Elimination Diets for ADHD Not Ready for Primetime

The news has been full of reports of the INCA study, including the following conclusion on National Public Radio from the lead author, Lidy Pelsser, MSc: “64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food.” CHADD experts have looked at the study published in The Lancet. Without a great deal more research that supports the findings of this study, we would urge people to slow down and not jump to trying an elimination diet.

The families in the study were either put on a rigorous and closely supervised elimination diet or assigned to a control group that received instructions for a healthy diet. An alternative explanation for the results could easily be that the children in the experimental group responded well to a highly structured environment and lots of attention—both necessary for an elimination diet—and not the diet itself. Another explanation is the all-powerful placebo effect.

While this was a randomized study, the participants all knew which group they were in. This lack of blind experimental and control groups is a major research design flaw. The placebo effect is usually controlled by making sure all participants are blind to the intervention they are receiving. For instance, an experimental group might get the elimination diet and the control group might get a bogus elimination diet which eliminates only foods unlikely to make a difference. Then the children in both groups would receive the same amounts of structure and adult involvement. That did not happen in this study. Conclusions about hypersensitivity to food and ADHD cannot be made on the face of this single study, and certainly not when the groups were aware of the interventions.

Years of research on diet and ADHD have concluded that a very small percentage of children with ADHD who also have food hypersensitivities may do well with a controlled diet. So if you know or suspect your child has food hypersensitivities, then you may want to try an elimination diet with good medical supervision. But for the vast majority of people with ADHD, there is not yet evidence that this will make a difference.

Ruth Hughes, PhD
CHADD Interim CEO

ADHD Relationship Tips

Maintaining and sustaining an intimate relationship is difficult for anyone. It can be more challenging if one or both partners have ADHD. When a spouse is constantly distracted or can’t slow down enough to pay attention to his or her partner’s needs, it often leads to relationship meltdowns.

The majority of my clients have marital problems. Clients wind up at my coaching door because their significant other has given them an ultimatum: “Get help for your ADHD or else!” At this stage, uncontrolled ADHD symptoms are not only jeopardizing their relationship but also their job and sometimes their health.

As I’ve said many times before, a client must want to be coached in order to be helped by the process. He or she can’t be forced to change. Frankly, though, I’ve never had a client with relationship problems who doesn’t want to make changes to improve his or her marriage.

When one spouse has ADHD and the other doesn’t, I often invite the non-ADHD partner, with the permission of my client, to give me feedback about how ADHD plays out in their life. When both have ADHD, problems can be compounded. Impulsivity and distractibility can cause fights and tear couples apart. Each person feels angry, humiliated, frustrated, and misunderstood. Partners can end up not trusting one another and, as a result, they feel disconnected and resentful.

No matter who has the ADHD, here are a few simple principles that couples can use to promote understanding and healthy relationships.

Nurturing the Marriage

Each person must take responsibility for his or her own actions—or lack thereof. In other words, the person with ADHD can’t use the condition as an excuse, and the non-ADHD partner must learn as much as he or she can about ADHD to understand how it affects his or her spouse. A relationship can’t survive—never mind thrive—if one partner blames another for things that are out of his control. The better option is to look for ways to nurture the relationship. Like choosing your fights. Each partner should ask, Does X, Y, or Z contribute to the growth of our relationship, or does it tear it down? If it doesn’t nurture it, agree to let it go.

Cathy felt like she was married to a ghost. When she tried to talk with her husband, Roger, about her needs, he would walk away, interrupt, or check his iPhone. Cathy, feeling alone and isolated, would stomp out of the room in frustration. When she confronted her husband about tuning her out when she wanted to talk, he would yell back, “Why does it always have to be about you?”

Through coaching, they came to understand that it wasn’t about Cathy or Roger, but about their relationship. By viewing their marriage as a third entity—as something that needs love and care to grow—they were able to slow down and listen to one another. They also realized that blaming one another and fighting over small stuff was only tearing down themselves and their 15-year marriage.

Reinforce with Praise

I remember getting a call from Sally, the wife of one of my clients, Bob. She was at her wit’s end and told me she was going to leave Bob. The trigger for such an extreme move? The Sunday newspaper. After reading it, her husband continually left the sections scattered all over the living room floor.

Bob and I developed strategies to help him to remember to pick up the paper and throw it away, instead of leaving it strewn in the living room and kitchen. Wanting to please Sally, he also decided, for the first time in their 20-year marriage, to pick up his clothes off the bedroom floor. He did this for a month without a syllable of praise from her. Yet the minute he blew it and left the newspaper on the floor again, she started yelling at him. He felt defeated, as if all his efforts were for nothing.

I found it hard to bite my tongue when Sally didn’t acknowledge Bob’s efforts. Looking at the relationship from her perspective, she was waiting for “the other shoe to drop.” She was so used to Bob reverting to old behaviors that she could focus only on his mistakes. Meanwhile, Bob became more discouraged.

ADHD is not an excuse, but if your partner is trying to change his behaviors, acknowledge it and encourage him or her. Praise is a tonic for persons with ADHD, who often have had a lifetime of shame and blame. Look for instances when your spouse is doing something right versus something wrong. Non-ADHD spouses should try to remember that change and progress might take a lot longer due to the wiring of the ADHD brain.

Plan Time Together

Schedule date nights and don’t skip them—no matter what. Make that commitment and stick to it. Time away will help you not only distance yourself from the day-to-day madness, but will also allow you to remember what you loved about each other when you first met. Always keep the door open for intimacy.

Eliminate Toxic Interactions

When one partner has ADHD, taking care of the details of daily living can often be the source of tension between a couple. It typically goes like this: The non-ADHD spouse asks the ADHD person to do something—pick up a few things at the grocery or change a light bulb. But because of ADHD symptoms, the request is never fulfilled. This type of dynamic almost led Craig and Beth to get divorced. Craig would tell Beth that he was going to fix something around the house, but he didn’t do it. After weeks of frustration, Beth’s anger would start to build and inevitably she would blow up.

I worked with them to create new strategies of communication, because it was clear to me that they couldn’t talk without hidden resentments emerging. I suggested that they use a notebook to list and check off tasks that needed to be done. Other suggestions included hanging up a white board or using Google Calendar, which allowed them to communicate without bitterness or anger.

Have a Sense of Humor!

I’ve had many clients say to me, “I feel that my partner just tolerates me these days. I wish he would embrace me for who I am—all of me—like he used to. He used to think my quirks were cute! Now I feel ashamed and demeaned.”

While it’s important not to use ADHD as an excuse, it’s equally important to see the humor in some of the behaviors it causes. For instance, I would avoid doing work by moving furniture. Thank goodness my husband never cared. He said it felt like he was coming home to a new house each day! It might have driven someone else nuts, but we still laugh about it.

Coach Nancy at CHADD blogspot

ADHD is Real!

The starting point for the Family ADHD Solution and for attention deficit/hyperactivity disorder (ADHD) care in the real world is understanding that ADHD (and this includes ADD, which is now more accurately labeled ADHD-inattentive type) is a proven, often misunderstood medical disorder. When parents, teachers, or kids are lead to believe ADHD is fake or in some way just an excuse for a child’s lack of effort, motivation or self-control, it leaves adults frustrated and confused, children wrestling with their own neurologic tendencies without guidance, and siblings caught in the middle.

We should be far beyond any debate about the reality of ADHD. It is real, and there are dozens of credible studies that prove it. When appropriately identified, ADHD is no different than any other medical condition. Where the problem occasionally arises is in getting an accurate diagnosis; ADHD can be hard to recognize in any individual. Instead of pouring effort into a meaningless debate about if ADHD exists at all, we can best support families by helping them understand what ADHD really is, and how to manage it.

ADHD is a poorly named condition. The stereotypical symptoms - lack of attention, hyperactivity and impulsiveness - merely scratch the surface. The parts of the brain implicated in ADHD also control executive function skills - abilities such as time management, judgment, organization, and emotional regulation. Executive function is kind of like the brain manager, responsible for supervising and coordinating our planning, our thoughts and our interactions with the world. The true issue with ADHD is one of executive function and as has been said by Dr. Russell Barkley and others, a more appropriate name for ADHD might be ‘executive function deficit disorder.'To guide families onto a better path, we need to stop debating the existence of ADHD and instead clear up misconceptions about it. When parents or teachers lose track of the fact that ADHD is a neurologically based deficit, kids get blamed for behaviors and choices not fully in their control. Understanding the neurology of ADHD allows us to recognize that a child's apparent misbehavior or poor motivation comes down to a concrete, skill-based difficulty with focus, staying on task, controlling emotions, or any other of a long list of life skills related to executive function.Just as some people can draw, shoot a basketball, or pick up how to play an instrument more easily than others, planning, remembering and paying attention are innate abilities driven in large part by our genetics.

Chronic issues with forgetfulness, poor planning, getting off task, leaving homework assignments behind, not listening when called, losing one's cool when frustrated ... all reflect deficits of executive function. You might choose to teach someone how to shoot a free throw, or a new way to keep track of their to-do list, but the skill will not materialize out of thin air.You wouldn't say to a child with asthma, "Just try harder, stop wheezing." Likewise, expecting a child with poor executive function skills to ‘pull it together' right now is unfair and sets up challenging, often unrealistic expectations. Instead, we must develop a compassionate and objective view of their true abilities, followed by detailed planning that both builds skills and creates strategies compensating for areas that remain difficult. We encourage appropriate behavior and hard work, but also must be aware that ADHD-related hurdles can get in the way.Addressing the wide-ranging impact of ADHD on families starts with recognizing it as a medical condition affecting executive function. When we start to understand the full reality of the situation - that someone with ADHD has a true disorder affecting how they manage their lives - we can then make skillful choices about how we parent, how we teach, and how we can best manage other aspects of care. When we recognize the actual cause of ADHD and its far reaching symptoms, we can compassionately change our expectations while offering intelligent long-range plans that develop skills and make certain all children with ADHD reach their full potential.

Published in Psychology Today, March 2011

Tips for Daily Self-Management

For me, trying to self-manage and get through a day with ADHD is equivalent to corralling a herd of wild stallions. I have to remain vigilant at ALL times. I have to remind myself that I have ADHD, self-observe, and use what I call my “survival” strategies. If I don’t, I’ll be left to my own devices—racing across the savannah headed who knows where!

Over the years I’ve learned that these strategies form the foundation that keeps me tethered and allows me to accomplish my goals for each day.

Stay focused—PARK IT!

To combat the racing thoughts that come with ADHD, create a method to “park” them. This could be texting or emailing reminders to yourself, using recording devices, or jotting them down on paper. My preferred method is paper. I keep paper everywhere—in my car, purse, kitchen, bedroom, office, bathroom, on the stairs, by the front door, the garage door. Even when I exercise, I carry paper and pen. By parking it, I won’t forget the thought, obsess about forgetting, or act on it—I’ve parked it and can act on it later!

Keep the day manageable

My motto is, “If your daily list/goals gets bigger than a post-it, you have too much on your plate.” And my post-its are the three-inch by three-inch ones (not the three feet by five feet flipchart-sized post-its).

Visualize yourself in time and space

At the beginning of each year, I print out the next twelve months—one month per sheet. I post them across the wall and fill in ONLY “big ticket” items such as conferences, vacations, or anything out of my regular routine, doctor appointments, visitors, and so forth. As each month goes by, I draw a huge ‘X” through it. This way I can conceptualize time passing, the future and events to come.

Smooth out transitions

Transitions are the bane of my existence. If I do not know what is coming up next I become anxious, panic and at times end up becoming paralyzed. To prevent this, I do the following:

• As far in advance as possible I collect, organize and set out everything I need ahead of time for projects, trips, or getting in the car to do errands.
• I then post notes, such as: “Nancy, remember, conference in 2 weeks!” or “Go to bank at 3 pm!”

Keep perspective

Anyone who has ADHD knows that life can be like a rollercoaster ride—there are ups and there are downs. The problem is we can become very myopic and convince ourselves during the down times that things will never get better. I’ve learned to appoint two to three trusted, longtime friends who know me well to give me a reality check. They remind me I have ADHD, that I tend to think catastrophically, that I tend to forget the positive things, and that within a few hours or by the next day I will have forgotten about it and be “back to normal.”

Manage meals

Set the table the night before. Pre-prepare any ingredients ahead of time—chop any vegetables ahead of time and put them in plastic baggies so all you have to do is throw them in the mix.

Remember to take things to the car when running errands—including your to-do list!

Tape or clip your car keys to whatever it is! Packages, letters, to-do lists, dry cleaning, and so forth.

Manage finances

Use one, and only one, credit card to charge everything, and ONLY do online paperless bills and banking.

Keep track of important things

I always tell someone else where I've hidden a spare key or put an important document. History demonstrates that I'll always forget, no matter how important it is. I also photocopy of all contents of my wallet, in case I ever lose it.

Organize papers

Don't sweat the small stuff! I clump things in categories. Any similar projects get clumped together. Conferences, bills, client work, health, office equipment, etc., get filed into a file cabinet and ONLY "active" projects stay on my desktop, either in wire baskets or expandable flex file folders so I can carry them around with me and work on them in different places.

http://chaddcoach.blogspot.com/2011/03/tips-for-daily-self-management.html

Learning Games to Help Students

Frequently in our classrooms we come across a topic or exercise that appears simple in its content, but for some reason, the students (or some of them) just don’t get it. This month I’d like to share an experience with you that walks through how my ADHD brain collided with another’s and how we solved the problem.

My client Susie is a very inattentive 20-year-old with inattentive-type ADHD, and we are working on getting her ready to take the Georgia driving exam. How hard can that be? Susie reads well, but only if you consider word pronunciation, pausing at commas and stopping at periods. She has learned the technique. However, content understanding is so missing. She daydreams, thinks of other things, like wondering if the Braves will play a good game that night, whether her dog dug out of the back yard, and whether she feels ill, so she doesn’t have to do work! Remind you of anyone you know?

The issue isn’t one of lack of intelligence. Perhaps some passive-aggressive tendencies interfere due to fear of failure. You can explain material to her until you are blue in the face, but the wandering attention and lack of focus get in the way, and you wear out long before she does. She responds best to visual prompts and remembers most clearly when she is actively involved in the learning. A real take on our learners who need active involvement to stay engaged. Therefore, how do we approach this in the most efficient way so that learning takes place?

Spinning the disks in my own ADHD brain, I came up with designing a game to make the concepts clear, the need for action inherent, and the approach energizing to retain focus. Printing off the Driver Manual, it became evident that it was written by politicians on the State Transportation Committee, and edited by a lawyer with an expertise in legal-eze.

Turning Right at a Red Traffic Signal
“Before turning right on red, drivers must come to a full and complete stop before the crosswalk. Do not block the crosswalk when waiting to make a right turn at a red light. This puts pedestrians at risk, forcing them to walk around your vehicle. After looking to your left to find a gap in traffic, you must look to your passenger side to ensure a pedestrian is not crossing in front of your vehicle.” - GA DDS 2009 Driver’s Manual, p.93

The first issue was to turn some high verbal, overly lengthy description into a simple step-by-step explanation. Make it short and to the point –Keep It Straightforward and Simple.

TURNING RIGHT AT A RED TRAFFIC SIGNAL
1. Come to a complete stop.
2. Do not block the crosswalk.
3. Do not obstruct pedestrians.
4. Look left; find a gap in traffic.
5. Look right; check for pedestrian traffic.
6. Proceed cautiously into a right turn checking oncoming traffic.

The second step was to determine how to operationalize the information so it is interesting, has multiple possibilities of demonstrating competency and makes learning operational and fun. As students with ADHD tire easily using only one approach, varying modes of responses were developed to make the game fast, fun and constantly changing. The name of the game soon determined the multiple operational styles.

DRIVE – ALIVE
The word DRIVE becomes the acronym for the various styles of responses the player would perform.

D - Demonstrate
The player will nonverbally role-play the situation presented on a card. Other players may be called upon to assist so the situation can play out successfully.
5 points for a successful demonstration

R - Reflect
The player will give a presentation as to why a particular driving rule must be followed and the consequences of failing to do so. Statements should be convincing and clear.
5 points for a successful demonstration (1 point per fact given)

I - Instruct
Using printed street plots, the player will demonstrate the situation presented on the card. Some situations will relate to rules of the road, others will relate to common courtesies needed to be a good driver.
5 points for a successful demonstration

V - Visualize
Using printed icons, drawings and other available objects, the student will show using their own imagination and skill, how to relate and pictorially represent a situation and its outcome.
5 points for a successful demonstration

E - Examine
The player will examine a scenario and determine whether or not the situation was legal, proper for a driver to have done, or some part of the event needed to be done differently. Clear and concise understanding of good driving habits should be used.
5 points for a successful demonstration

Instruction cards will be drawn for each play. The color on the card will indicate the type of activity requested. Materials necessary for play will be in boxes, sorted by the type of play.

Actual road scenes, cars, school buses, railroad crossings were captured from Google Images to assist in demonstration. I felt that the closer to reality the visuals became, the more realistic the image reinforcement, the more serious the output. For consequential learning, scenes from automobile accidents and other serious outcome images were used, with tact and appropriateness, of course.

For the Demonstrate phase, a collection of hats, scarves, sunglasses enhances the ability to role play.

Scenario: Darin and Phelicia are walking across the street. Susie is approaching the intersection and intends to turn left. Portray the scene and demonstrate the correct safety precautions and procedures for the left turn.

For the Reflect phase, a simple microphone or podium sets the scene.

Scenario: You are at a party with a bunch of your friends. Some of the kids begin drinking beer and appear drunk. What do you say to them to be sure you all arrive home safely that night?

For the Instruct by showing phase, craft magnets were glued to colored blocks with stickers to represent various cars, trucks, buses. Using a simple cookie sheet, street plots with were placed on the cookie sheet. Adding pedestrians, trees to obstruct the view, cars traveling in various directions, you can easily create a motoring situation to address. The materials were easy to find, easily obtained through the internet, big box and/or art store, and in a short period of time, the highly verbal confusing text of the drivers’ manual has become an operational game.

Answer these questions: What do the signs tell you about how you should drive? Indicate the outcome if you do not obey. Show the outcome.

Instructions: Using the mountain road scene, instruct the proper way to navigate this pass using the car and the truck. On your tray portray what you should do. Can you pass safely? What do the lines in the road tell you?

For the Visualize phase, a box of drawing paper, color markers, icons of signs and vehicles printed on sticky labels assists those who are grapho-motorically delayed. Everyone has a chance to succeed.

Instructions: Draw a picture showing what you should do as you approach a schoolbus loading children.

An easy way to develop stickers or icons is to import simple Google images into an Avery label frame. Stickers can easily be removed and placed on diagrams, avoiding the need to draw with accuracy, enhancing the feeling of success.

For the Examine phase, pictures of auto accidents, judges, court scenes, police all help the player to bring his/her message home.

Answer question: When an officer approaches your vehicle, what violations will result in your immediate arrest?

DRIVE – ALIVE is not completed yet, unfortunately, but using the DDS Manual, having Susie describe events as we wander through the manual, it is a work in progress. Demonstrating, Reflecting, Instructing, Visualizing, Examining all enhance the learning process.

Teaching is a challenge, especially when our learners hit a brick wall.
I hope this gives you some idea as to how to take one simple subject, and by presenting it in multiple ways, create an exciting learning outcome. I’ll let you know how the game develops as our time together progresses.

by Joan Teach at http://adhdteacher.wordpress.com/

Teacher to Teacher: Classroom Interventions for the Student with ADHD

Teacher to Teacher:
Classroom Interventions for the Student with ADHD

Sunday, May 15, 2011

Hyatt Regency Wind Watch, Long Island, NY

1717 Motor Parkway, Hauppauge, NY

Do you have students with ADHD in your classroom? Every teacher does. Do you feel challenged to find the balance between the needs of your class and helping the student with ADHD learn effectively? You are not alone. If you are a parent of a child with ADHD who is struggling in school, would you like to learn about effective classroom interventions? Then Teacher to Teacher is for you.

Join us for a day-long workshop that identifies common ADHD-related learning problems plus practical classroom techniques, interventions, and the latest research to enhance school success for students with ADHD. Designed for mainstream classroom teachers, Teacher to Teacher will provide best practice strategies in an interactive, hands-on format. Attendees will have the opportunity to discuss solutions to common academic and behavioral problems in a "case-based" format. Each workshop is limited to 100 attendees, so don’t wait to return your registration. Each attendee will also receive the CHADD Educator’s Manual on ADHD: An In-Depth Look from an Educational Perspective. This is "the" manual for managing students with ADHD and a fantastic resource.

The Content

From theory to practice you will learn evidence-based interventions to manage every aspect of AD/HD in the classroom, including:

* Understanding ADHD
* Keys for Academic Success
* Organizational Deficits and ADHD
* Effective Behavioral, Emotional and Social Interventions
* Real Life Challenges: Case Based Problem Solving
* Designing ADHD-Friendly Classrooms

The Trainers

Chris Dendy, MS, has over 40 years of professional experience as a teacher, school psychologist, mental health counselor and administrator. She is a prolific author and the producer of three videos on ADHD. She is a previous member of the CHADD board of directors, and in 2006 was inducted into the CHADD Hall of Fame for outstanding contributions to the field. She is also the mother of three children with ADHD. Chris is the editor of the highly acclaimed CHADD Educator’s Manual on ADHD: An In Depth Look from an Educational Perspective.

Anne Teeter Ellison, EdD, is professor emeritus of Educational Psychology at the University of Wisconsin-Milwaukee (UWM), has served on the CHADD board of directors since 2002 and served as president from 2005–08. Prior to service on the national level, Ellison was a professional advisor to the Wisconsin ADHD Project, and a member of the State of Wisconsin ADD Council. Formally the training director of the school psychology doctoral program at UWM, Ellison has published numerous scientific articles and books and is the co-editor of the CHADD Educator's Manual on ADHD: An In-depth Look from an Educational Perspective.

Continuing Education Credits

All participants will receive IACET approved continuing education credits of .75 (equivalent to 7.5 hours of training).

Time and Place

Sunday, May 15, 2011
Hyatt Regency Wind Watch, Long Island, NY
1717 Motor Parkway, Hauppauge, NY

Online Registration! Download the Teacher to Teacher Application for the next Training (requires Adobe Reader ).

Register Online Here

Cancellation Policy

Any cancellations must be received in writing, or by email, stating the person's name and address, and must be postmarked or date-stamped at least three (3) weeks before the training to qualify for a refund. A non-negotiable $25.00 administrative fee will be deducted from the total registration refund, unless the registration is 'transferred' within six months (Call the Coordinator for details). No refunds will be made after the event deadline and no-shows will forfeit their registration fee.