/5728716/story.html#ixzz1e53OmdjP