Medication Risks

Washington Post: Study Finds Possible Link Between Childhood Deaths and Stimulants for ADHD - washingtonpost.com

My response to the above headline is just below. Further down, I added some of the follow-up discussion from people who have struggled with ADHD.

Children with ADHD are several times more likely to have accidental injuries requiring emergency room treatment and die from accidental causes; ADHD teens are more likely to have serious automobile accidents and are at a much higher risk of unwanted pregnancy. The negative impact of ADHD on academic performance, peer acceptance, and self-esteem can be enormous -- all contributing to negative adult outcomes. ADHD is a significant childhood difficulty with many significant risks. All of the pros and cons have to be weighed in making a decision on how to support ADHD children in achieving better outcomes.

Best wishes,

Ken

See some of the follow-up comments posted in this Washington Post discussion:

Greg Sleter at 9:34am June 16
"As a parent with a son who has ADD, we did a great deal of research into behavior modification before going to medication. My son does not take Ritalin, but takes another medication and it has helped him immensely. He was not completing school assignments and losing focus when taking test. Since his diagnosis, his school work has improved immensely... Read More and his confidence has grown as well. While constant study and review of this topic is necessary, please don't paint everyone with a broad brush stroke. And thanks to Ken (see above) for his comments. In many cases this is not about "bratty" kids or drinking too much soda. ADD is a medical condition no different than, say, diabetes and needs to be treated."

Josh Rouch at 9:37am June 16
"Ken Little: you're awesome. Its like seeing my childhood summed up in one paragraph. lol. There are always risks involved when taking medication, particular narcotics but that does not mean that the risk isn't worth taking. It depends on what degree of risk. And I can personally attest to Ken Little's comment in that without ADHD meds like Ritalin ... Read MoreI would of been at higher risk of accidental injury. As it stands (or stood?), before I was medicated I got part of my finger cut off in a door, cracked my head open several times, and had my foot partially amputated by a riding lawnmower all before I was 7 or 8 years old. Then in college when my meds weren't working properly, I fell off a forklift from 18 feet and now have a traumatic brain injury. Thank god though for ADHD meds when I was growing up. I wouldn't have survived childhood socially, academically, or perhaps even literally."

Bonnie Brownstein Schendell at 9:37am June 16
"Ken Little hit the nail on the head with his post. I have a son with ADHD. It was my husband and me who knew something was awry long before school even began...and to the person who said it's soda related, get real. My son drinks no soda! His hyperactivity is not much of an issue anymore, but his impulsiveness and lack of focus are. And if you... Read More knew much of anything about the drugs, they don't make kids into zombies. That was the old days. And there are many drugs out there. Also, any informed pediatrician will have the patients go for heart scans, etc. My son just had his annual EKG...perfect results.

Please be informed before passing judgement."

Michele Somers Cullen at 9:53am June 16
Our 7-year-old is dyslexic and must attend a school geared toward teaching dyslexic kids. It's a very intense program, but it works. Before Ritalin the school said that he was being rejected because he was simply unable to focus on the work at hand (on the trial days), and that they didn't think they'd be able to teach him with that lack of ... Read Morefocus. After Ritalin, he was able to focus just fine, and as a result of attending that school, he's reading now. Our little dyslexic boy is reading on the same level as rising 2nd graders from a traditional classroom.

I understand completely the fears that arise as a result of over-prescribing drugs like Ritalin,and we had to weigh the pros and cons. He just seemed so young to be put on Ritalin, and hyperactivity was never his problem. (His ADHD was the "inattentive type.") But there are times when it truly is the answer. Until something better comes along, we're sticking with what helps him the most.

Sons and Behavioral Summer Camps

Mr Little,

I came upon your website after seeing a link on Facebook. I have been searching for information on Behavior Modification camps, programs, or specialists in my area all week as we have reached a breaking point with my 13 year old son. I think he definitely needs a behavior modification program that is aggressive and he needs it soon. The only camps I could find in the New England area are $6000 to $8900 per month for a residential program and this is not a possible option for my family financially.

Can you make any recommendations for doctors and/or programs in Southern NH for that could benefit us? I live just outside of Manchester, NH.

Any information you can share would be appreciated.

Reply:

Dear xxxxxx,

I'm and very sorry for your struggles.

I really can't wade in with an informed opinion as I do not know your son or situation. However, I do have some thoughts and suggestions that I can offer for your consideration.

Suggestions:

• Find a Child & Adolescent Psychiatrist in your area. (http://www.aacap.org/)

• Find a good therapist that will help both your son AND your family. If you have health insurance you should be able to get a list of professionals that can help.

• Learn about / look into Ross Greene's "Explosive Child" approach -- it is excellent! (http://www.cpsconnection.com)

• I would suggest staying away from behavioral programs. They may have qualified adults who may be able to help your son, but these programs will also be filled with other boys with similar problems. There is no way to be certain, but there is a risk that your son may get worse by attending a behavioral program. Children his age are very susceptible to peer influence, often more so than adult influence. Harvard Univ. published some research on summer camps for behavioral kids some years ago that indicated increased behavioral difficulties after attending behavioral summer camps. Further, an article entitled: "Forensic Psychiatry and Violent Adolescents: Risk Factors for Adolescent Violence" described the following -- "Risk factors were demonstrated to have different effects at different ages of development. Within the late-onset or adolescent group, most risk factors had only a small individual effect. In keeping with adolescent development, however, peer group factors had a strong effect such that association with antisocial peers, belonging to a gang or lacking social ties strongly predicted antisocial behavior." (http://www.medscape.com/viewarticle/571434_3)

• I suggest that you spend your time and money connecting your son with healthy, growth producing, and self esteem enhancing challenges, activities, and peers that are non-behavioral: AMC (http://amc-nh.org/index.php), hiking, biking, skate boarding, and / rock climbing camps, tennis, sports, chess, Lego's / Invention camps, etc.

There are many protective factors that he will gather while attending these sorts of camps / activities while behavioral camps have risk factors associated with them that may end up being counter-productive.

• Master advanced parenting skills for difficult children (see Ross Greene, or a family therapist, or a good behaviorist (a positive and proactive behaviorist), read Alan Kazdin's book: The Kazdin Method for Parenting the Defiant Child. Home based behavior modification and management is quite possibly the most important component of a child's well-being. Community and extended family supports and activities can be of significant value too. 

• Study and understand the adolescent stage of life. Your son is either currently experiencing or on the verge of experiencing a massive burst of life changing growth. Puberty and neuro-biological changes are underway that will affect your son's moodiness, way of thinking about life, and feelings. Sexual feelings alone can be distressing and destabilizing to some pre-teens and teens.

• A thorough assessment of your son's strengths and weaknesses, of the issues and problems he and your family are facing is the first step. Once a comprehensive understanding is developed a comprehensive plan to resolve his difficulties can be developed too.

Please feel free to write with any questions or concerns.

My best wishes to you and your family,

Ken

Kenneth H. Little, MA
603-726-1006
KenLittle50@gmail.com
https://www.achieve-es.com

Behavioral Problems

Behavioral Problems

Families and schools have a wide range of ideas and beliefs about what constitutes a behavior problem and a range of expectations for what level of behavioral compliance is reasonable. Further, our understanding of what "normal behavior" is not well understood. One informal study estimates that average children follow approximately 70% of their parent’s instructions. Is that good, bad, or medium? That depends on the family’s expectations for compliance. Family "A" may think that 70% compliance is fantastic, while family "B" sees it as horrible.

The same applies to school systems and teachers. Expectations for behavioral compliance alter the way in which behavior is assessed and interpreted.

Behavior problems beyond what is developmentally appropriate (one would hardly expect a toddler or a teen to be completely well behaved) can and should be seen as an indication that something is wrong, that the child or adolescent is in distress. This seems straightforward enough, almost obvious; but the "something" that is wrong is far more difficult to identify than would first appear; and the solution can be even more daunting.

To make matters even more difficult, children often don’t tell us what the problem is, children only show us that there is a problem with their behavior. Our job is to decode the message and detect the source of distress. We then need to devise a coherent and effective intervention.

Children experience distress for many reasons and from several different sources. To understand this complexity we have to think of a child as a dynamic unique organism complete with his / her own special set of characteristics and attributes. For example, infants come complete with their own distinct personalities, characteristics, and abilities. Some are temperamental and some easy going; some are affectionate and some distant; some are very outgoing and social and others are shy. Some children walk sooner; other children talk sooner. Each child is unique. As children grow they interact with their world – home, school, neighborhood, and community, and so on – in more and more complex ways. Young children usually have limited exposure to others. However, exposure to the world expands as children age. They move farther and farther out into the world encountering ever more people, situations, and environments.

As the child's world grows more complex so too does the likelihood that friction will develop, that something will "rub" the wrong way. That’s the natural course of life. But for some children, it’s this interactive friction between the child and some part of the environment that is the root cause of many behavioral problems and conflicts.

Families and schools wishing to address the misbehavior of children must seek to understand not only the child, but also the child's environment (the situation and system), and the child-environment interaction. For most children with behavioral problems there is a mismatch somewhere in the child-environment interaction.

Interventions can be designed to modify the environment to be more favorable to the child, thereby alleviating enough of the discomfort to allow for improved performance. An alternative approach is to enhance the child’s skills set in order to improve performance through more
effective, adaptive coping skills. A combination of environmental modification and skill enhancement may be the most beneficial strategy in both the short and long run.

Children experiencing distress beyond threshold levels may fail to mature and gather new skills as they age. Constant distress tends to drain the child’s emotional resources and as a result contribute to regressed behavioral patterns, heightened situational reactivity, and maladaptive coping strategies. In this situation the child’s behavior will deteriorate at a fairly steady rate over time, problems become compounded, and the situation worsens as the crisis state approaches.

Family Behavior Management

Families struggling to exist with behavior challenged children and teens will recognize the deteriorating state. As the problem grows for the child it also becomes more daunting for parents and siblings. And as the burden increases the family will reach it’s own threshold of tolerance. As the stress load passes this threshold family functioning can become severely impaired. Parenting techniques and tactics regress, become reactive (rather than proactive), and maladaptive management strategies may become the primary mechanism of behavior management. This state once reached so taxes internal resources that parents and siblings often react out of shear desperation.

How to Turn It Around

Behavior management and behavior modification are the primary points of intervention. Modifications and accommodations to or within the environment are effective and essential components too.

Behavior management is the skill set that other’s acquire in order to more effectively manage a child’s behavior. Behavior modification is a skilled and targeted activity designed to change behavior gradually over time. Behavior change occurs in two directions at the same time: suppression of negative or unwanted behaviors and encouragement of new more positive and adaptive behaviors. The primary effort is on the growth of new, more positive behaviors to replace or make obsolete, the negative behaviors. Suppression of unwanted behavior is desirable, but alone does nothing to encourage the growth of positive and adaptive behavior.

Behavior is not the only concern. The over-riding concern is the internalization of a positive value system. Value systems derive from family, school, and community; each having perhaps a unique set of prized values. Families may foster more autonomy while schools may foster a sense of cooperation. Both autonomy and cooperation are valued assets in navigating the complex social world in which we live.

Sincerely,

Kenneth H. Little, MA
Thornton, NH 03285
603-726-1006
KenLittle50@gmail.com
https://www.achieve-es.com

Educational and Behavioral Consulting Services

Education: Tufts University
Degree: Master of Arts
Major Subject Area: School Psychology

Professional Experience:

25 Years of clinical experience working in residential, day treatment, and public school settings with children, adolescents, and families struggling with behavioral and educational challenges.

Kenneth H. Little, MA
Consulting Services
New Hampshire
603-726-1006

KenLittle50@gmail.com / www.achieve-es.com