ADHD and the Concept of Recovery

Statement of the CHADD Professional Advisory Board (PAB)

In response to numerous stories about the relationship between ADHD and the concept of recovery, the CHADD Professional Advisory Board (PAB) approved the following statement on April 6, 2009.

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Background

In 2002, then-president George W. Bush created the President's New Freedom Commission on Mental Health. The Commission's charge was "to study the mental health service delivery system, and to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbance to live, work, learn, and participate fully in their communities." The Commission submitted its final report to the president in July 2003 in a report entitled, Achieving the Promise: Transforming Mental Health Care in America.

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the United States Department of Health and Human Services (HHS), continued the work of the Commission when it published, Transforming Mental Health Care in America, Federal Action Agenda: First Steps in 2005. Prior to publishing this Agenda, SAMHSA consulted with other federal agencies and numerous experts, including mental health consumers, family members, providers, advocates, researchers, and others. This consultation resulted in a National Consensus Statement on Mental Health Recovery.

This statement identifies ten (10) fundamental components¹ of recovery and defines the term as follows:

• Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

Relationship to ADHD

The concept of recovery may not be familiar to most families and individuals faced with the challenges of attention-deficit/hyperactivity disorder (ADHD). The term itself may also suggest a different meaning to health professionals whose primary work is not in a mental health setting. Nonetheless, there are numerous points of connection between recovery as defined above and the successful management of ADHD. In this context, it is important to understand both what recovery means and what it doesn't mean.

Here, recovery does not refer to a process that necessarily has a foreseeable endpoint. The individual who breaks a leg will typically go through a process of recovery from such an injury. At some foreseeable point down the road, the individual will be said to be fully recovered. This is typically not how recovery is used with reference to those facing mental health challenges, including many with ADHD. While some individuals with particular mental health challenges (including a subgroup of children with ADHD) are able to move to a condition of being recovered, for many individuals with mental health conditions, recovery is usually dynamic and ongoing, not fixed and static.

This applies to most adults with ADHD. For such individuals, recovery can best be understood as the ongoing management of ADHD symptoms. The two main hallmarks of mental health recovery are living a "meaningful life" and growing toward one's "full potential." For those with ADHD, these are not only applicable, but are also highly attainable. Despite the many challenges they face, resources exist that can help individuals with ADHD attain a level of well-being marked by independence, healthy interdependence, hope and personal satisfaction.

The bulk of treatment research on ADHD has focused on the condition in children, and the options for them have a strong evidence-base for symptom reduction. For many, the need for intervention persists over the long-term. Although ADHD has been less thoroughly researched in adults than in children, adults who have been correctly diagnosed with the disorder can still take advantage of whatever treatments best meet their needs. In addition to evidence-based interventions, there are those which have been shown to be "promising," and which may be experienced as effective by the individual. Working with one or several health and mental health care practitioners, adults with ADHD can learn to manage symptoms as they are expressed in their lives.

CHADD recognizes that ADHD is a condition that affects individuals "across the lifespan." This means that ADHD symptoms are usually experienced from one phase of life to the next, and that they extend to the various spheres of life during any particular life phase. Based on the notion that adults with mental health challenges should be empowered to exercise their right of self-determination, the concept and components of "recovery" have much to offer individuals with ADHD and all those who are a part of their lives.

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1. These components are: self-direction, individualized and person-centered, empowerment, holistic, non-linear, strengths-based, peer support, respect, responsibility, and hope.

Difference Between Asperger's and ADHD

Ask the Specialist: What is the difference between Asperger’s and ADHD? Dear Specialist: There is a child in my daughter’s class that seems to display some of the symptoms of ADHD but I have been told he has Asperger’s and not ADHD. What is the difference between these disorders? -- Classroom Mom Dear Classroom Mom: Thank you for writing. These two disorders often share some symptoms, such as appearing not to listen when spoken to, unable to maintain attention on a directed task, or difficulties with social skills. The root causes of these behaviors, though, are very different and the disorders need different forms of treatment to help the child. Asperger’s Disorder (sometimes called Asperger’s Syndrome) is often considered to be on a spectrum of related conditions which have similar symptoms (sometimes referred to as the Autism Spectrum, though more properly known as Pervasive Developmental Disorders) and includes Autistic Disorder, among others. Unlike children with Autistic Disorder, children with Asperger’s disorder generally have good language skills. However, they also have difficulty with the subtleties of language, such as humor, irony, or metaphors. They have a trouble with the give-and-take of a conversation and trouble with turn-taking between friends or in a group. Like children affected by ADHD, they display attention difficulties but those are more related to a need for rules and routines to be followed than to a perceived overload of stimuli. By comparison, a child with ADHD has difficulties with attention due to impulsivity, novelty and, for some, hyperactivity. A child affected by Asperger’s tends to focus all of her attention on one task or activity. A child affected by ADHD normally has her attention drawn away from a task or activity by trivial stimuli in her environment, such as another child coughing or a bird flying by the window. While the child with Asperger’s remains focused to the exclusion of other events, the child with ADHD is more likely to be distracted by her environment and may quickly jump among activities or behaviors. Another difference between the expressions of the two disorders is a child affected by Asperger’s generally does not show a wide range of emotion, while the child affected by ADHD may have difficulty controlling his emotions and move very quickly among emotional states. Children affected by Asperger’s have difficulty making or maintaining eye contact. For this reason, they may appear to not be listening to adults when they actually are. A child affected by ADHD is not listening because he is focusing on other things, environmental stimuli or even his own thoughts. Another area of significant difference is the understanding that other people have separate thoughts, emotions, wants, and needs than the child does. This is called social reciprocity. A child with Asperger’s lacks this understanding of social reciprocity, while the child with ADHD in most instances grasps the understanding. Both ADHD and Asperger’s Disorder are typically not diagnosed before middle-childhood (i.e. not before the age of six or seven, though possibly later). Parents who are concerned that their child shows any of these symptoms need to discuss these concerns with their child’s health care provider and seek a thorough evaluation. For both disorders early treatment is key to future success in life. The majority of children identified with either disorder and who receive proper treatment, grow up to be happy and successful adults. Have a question about what you just read? Our health information specialists are here to help. Contact us at 800-233-4050 or online.

National Resource Center on AD/HD: A Program of CHADD

Is it More than Adult ADHD?

There are approximately eight million adults in the U.S. with ADHD, and research suggests that as many as 80% of that population have at least one accompanying disorder, and more than half have two or more co-occurring disorders. A proper diagnosis given by an experienced professional who understands which symptoms are and are not caused by ADHD can identify these co-occurring conditions and lead to a comprehensive treatment plan addressing all symptoms. “It would be incredibly demoralizing to address ADHD and still struggle because some other problem has gone undiscovered and untreated,” writes Russell A. Barkley, PhD in Taking Charge of Adult ADHD (available for purchase here). Barkley and fellow researchers Kevin R. Murphy and Mariellen Fischer (cf. ADHD in Adults: What the Science Says, 2008), identify conditions commonly co-occurring in adults with ADHD, including: Oppositional Defiant Disorder Conduct Disorders/anti-social personality disorder Substance use disorders Anxiety Depression In March 2011, researchers from the University of Bergen in Norway reported finding an ‘overlap’ of symptoms between ADHD and bipolar disorder when looking at mood swings (see NRC’s ADHD In the News, March 3, 2011). These researchers state that discussions are currently underway to consider whether or not mood swings should be included in the official list of diagnostic criteria for ADHD. “AD/HD is only one of many conditions that can affect concentration and make someone distractible and forgetful,” writes psychologist Ari Tuckman, PsyD “…[T]rouble concentrating just tells us that something is going on, but it doesn’t tell us what,” (cf. Along for the Ride: conditions that Co-Exist with ADHD, Attention, February 2010). Tuckman states that one study found as many as one-third of adults with ADHD experience either major depression or a longstanding, milder form of depression known as dysthymia. Because depression can affect concentration and focus, Tuckman cautions that a professional who is not familiar with ADHD may miss one disorder or the other. This reinforces the importance of finding a health care professional [FAQ on finding a professional link] who is experienced with diagnosing and treating ADHD, and who can make the necessary distinctions between the full presentation of all symptoms. General information on co-existing conditions is available through the NRC’s website, and in the What We Know #5 – 5D series of information sheets regarding ADHD and common co-occurring conditions. The prevalence of disorders that occur with ADHD is no small matter; these conditions affect a large majority of adults with the disorder. Diagnosing and treating the wrong disorder, or diagnosing ADHD and missing a coexisting condition, can lead to treatment plans that will not be as therapeutic as they could and should be. Only a well-crafted plan that addresses all conditions and symptoms will give adults with ADHD a better chance of fulfilling their potential and achieving a higher degree of success. Have questions about what you just read? Our health information specialists are here to help. Contact us at 800-233-4050 or online.

National Resource Center on AD/HD: A Program of CHADD | 8181 Professional Place, Suite 150 | Landover, MD 20785
ph: 800-233-4050

Your Rights in the Workplace: ADHD and Employment

Note to parents: Chances are your teen or young adult did not receive information like this from high school guidance counselors or the college employment office. Before your young adult enters the working world, be sure he or she is aware of its realities for people affected by ADHD or other disabilities.

by Lewis Maltby


THE TRANSITION FROM SCHOOL TO THE WORKPLACE IS A CHALLENGE for people with ADHD. The demands are higher and the willingness to accept lapses is lower. Worst of all, unlike in other aspects of life, there are no true second chances. It’s like a parachute jump; you have to get it right the first time.

Having ADHD presents special challenges in the world of employment. Difficulties focusing, being easily distracted, impulse control, and difficulty managing time often interfere with a person’s ability to perform his or her job. Employers generally don’t understand that these are symptoms of a medical condition and often move to get rid of the person.

Fortunately, the law provides some help to people with ADHD. This protection, however, is limited and not easily obtained.

Under the Americans with Disabilities Act, it is illegal for employers to discriminate against employees or job applicants because they are disabled. Even more important, the ADA requires employers to provide “reasonable accommodation” to people with disabilities.

Is ADHD a disability?

For someone to be protected by the ADA they must have a “disability.” Not every physical or mental limitation is a disability under the ADA. To be considered a disability, the condition must “substantially limit a major life activity.” Unless the limitation is substantial, the condition is not a disability. Mild ADHD symptoms may not meet this standard.

People with more serious ADHD symptoms have a disability under the ADA. Employers may not legally discriminate against them. If an employee with AHHD performs her job as well as other employees, she cannot be terminated because her occasional lapses in concentration or other symptoms annoy her employer.

But even here, getting legal protection can be difficult. Judges, like most people, don’t understand ADHD and are reluctant to consider it a disability. While some court decisions have held that ADHD is a disability, the majority have held that it is not. Winning a disability discrimination case involving ADHD requires educating the judge about ADHD and the way it affects the person involved in the case. Having a qualified expert can be the key to this process.

Fortunately, one roadblock to legal protection has been eliminated. Prior to 2008, the courts determined whether a person is disabled by examining the extent of her limitation after mitigating steps have been taken. A person with ADHD would be evaluated by the extent of her limitation after she had taken medication. In 2008, the ADA Amendments Act changed this rule. Whether a person is sufficiently limited to be legally disabled is now determined by their condition without medication (or other mitigation).

Is the accommodation reasonable?

Many people with disabilities have difficulties performing a job under exactly the same circumstances as other people, but can perform the job if changes (accommodations) are made. If these accommodations are reasonable, the employer is legally required to make them.

Whether an accommodation is reasonable depends on how much cost it would impose on the employer. While there is no numerical formula, the costs must be modest. Examples of accommodations courts have held reasonable include:

● providing a telephone amplifier for an employee with a hearing impairment
● providing anti-glare computer screens for employees with visual disorders
● raising the level of desks and other work stations for people in wheelchairs

While there have been very few cases involving reasonable accommodations for people with ADHD, decisions involving other disabilities indicates that physical devices that reduce the amount of distraction would be considered reasonable. Accommodations that might help people with ADHD that would generally be considered reasonable are:

● being allowed to wear ear plugs or headphones to reduce distracting noise
● being allowed to work behind a closed door
● receiving instructions in writing

In some cases, a person with ADHD may be incapable of performing one job at a company but capable of performing another. If the employer has an opening for such a job, a transfer would generally be considered a reasonable accommodation.

Flexibility on time might also be valuable to employees with ADHD. For example, an employee with ADHD-induced time-management problems might be excused if he or she came in a few minutes late for work occasionally, unless it interfered with getting the job done. An employee who works on his or her own could easily make up the lost time by staying late or skipping lunch. For an employee who works as part of a team, it would be different. Unfortunately, there are virtually no judicial decisions in this area.

Requesting accommodation

Whatever the accommodation, it is essential that the employee ask for it. Under the ADA, it is the employee’s responsibility to inform the employer of her disability and the accommodation that she needs.

ADA Amendments Act

Many people have the impression that the ADAAA eliminates all the legal difficulties facing someone with ADHD. This is not the case. While the ADAAA solves the problem of a person with ADHD not being protected because his or her symptoms are reduced by medication, it does not change the accommodation standard. An employer is required to provide an accommodation only if it is “reasonable.” As discussed above, courts have not been generous in their definition of what is reasonable.

Practical considerations

There is no single right way for a person with ADHD to approach the workplace; every job and every boss is different. But here are some general guidelines:

● Look for a job and workplace where your ADHD symptoms will not interfere with your job performance. Momentary lapses in attention, having trouble with deadlines, and other ADHD symptoms interfere with performance more in some jobs than others. Among medical professions, for example, ADHD is less likely to affect a researcher than a surgeon. Some workplaces are more conducive to success for people with ADHD. A small, informal, cooperative workplace is generally better for someone with ADHD than a large, impersonal, corporate one.

● Look for an employer with an enlightened attitude about disabilities. Some employers are willing to do much more than others to accommodate people with disabilities. Before you accept an employment offer, ask employees what it’s like to work there. There is absolutely nothing inappropriate about this. Any employer who objects probably has something to hide.

● Do not tell prospective employers about your ADHD. This disclosure cannot help you and can easily hurt you. Having ADHD is not an asset; it is a disability that can be managed. By telling prospective employers about your ADHD, you raise the question of how well you manage it. Technically, it is illegal for a prospective employer to reject your application because of your ADHD. But that doesn’t mean that some employers won’t do it. It’s better to have a job than a lawsuit.

● If your boss criticizes your job performance for reasons related to your ADHD, explain that you have ADHD and how this affects your job performance. Be prepared to explain how you will perform your job to your employer’s standards by managing your ADHD or the accommodation you need in order to meet these standards.

● If you lose your job because of your ADHD, seek help. If you can’t afford an attorney, contact the closest office of the EEOC or your state’s human relations commission.

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Lewis Maltby is president of the National Workrights Institute and a nationally recognized expert on employment rights. He has testified before Congress many times and has appeared on 60 Minutes, Larry King Live, Oprah, and NPR’s All Things Considered. A human rights attorney, Maltby founded the National Workrights Institute after leading the American Civil Liberties Union office on free speech and privacy protection in the corporate world. He is also the author of Can They Do That? Reclaiming Our Fundamental Rights at Work (Portfolio, 2009).

This article originally appeared in the April 2011 issue of Attention magazine. Copyright © 2011 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights reserved.

ADHD and Social Challenges at Work

By Michele Novotni, PhD

THE SOCIAL IMPACT OF ADHD CAN TAKE A TOLL, not only in personal life, but also in the workplace. Especially in this time of job loss and uncertainty, it would benefit everyone to be mindful of the social challenges ADHD can sometimes present in the workplace.

Many times a job is spared or someone is promoted not just because of their workplace performance, but rather because of their ability to form and maintain social relationships in the workplace. Fortunately, there are strategies, structures, and supports to help mitigate many social errors and missteps. It is also equally important to lead with your strengths.

Lead with your strengths
Everyone has strengths. Sometimes with ADHD there is so much emphasis on what is not working well that strengths are overlooked or placed on the backburner. What strengths do you bring to social relationships? What relationship skills have people acknowledged either in or out of workplace in the past? Are there ways to use those strengths more in the workplace? While it is important to manage your challenges, it is also important to exploit and build on your strengths.

Try this:
Each day intentionally set out to build or improve a relationship at work though an area of your strength. If you are kind, find a situation to demonstrate your kindness. If you are funny, brighten someone’s day. Look for an opportunity to shine each day.

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The workplace IS a social environment.

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Play the game
How many times have we heard the following remarks: “I’m not going to play the game.” “I’m just going to do my job and that should be enough.” “My work should stand on its own.”

Unfortunately, the workplace IS a social environment. Unfortunately, the “game” IS going on. And unfortunately you ARE “playing.” You just might be playing poorly or passively, but you are in the game. It can be compared to investing money. You might decide to not invest your money right now. You have it under your mattress. You are however still investing your money. You are choosing to invest it at zero percent interest under your mattress. Or, if you take your hands off a wheel and choose not to steer a moving boat, you are still responsible for the direction of the boat. If you are not actively paying attention to relationships in the workplace, you are less likely to be doing well—especially with ADHD onboard.

Relationships generally require work for individuals with ADHD to manage well. Challenges with fluctuating attention span, impulsivity, and (at times) hyperactivity generally need to be actively managed. It is understandable that adding these social skills to job performance skills feels like an additional burden. However, if workplace relationships are not managed well, your job performance may not matter as much as you think.

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You are playing the “game.”

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ADHD Social Challenges in the Workplace

• Not recognizing importance of relationships at work
• Impulsive emails or texts
• Talking too much
• Not talking enough
• Oversharing on social media
• Holding others hostage with lateness
• Missing subtle cues—subtext
• Interrupting people while working
• Interrupting in conversation

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Pause before posting
Impulsivity can create enormous challenges in the workplace. Thanks to technology, there are now methods of passing on information in seconds. This is not necessarily good for those with ADHD who are working hard to navigate social relationships. If you are upset, it is never a good idea to instantly send an email expressing your feelings.

Try this:
Take the time to create an email but do not include the intended recipient’s name in the email. Write your email and place it in your draft file. Wait at least a few hours, and better yet a day, and look over the email again. This way, in the event you inadvertently hit send, the email will not go out since there is no address included. Many an email has gone out unfiltered and fractured relationships.

When writing an email or a text, assume that it will or at least could be re-sent. It is all too easy to forward an email. In the workplace, this is very common. If you always write them with that in mind, it may help you avoid a few landmines.

Facebook is not confidential. Although Facebook is a form of social media, it is not just social and isolated from work and work relationships. Facebook is also viewed or could be viewed by people from your workplace, too. You don’t need a permanent record of a fleeting thought or a private look at your social life. That goes for Twitter too.

Try this:
Only post things on Facebook that you wouldn’t be embarrassed to have your boss or your employees see. Use face-to-face or phone conversations for private or personal matters.

Interrupting
If you have ADHD, you might want to share a thought as soon as it comes to you. In your enthusiasm, you could miss the social cues that let you know that sharing that information now might not be a good idea. Interrupting people at work is often viewed as an annoyance. People generally try to avoid annoying people and you don’t want that to happen to you.

Try this:
If you see someone and want to share information or if you want to go to their office, try to stop and ask yourself, “Is this a good time?” Just like you have systems like checking for your keys and wallet, get in the habit of checking to see if the person is working or socializing before interrupting them. Sometimes an interruption is necessary, most of the time it is not.

Interrupting others in a conversation is a common ADHD trait. Interrupting is also on the list of social skill errors. While you might interrupt because you are afraid you will forget what you want to say, or because you get caught up in the excitement of the moment, people often feel that you are rude when you interrupt. They might feel like you don’t value what they are saying.

Try this:
Have a notebook handy to jot down things you want to say if you are on a conference call or in a meeting where it wouldn’t look unusual.

If you must interrupt, let the person know that you don’t want to permanently interrupt, but could they please help you remember to ask them about whatever it is you want to say. This way you are interrupting a little, but also still honoring the person who is speaking.

Late again
Running late is common for individuals with ADHD. Time management is also a relationship management issue. Running late is a quick way to frustrate and alienate relationships. It can even cost you your job. One of my clients was fired for lateness even though he was an outstanding employee. It was demoralizing to the team to have him arrive whenever he pleased.

When you are late at the workplace, others often take it personally. In addition to thinking that you don’t take your job seriously, to them it could also means you don’t value their time. Whatever you wanted to do was more important to you than what they wanted to do. You are holding them hostage waiting for you. It may also leave others picking up the slack. None of these are endearing qualities for building successful relationships.

Try this:
Redefine your concept of “on time.” For most, if you have a nine o’clock meeting you would aim to be at the meeting at nine o’clock. Change your target to at least ten minutes ahead. Plan to be at the nine o’clock meeting at eight-fifty. Bring something to do, or better yet, plan to connect with people and build relationships in the few minutes before the meeting.

If the meeting involves travel, add additional time to you arrival. Allowing an extra thirty minutes can save you in the event of a traffic delay.

Talking too much or too little
Regulating speech can often feel like a full-time job for individuals with ADHD. Some have been accused of talking too much, while others for not jumping in enough.

Try this if you talk too much:
It’s difficult to build and maintain relationships if you use monologues rather than dialogues. Use a vibrating setting on your cell phone or watch to cue you every few minutes to remind you to stop talking.

Consider asking someone you trust to prompt you with a glance, pen tap or even a foot stomp if you are headed over the line.

Try this if you don’t talk enough:
You may want to preplan a few interesting comments to insert in advance. Current events or interesting experiences add to building relationships.

When in doubt about what to say, asking a question about the other person will usually save the day. Most folks enjoy talking about themselves.

Subtext and picking up social cues
It would be great if people always said exactly what they meant. It is difficult enough for individuals with ADHD to hear all that is said. In the workplace, more often in than non-work environments, people often drop subtle hints and clues. Office speak is often dialed back due to others’ navigating relationships—playing the game.

Individuals with ADHD need to develop ways to not only hear what is said, but to also pay attention to the subtle clues that would let them know if what was said is actually what is meant.

Try this:
Try checking your understanding of a meeting or conversation with someone who seems to navigate relationships well. Run your understanding by them to see if that is also their understanding.

Watch part of a television show that is prerecorded without sound. By only looking at the faces and body language, see what you can pick up. Replay that section and check your accuracy. Replay a few times if needed to see what you might have missed.

Who is on your team?
You may want to work with an ADHD coach or psychologist to improve your ability to navigate relationships. This would be especially important if you have already been alerted that there are concerns about your performance and need to make changes as quickly as possible. There are also a few books available as well as teleseminars on the topic to help.

It’s worth it
Good relationships in the workplace can translate into more money for you and your employer—and more job security. It’s probably worth the extra time and energy to learn to play the game well. You might even find a few friends along the way.



FOR MORE INFO
Check out the Job Accommodation Network for more tips on workplace accommodations: http://askjan.org/media/adhd.html.

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Michele Novotni, PhD, is the author of What Does Everybody Else Know That I Don’t? (Specialty Press, 1999). A past president of the Attention Deficit Disorder Association, she is a psychologist and ADHD coach in Wayne, Pennsylvania.

This article originally appeared in the April 2011 issue of Attention magazine. Copyright © 2011 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD).

Artificial Food Dyes and ADHD

by Ruth Hughes, PhD
CHADD Interim CEO

This week's news is all about food dyes and ADHD. For more than 30 years there has been concern about synthetic food dyes and ADHD (think Feingold diet) and a fair amount of research has been done to investigate this connection. The conclusion of the scientific community has been that artificial food dyes are not a major factor in ADHD. But a small subset of people diagnosed with ADHD who also have food hypersensitivities may see symptom improvement when the food dyes or the offending foods are eliminated.

Over the last several days, the US Food and Drug Administration convened a meeting to examine the scientific evidence on artificial food dyes and make recommendations in response to a petition from the Center for Science in the Public Interest, a food advocacy group opposed to the use of artificial food dyes in the food supply chain. One of the major questions before the FDA’s Food Advisory Committee was the effect of food dyes on all children, not just those with ADHD. This is the distinction many journalists missed in reporting on the meeting. I listened to the presentations by a number of scientists, including Dr. Gene Arnold (CHADD’s representative), and I want to share the discussion and conclusions of the FDA committee with our members.

The body of research to date, which has confusing and mixed results, suggests there may be a low-level, short-term effect on behavior for children in general. But both the severity and the chronicity of the symptoms of inattention, hyperactivity, and impulsivity needed for a diagnosis of ADHD are of a much higher magnitude than demonstrated in these studies. In addition, food dyes may lead to some mild increase in the level of symptoms for children who are diagnosed with ADHD.

An important change that led to this week's hearing was a study published in 2007 in the British journal The Lancet looking at the effect of two mixtures of food dyes on children who were NOT diagnosed with ADHD. The investigators, from the University of Southampton (UK), found a small increase in activity levels and inattention by parent report. The changes were short-term in nature and would not lead to a diagnosis of ADHD. When increases in hyperactivity are reported in the media, they are referring to the activity changes reported in this study and not the symptoms of ADHD.

The Southampton study did raise many questions about the safety of food dyes on all children. As a result the European Union made the policy decision to add a label to foods containing artificial food dyes, warning that this food "...may have an adverse effect on activity and attention in children." Although many food manufacturers in Britain and throughout Europe eliminated artificial food dyes rather than add the warning labels, the UK did not ban the use of these dyes, as some media have incorrectly reported.

At the end of the two-day meeting, the FDA’s Food Advisory Committee voted to take no action on our current use of food dyes. Concern was expressed that there are many unresolved questions about the studies done to date and many design concerns. For instance, the Southampton study included a preservative in both mixes in addition to the dyes, and this could account for the results. The behavior changes were only noticed by parents and not consistently picked up by teachers, clinicians, or performance scores on an objective test of attention. The Food Advisory Committee concluded, by a vote of 79% of its members, that the research to date is inadequate to conclude that food dyes have an adverse effect on children’s behavior.

Concern was also expressed about the public health impact of waiting for better-designed studies and a larger body of research. Given the finding in some studies that both attention and activity levels in children are affected by artificial food dyes, should the FDA be more proactive than the scientific evidence suggests? There was much discussion about warning labels or other methods to inform parents that there is some indication that artificial food dyes might have a mildly negative effect on attention and activity levels. But in the end, 57% of the committee members voted no action should be recommended because the scientific evidence is so muddled.

The FDA committee members were also asked to consider the prevailing guidance on food dyes and the impact on children diagnosed with ADHD. The committee voted no change by 93%, and were clear in the discussion that no new evidence had been presented that indicated any consistent connection between food dyes and ADHD. Current clinical guidance suggests that elimination of food dyes should not be considered a mainstream intervention, but should be considered if there is a history of food sensitivities or if parents notice a behavior change after ingesting certain foods.

And the FDA committee members agreed, by a vote of 93%, that more studies are needed to clarify these issues.

So what is the takeaway message for families coping with ADHD?

• A small number of kids who appear to be hypersensitive to foods and who are diagnosed with ADHD may respond well to a diet eliminating food dyes or other irritating foods.
• If your child's behavior or inattention gets worse after eating foods with artificial food dyes, then consider avoiding them. This will probably not make the symptoms of ADHD disappear, but it may reduce the severity.
• A healthy diet is important for all children, but especially for children with ADHD.
• If there does not seem to be an effect from eliminating foods with dyes and/or if avoiding food dyes is too expensive, too difficult, or creates too much tension in your relationship with your child, then this may not be a change that is important in your child’s overall treatment.
• About 80% of all ADHD appears to be related to genetics. It is inherited. Other things happening in the environment may make the symptoms worse (no treatment, family stress, poor diet) and other factors may help to reduce the symptoms (good parenting, multimodal treatment, healthy diet). Our job as parents is to provide the best treatment and supportive environment for our children that we reasonably can.
• If you are an adult with ADHD, there is no research available on the effect of food dyes in adults. Your best bet is to assume the effects may be similar, though we are not clear on what those effects are. How’s that for clarity!

CHADD’s job is to make sure you have the best information available so that you can make informed decisions about treatment and management of ADHD.


http://chaddleadershipblog.blogspot.com

Is it more than ADHD?

There are approximately eight million adults in the U.S. with ADHD, and research suggests that as many as 80% of that population have at least one accompanying disorder, and more than half have two or more co-occurring disorders.

A proper diagnosis given by an experienced professional who understands which symptoms are and are not caused by ADHD can identify these co-occurring conditions and lead to a comprehensive treatment plan addressing all symptoms.

“It would be incredibly demoralizing to address ADHD and still struggle because some other problem has gone undiscovered and untreated,” writes Russell A. Barkley, PhD in Taking Charge of Adult ADHD (available for purchase here). Barkley and fellow researchers Kevin R. Murphy and Mariellen Fischer (cf. ADHD in Adults: What the Science Says, 2008), identify conditions commonly co-occurring in adults with ADHD, including:

• Oppositional Defiant Disorder
• Conduct Disorders/anti-social personality disorder
• Substance use disorders
• Anxiety
• Depression

In March 2011, researchers from the University of Bergen in Norway reported finding an ‘overlap’ of symptoms between ADHD and bipolar disorder when looking at mood swings (see NRC’s ADHD In the News, March 3, 2011). These researchers state that discussions are currently underway to consider whether or not mood swings should be included in the official list of diagnostic criteria for ADHD.

“AD/HD is only one of many conditions that can affect concentration and make someone distractible and forgetful,” writes psychologist Ari Tuckman, PsyD “…[T]rouble concentrating just tells us that something is going on, but it doesn’t tell us what,” (cf. Along for the Ride: conditions that Co-Exist with ADHD, Attention, February 2010).

Tuckman states that one study found as many as one-third of adults with ADHD experience either major depression or a longstanding, milder form of depression known as dysthymia. Because depression can affect concentration and focus, Tuckman cautions that a professional who is not familiar with ADHD may miss one disorder or the other. This reinforces the importance of finding a health care professional [FAQ on finding a professional link] who is experienced with diagnosing and treating ADHD, and who can make the necessary distinctions between the full presentation of all symptoms.

General information on co-existing conditions is available through the NRC’s website, and in the What We Know #5 – 5D series of information sheets regarding ADHD and common co-occurring conditions.

The prevalence of disorders that occur with ADHD is no small matter; these conditions affect a large majority of adults with the disorder. Diagnosing and treating the wrong disorder, or diagnosing ADHD and missing a coexisting condition, can lead to treatment plans that will not be as therapeutic as they could and should be. Only a well-crafted plan that addresses all conditions and symptoms will give adults with ADHD a better chance of fulfilling their potential and achieving a higher degree of success.

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