Regretfully it has been a long time since our last Newsletter although most of you who attend our monthly meetings have been kept up to date with what has been going on, we know that there are a number of members who for one reason or another, cannot attend.
This is why this Newsletter is so important and we have been trying to continue with it but time is no man’s friend.
We are still in the ridiculous situation where the Slow Release Methylphenidate, either in the form of Ritalin or Concerta has not been imported into Malta. Lots of excuses from everyone do nothing to help us. We have appealed to the Minister, Director General of Health and the Drug Therapeutic Committee themselves but to no avail. Please don’t think we have stopped trying.
The situation vis a vis the administration of medication in schools has also been shelved despite appeals to the Ministry of Education. The Ministerial Committee for Inclusive Education has also proved impotent in the face of this dilemma and put the ball in the court of the Attorney General. We know the law needs to be changed before teachers will be allowed to administer medication, the question is when is this going to happen? Like the old rhyme from our childhood days “this year, next year, some time, never”. Again I appeal to all those parents who are having problems with the administration of medication to their child during school hours to contact me. Unless we show a united front, we will get nowhere! Whereas St. Luke’s Hospital is proving competent at diagnosing AD/HD, the after sales service remains nil. When are we going to see a counselling service set up for parents and siblings? When are parent training sessions going to be started? THE RELATIONSHIP BETWEEN
parenting. It is also important to study ADHD SYMPTOMS IN PARENTS
whether ADHD symptoms in parents affects the benefit they derive from parent training PARENTING
programs designed to teach parenting skills BEHAVIOUR
and strategies that are helpful for a child who has ADHD. This knowledge could Although researchers and clinicians have potentially contribute to the development of noted difficulty that adults with ADHD are likely to experience in their interpersonal relationships, little attention has been paid to how the disorder might affect their behaviour Despite the importance of this issue, there has been only one prior study in which ADHD symptoms in parents were related to the effectiveness of parent training. In this ADHD symptoms may place a parent at risk for engaging in parenting practices that improvement following parent training, while behavior difficulties in their child. For children who benefited strongly from the intervention. Participants in this study were limited to parents of preschool children, emotions when disciplining their child.
Impulsivity may also contribute to a parent being overly permissive by increasing A recent issue of the Journal of Attention likelihood that the parent will "give in" to a child's coercive behavior because this can Vaa3s18b3aZCHb/ - includes an interesting reducing/eliminating a child's whining), even though this typically creates more problems behavior (Harvey, E.J., et al [2003]. Parenting of children with ADHD: The role of parental ADHD Symptomatology. Journal of also create difficulties in parenting. For Attention Disorders, 7, 31-43). In this study, example, parents who are highly inattentive the authors examined the relation between parents' self-reported ADHD symptoms and their parenting behavior both before and after participating in a behavioral parent- attending to what the child is doing and training program. The authors predicted that for different behaviors. This may be more symptoms would demonstrate less effective difficult for parents who are highly inattentive parenting strategies before parent training and would show less improvement in their parenting It has been found in prior research that as many as 25-30% of parents who have a PARTICIPANTS
child with ADHD have ADHD themselves. In many cases, ADHD in parents has never Participants in the study were 46 mothers and 26 fathers who were recruited through become aware that they have ADHD until it becomes apparent when having their child schools. All were parents of a child (age range 4-12) with ADHD, the vast majority of whom were boys. The age of mothers and fathers in the study ranged from the mid-20s children with ADHD, and may contribute to difficulties in parenting, it is important to learn how ADHD in parents may impact their or nagged; and 4) compliance - used when STUDY PROCEDURE
the child complied with a request made by the parent.
Prior to participating in the parent training intervention, parents completed a number of The parent-training program consisted of 8- measures intended to assess their level of weekly sessions that lasted for 75 minutes.
instruction on giving effective commands, assessed via their self-report on the Adult and how to use praise, reprimands, and time Attention Deficit Disorder Evaluation Scale.
typical for the general adult population.
effective and ineffective parenting practices Parenting behavior was assessed in several parents completed the parenting measures Parenting Scale in which they rated their for a second time, including audiotaping tendency to employ a variety of specific interactions with their child. This enabled changes in parenting behavior had occurred.
summary score for each parent that indicated their tendency to be overly reactive/punitive in their disciplinary style and overly lax/permissive. Parents also Is there a relationship between parents' assess their general level of nurturance and For mothers, higher levels of inattentive Finally, parents were asked to audiotape symptoms were associated with a more lax their interactions with their child for 3 hours parenting style (i.e. being more permissive) both before and after parent training. This is discipline (e.g. getting ready for school in the parenting tends to be associated with higher morning, getting chores completed, etc).
levels of child behavior problems. After parent training, higher levels of impulsivity evaluated to determine the frequency of the following parent behaviors: 1) using negative command/directive in an effort to get the child to comply; 3) arguing with the child to get the child to do something or to stop doing something; and, 4) praising the child reported ADHD symptoms and self-reported or verbalizing some other form of affection.
parenting style were stronger. Fathers who reported interactions were coded as: 1) noncompliant - used when child did not comply with their emotionally reactive with their child. These parent's request; 2) ignore - used when the relationships were found both before and child did not respond to parent or produced after parent training. The combination of high reactivity and high permissiveness may be especially problematic, as it suggests a when the child talked back, argued, swore, parenting style in which one frequently loses one's temper but fails to follow through on however, these changes were substantially enforcing consequences. As with mothers, greater among mothers without high levels there was no indication that fathers' ADHD of inattentive symptoms. Among children, symptoms were related to their general level ignoring parental commands were reduced.
Is there a relationship between parents' ADHD symptoms and their interactions with negative tone and arguing were found.
Significant changes in child behavior, however, were not evident.
Before parent training, maternal reports of impulsive and inattentive symptoms were IMPLICATIONS
not associated with their own or their child's behavior. After parent training, however, Results from this study are consistent with mothers who were more impulsive and more commands and higher levels of arguing.
Their children were more noncompliant, engaged in more verbal misbehavior, and were more likely to ignore their mothers' permissive and reactive with their child before and after parent training. Fathers' These results appeared to reflect the fact impulsivity was also associated with more that highly inattentive mothers were helped least by the parent training - i.e., parent training produced little if any change in their parenting behavior. Mothers who reported For mothers, inattention was associated with lower levels of ADHD symptoms, in contrast, showed significant change in their parenting training, and with more problematic child behavior after parent training. In addition, mothers with clinically elevated levels of For fathers, higher levels of impulsivity and inattentive symptoms benefited less from the inattentiveness were associated with more parent-training program. This is consistent arguing with their child prior to parent with a prior finding that mothers with high training. After parent training, none of the levels of ADHD symptoms showed the least symptoms, fathers' behavior, or child behavior were significant. There was also no indication that fathers with high levels of important implications. First, they highlight symptoms in parents when their child is being evaluated for ADHD. ADHD is known Was the parent training program effective? to be more common in parents who have a child with ADHD and may not have Although the central focus of the study was to examine the association between parents' indicates that in such situations, parents' behavior, it is also interesting to examine the effectiveness of their parenting and the impact of the parent training program on benefit they derive from working on their parenting skills. Treating ADHD symptoms in parents may thus be an important component of effectively managing ADHD in indicated that mothers reduced their use of a children, not to mention the benefits such negative tone with their child, reduced their treatment may have for parents independent Second, for mothers in particular, high levels The authors have done the field a service by initiating work in this important area.
benefits they derive from participating in Hopefully, additional research on this topic programs can be modified to provide greater Dr. David Rabiner, PhD, Duke University, USA This study has several limitations that the YOUR CHILD HAS SCHOOL
First, the sample size, particularly of fathers, TO BLAME?
was relatively small. Replicating the study by Pamela Darr Wright, M.A.,
with a larger sample would thus be important. M.S.W. Licensed Clinical Social

Second, it is problematic that parental ADHD symptoms were assessed only via self-report, rather than by conducting more I know they think Brian’s problems are my
fault. When I said that I thought he needed
more individual help from the LD teacher, they shook their heads. They only "do Third, this study does not enable one to collaborative" now. They told me I shouldn’t use the word "dyslexia" because it sounds so hopeless. Then they asked how my husband and I wre getting along! (Denise, behavior that characterized parents with mother of a boy diagnosed with emotional related to other factors beside their ADHD The school psychologist said that all these Despite these limitations, results from this school problems were Shannon’s fault. He
said that she was lazy and unmotivated and that we needed to pressure her to work harder. We didn’t allow her to watch television. We didn't allow her to go out with Homework took hours to complete, even 2) The value of assessing parents for ADHD when we helped her. We didn’t know what when evaluating their child, or, when parents else to do. We didn’t want to raise a lazy child. (Emory and Elaine Carter, Shannon’s parenting suggestions that are offered as daughter had dyslexia and ADHD. See Florence County School District Four v. Shannon Carter, 510 U.S. 7, (1993).
treatment of providing effective treatment for ADHD to parents Parents of special ed kids often say that 4) The need to consider how parent training they are intimidated, patronized and made to programs can be modified so that they may feel guilty and inadequate by staff at their be more effective for parents who may have helpless, frustrated, and defensive. Not surprisingly, parents behave exactly like Dr. Alessi’s study illustrates why so many parents have problems dealing with schools. uncomfortable, most parents try to explain Dr. Alessi’s article is "Diagnosis Diagnosed: and justify their position, in hopes that they will be understood. A few go on the offence, Professional School Psychology, 3(2), 145- firing volleys of blame back. Many parents find these experiences exquisitely painful (Since this study is based on practices in the and humiliating. If they withdraw and try to USA I have not included it but if anyone is avoid school functions, they find that they've particularly interested in reading it, please contact been labelled as "uninvolved parents." me. The problems described here, however, Again, they are blamed for their children’s Sometimes, emotions get out of control. Feelings of anger, bitterness, and betrayal HELPING CHILDREN WITH ADHD
consume parents and school personnel -who are then unable to work together to FRIENDSHIPS
make educational decisions. In these cases, everyone loses. The child is usually the A consistent finding in studies designed to biggest loser if the parents and educators developmental outcomes is that peer relationship difficulties predict a number of experiences? Are parents too sensitive? Do (particularly those who act aggressively towards peers) fare significantly worse in happens in their contacts with educators? Or are parents just over-protective of their relations. One reason this may occur is that rejected children often gravitate towards one If you are a "special ed" parent, you know that it's hard to fight - and almost impossible reinforce/escalate each other's antisocial to bail out. If your child receives special behavior. Rejection by peers can also have a negative affect on children's self-esteem school meetings and you have to cooperate in developing your child’s IEPs. How can And here's another question: If the school staff believes that you or your child are responsible for your child’s problems, how behavior and difficulties reading social cues can you work with them so your child’s that may result from attention deficits, many children with ADHD have problems getting ensure that your child gets a good quality along with peers. In fact, prior research has shown that many children with ADHD begin to be rejected by unfamiliar children after If you have run into a "brick wall" of only a single day of contact. And, once a resistance when you tried to obtain changes in your child’s educational program, you
established, it can be difficult to change need to understand how schools really
even if a child's social behavior improves.
work. You need to understand "school
culture" and the beliefs held by many
Because developing positive peer relations can be so difficult for children with ADHD, administrators, and guidance counselors. there have been several studies in which efforts to peer relations in children with Dr. Galen Alessi, Professor of Psychology at Western Michigan University, conducted a fascinating study on school psychologists. psychostimulant medication and behavioral interventions do not generally normalize the social standing for children with ADHD. In interesting preliminary examination of efforts addition, efforts to directly teach social skills to children with ADHD have so far yielded friendships (Hoza, B. et al., A friendship results that are less positive than one would Preliminary findings. Journal of Attention Disorders, 6, 87-97).
One limitation of research on improving peer relationships for children with ADHD is that Participants were 209 5-12 year old children improving children's overall standing in the peer group, rather than trying to help them develop a single close friendship. Although presence vs. absence of even a single close A variety of child-focused interventions are Whether or not a child has a close friendship implemented during the program including a can be relatively independent of the child's social standing within the wider peer group, training, social problem solving training, and sports skills training. Children also spend current and future adjustment. For example, part of each day in a structured classroom research has shown that even if a child is lessons are taught. All interventions are friend is associated with less loneliness, that includes ample time for recreational higher feelings of general self-worth. Thus, it appears that having a close friend can typically do not know each other before the help compensate for the negative effects of being rejected by the larger peer group.
In addition to the interventions mentioned above, a program called "the buddy system" that social interventions for children with ADHD should include efforts to help them development of dyadic friendship skills. This involved pairing each child with an age and possible, children were paired according to argued that helping a child establish a good weeks into the program. Buddies were also friendship should be easier than trying to paired based on similarities in behavioral, overcome a child's negative reputation in the athletic, and academic competencies and on larger peer group. And, the known benefits of having a close friend suggest that this together that play dates could occur outside children with ADHD. Of course, not all children with ADHD are disliked by peers or Parents were encouraged to talk with the lack friends, but for those who do, helping parents of their child's buddy's t arrange play them make and keep a friend could be very dates outside of the STP. Children and their buddies were also given special privileges within the STP in order to optimize the Although this is a compelling and logical idea, there has not been prior research on another and form a friendship. In addition, a this topic. A study published in the April coach for each buddy pair. Each morning, the coach checked in with members of the pair to learn how the child and his/her buddy were getting along, and to suggest ways to handle any problems that were reported. At impact of the buddy's antisocial behavior on the end of each week, the coach met with both children together to help them work out more antisocial behavior a child's buddy any difficulties in their friendship that displayed, the less likely teachers were to see academic or behavioral improvement in efforts, it was hoped that each child would the child. Conversely, when a child's buddy maintaining a good friendship during the likely to be regarded by teachers as making As part of the STP, extensive information was collected on all children. This included IMPLICATIONS
behavior ratings by counselors, teachers, and parents, and teacher ratings of This study represents an initial effort to evaluate an intervention designed to help activities. Ratings were obtained at the children with ADHD establish and maintain a beginning and end of the program so that friendship. The results of this preliminary change could be evaluated on a variety of work are both instructive and encouraging, and have potentially important implications for helping children with ADHD.
Counselors, teachers, and children also rated the quality of each child's relationship First, it is noteworthy that the antisocial behavior of a child's buddy influenced how teachers perceived the child. Specifically, influenced the quality of children's buddy when a child's buddy was highly antisocial, relationship, as well as factors the predicted teachers rated the child as less successful Although teachers' may have rated children with an antisocial buddy in a more negative manner than was truly warranted, children with an antisocial buddy may also have been negatively influenced by their buddy's behavior. It is well established that children relationship with their buddy. Children who who associate with disruptive and antisocial engaged in more antisocial behavior during the program were seen by their teachers as themselves, and the finding in this study is achieving a relationship of lower quality with consistent with this. This highlights how their buddy. Children whose parents were important it is for parents to monitor who more supportive of the buddy intervention - their child is spending time with, and to work i.e. those who parents arranged frequent hard to keep their child from associating with antisocial peers. This can be critically show better relationship quality according to important in preventing a child from traveling down an antisocial path him or herself.
the buddy program, children tended to be seen as more positive and adaptive by Second, it was encouraging to learn that counselors at the end of the program.
when parents worked hard to support the buddy program by arranging play dates for Importantly, parents' support of the buddy program also predicted children's perception of the quality of their buddy relationship: Furthermore, there was some indication that when parents were more supportive children were more satisfied with the friendship they associated with more positive behavior in Although other medications are sometimes These findings highlight the important role parents can play in helping children with antidepressants, clonidine, buproprion), until recently, the FDA had not yet approved any Because many children with ADHD struggle non-stimulant medication as a treatment for negative effects of being rejected by the larger peer group, parents who help their approval as an ADHD treatment for children, adolescents, and adults. In fact, although shown to be effective for adults with ADHD, Strattera is the only FDA approved Although research to guide parents' efforts medication clinically proven effective for to assist their child develop a friendship is needed, it appears that this is an area where parents can make an important difference in Unlike stimulants, which are believed to their child's life. Teachers and professionals can help support parents' efforts in this impact on the availability of dopamine in the regard, perhaps by acting as a "buddy central nervous system, Strattera exerts its coach" as counselors did in this study.
effect on the neurotransmitter known as norephinphrine. Like some of the longer Helping children with ADHD build close peer acting stimulants (e.g. Concerta, Adderall relationships is an important goal to focus XR), Strattera offers the convenience of on, and is one that may often be overlooked classified as a controlled substance, more convenient phone-in prescription refills will Results from this study indicate that parents have an important role to play in achieving helping their child accomplish this important social goal, and one hope that additional research in this area with be forthcoming.
introduction of an effective new medication for treating ADHD represents an important addition to the range of available treatment options. Because Strattera works through an A Comparison of Atomoxetine
mechanism, individuals for whom stimulant medications were not effective, may derive (Strattera) and Methylphenidate
significant benefits from this new treatment.
treatment in children with ADHD
And, individuals who experienced intolerable side effects from stimulants may not shown to be a helpful treatment for many Strattera. Finally, some parents who had children and adolescents with ADHD, there remains considerable interest in developing medication for their child may be amenable other medicinal options. This is because not all children with ADHD respond positively to because it is not classified as a controlled reactions that preclude their use. In addition, although stimulants are generally An important question regarding the use of believed to be extremely safe medications, this new medication, however, is whether it they are classified as controlled substances will generally be as effective as the currently and many parents have concerns about the available stimulant medications. In two prior generic form of Ritalin) no differences in Prior to beginning medication treatment, patients received methylphenidate in these Scale on each child to assess the severity of studies to draw any firm conclusions. Thus, additional investigation of how this new the Conners Parent Rating Scale, a widely medication compares to the stimulants is needed. This was the issue addressed in a study published recently in the Journal of the during weekly follow up visits over a 10- American Academy of Child and Adolescent week period. Because not all participants Atomoxetine and methylphenidate treatment weeks (see below), the final set of rating randomized, open-label trial. JAACAP, 41, treatment outcome measure for each child.
Comparing these ratings with those obtained prior to treatment was then used to determine each child's treatment response. between the ages of 7 and 15 (all girls were younger than 9) who had been diagnosed with ADHD using a structured psychiatric interview and standardized behavior-rating scales. Approximately 75% of participants Ten of the 184 children given atomoxetine were diagnosed with the combined subtype had their medication discontinued prior to of ADHD (i.e. they displayed both inattentive the conclusion of the 10-week trial because almost all others were diagnosed with the inattentive subtype. (Note: For a complete parent and/or the physician did not believe Approximately half of all participants had a comparable to what is generally reported for stimulant medications. In the current study, because of adverse events or lack of effect For children in both groups, investigators' ratings of ADHD symptom severity declined atomoxetine or methylphenidate. (Note: In substantially from the pre-treatment rating to an open-label trial participants and those the final rating obtained. These declines were clinically meaningful in addition to medication is being received). Because this being statistically significant, and were study was primarily intended to establish the evident for both hyperactive-impulsive and efficacy of atomoxetine, approximately 4 inattentive symptoms. The magnitude of the atomoxetine than methylphenidate (i.e. 184 equivalent for children treated with the 2 medication were started on a low dose and declines were obtained even though children titrated upwards based on the investigator's who had stopped treatment early because of assessment of clinical response. Unlike the poor response were included in the group methyphenidate received 3 doses per day regimen, children receiving methylphenidate Parent ratings followed a similar course.
in this study were dosed 1 to 3 times per day Prior to treatment, average ADHD symptom based on the investigator's assessment of ratings for children in each group were in the top 1% based on age and gender norms. This indicates exceptionally high levels of difficulty. Following treatment, average methylphenidate on children's behavior at scores in both groups dropped significantly and approached - but did not quite reach -normal levels. Once again, these declines hyperactive-impulsive symptoms, and were roughly comparable in each group. Similar reductions in parents' report of children's relationships, etc. - is also unknown. It would not be prudent to assume that comparability on core ADHD symptoms necessarily translates into equivalent impact tolerated by participants and there was little on associated difficulties, and this issue difference in adverse reactions reported.
awaits further research. This is important, drowsiness/sleepiness - were more common medication treatment on long-term academic among children taking atomoxetine. Small reductions in weight occurred both groups.
The authors note that although this is unlikely to be of importance during short- Finally, short acting methylphenidate may term treatment, medication effects on weight more substantial, and that data on weight change associated with ongoing treatment are currently under study. Information on this issue has not yet been published for any does not necessarily mean that it will be as effective as these more recently introduced stimulants. It may be more effective, it may Summary and Implications
be less effective, or it may be equally effective. atomoxetine (i.e. this medication will be marketed under the brand name Strattera) It is important to note that even if these symptoms in children. Each medication was well tolerated by most children, although 2 and a particular medication is found - on average - to be superior to others, no single medication will be the best choice for all children. Thus, a terrific benefit of having Strattera become available is that many children who were not helped by stimulants atomoxetine and stimulant medications may Strattera. On the other hand, it cannot be prevent a firm conclusion on this issue.
assumed that a child who is doing well on a stimulant will do as will if switched to Strattera. This may or may not be the case.
Thus, for a child who has been receiving acknowledge, this was not a double-blind, stimulants and doing well, it is likely that placebo-controlled study, which makes it physicians will be appropriately cautious impossible to completely rule out parent or investigator expectations as influencing the results. What about children beginning an initial trial of medication for ADHD treatment? Will physicians continue to regard stimulants as the initial treatment of choice or will Straterra Pediatrics recommend that 2-3 stimulants be tried across a full range of doses before switching to another class of medications.
Drug Administration (FDA) today approved Strattera ™ (atomoxetine HCl), judging it The stimulants have also been around for much longer, obviously, and several studies Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents and adults.
- including the MTA study - have documented their efficacy in symptom Studies on the longer-term effectiveness of treatment for ADHD that is not a stimulant Strattera are ongoing, however, and should be available shortly. These will be very interesting and important results to know Strattera, reduces prescription hassles for about, and will likely have a significant patients, families and physicians by offering impact on physicians' decisions about which samples. Strattera is also believed to be a less likely candidate for abuse by patients medication for their child, and for physicians than other attention deficit drugs because it is the only FDA-approved treatment for the disorder that is not a stimulant.
another clinically proven option that works by a different mechanism and which is not a "Strattera is an important development in the controlled substance represents a valuable addition to existing treatments. Research about its future," said Sidney Taurel, Lilly's that documents the long-term benefits of Strattera in managing ADHD symptoms, and officer. "It gives patients, families and in helping with associated difficulties, will physicians an effective new tool for treating hopefully be published shortly. As with any medication, however, efforts to enhance functioning across a range of areas will continue to require additional behavioral and after the FDA issued an approvable letter for academic supports for many children. And, Strattera. Lilly expects to have Strattera careful, systematic monitoring the ongoing effectiveness of treatment will remain essential. Clinical Studies
Lilly demonstrated Strattera's effectiveness in treating ADHD with data from six placebo- controlled clinical studies, involving children, adolescents and adults. So far, more than Dr. David Rabiner, PhD, Duke University, USA 4,000 patients have taken Strattera in all completed and ongoing clinical trials, some for as long as two-and-a-half years. Strattera comes in a capsule and can be taken once or twice a day. Strattera is the first ADHD FDA Approves Strattera™,
medication proven clinically effective in First Noncontrolled Option
For Treatment of Attention-
"Strattera is unique, because of its different Deficit/Hyperactivity Disorder
mechanism of action for ADHD; it's the first noncontrolled medication indicated for the treatment of ADHD. It provides full-day relief impulsivity that are inappropriate for the insomnia in most children and adolescents," suggests a biological cause and a genetic professor of psychiatry, Harvard Medical link for the disorder, and experts estimate up to 60 percent of children with the disorder continue to have symptoms as adults.
Spencer is one of the initial investigators to "Left untreated, ADHD can have significant conduct clinical trials with Strattera.
negative consequences, and not just at school or work. It also affects social and How Strattera Works
family situations, as well as self-worth," Dr. Spencer said.
reuptake inhibitor, works differently than any other FDA-approved ADHD treatments. It's recognized, experts estimate 4 percent of not known precisely how Strattera reduces adults, more than 8 million people, have the ADHD symptoms. Scientists believe it works norepinephrine, a brain chemical considered important in regulating attention, impulsivity disorder, and in part because of concerns about giving controlled substances to adults.
norepinephrine at work in the tiny spaces between neurons in the brain.
"Adults with ADHD tend to have lower rates of professional employment, more frequent Strattera should not be taken at the same job changes and lower self-esteem. These time as, or within two weeks of taking, a monoamine oxidase inhibitor (MAOI), or by professional, highlight the need for effective treatment of the disorder," said Lenard Patients with a history of high or low blood Adler, M.D. Dr. Adler is a psychiatrist and pressure, increased heart rate, or any heart director of the Department of Neurology, or blood vessel disease should tell their Attention Deficit Hyperactivity Disorder doctor before taking Strattera. Strattera has Program, and associate professor of clinical not been tested in children less than 6 years psychiatry and neurology at the New York when starting treatment with Strattera. As with all ADHD medications, growth should DO BOYS WITH AD/HD
experienced side effects were not bothered enough to stop using Strattera. The most about themselves, there have actually been relatively few studies in which the self- stomach. In adults, the most common side concepts of children with and without ADHD effects were problems sleeping, dry mouth, decreased appetite, upset stomach, nausea or vomiting, dizziness, problems urinating, children with ADHD regard themselves less favorably in a number of different domains than other children, while other researchers have not found these differences.
ADHD affects 3-7 percent of school age children, making it the most-commonly A related area of research has examined the diagnosed behavioral disorder of childhood. appraisals that children make of their own It manifests itself in levels of attention, concentration, activity, distractibility and participation in a laboratory task. Thus, in comparison subjects. Unfortunately, as has these studies, researchers have examined often been the case in research on ADHD, how the self-appraisals of ADHD children females were not included as participants.
vary in situations where their actual level of performance Participants' self-perceptions were assessed using the Self-Perception Profile for Children involved academic or social activities, boys with ADHD tend to report they did better assesses children's views of themselves in five specific areas: academic performance, evaluate their performance more accurately.
Findings from these laboratory studies have specific ratings, the SPPC also includes led some researchers to speculate that boys items designed to assess children's general with ADHD (unfortunately, girls with ADHD feelings of self-worth. The idea behind this have not been included in this research) have "positive illusory self-concepts". It has specific self-perceptions that can vary from been argued that holding unrealistically one area to another, in addition to more positive views about themselves may serve general feelings about themselves that are an important protective function for boys with ADHD, by allowing them to cope with repeated To assess the boys' actual competencies in SPPC, their teachers completed a teacher that this "self-protective" strategy may responses to the same sets of items were problems if it leads them to deny that they assessment of how the boys were actually doing in each domain, and provided a Although these are interesting speculations, benchmark against which boys' self-ratings it is important to recognize that there has been no previous research in which the self- ratings were higher than the ratings provided by his teacher in a particular domain, it examined in relation to their actual abilities suggests that the child's self-perceptions in and competencies. The laboratory studies that domain were inflated. Similarly, if a child's self-ratings were lower than those of appraisals of their performance on specific his teacher, it suggests that the child was tasks, and findings from these studies may being unrealistically negative. When child not generalize to the more enduring views and teacher ratings corresponded, it was assumed to reflect the fact that the child had an accurate perception of his competence.
have inflated self-concepts has not been (Note: The teacher measure did not include items reflecting children's feelings of general self-worth because these reflect a child's Do boys with ADHD actually have "positively views of self that are independent of specific areas of competence, and thus can not be suggested? This question was examined in compared to an "objective standard".) a study published recently in the Journal of Abnormal Psychology (Hoza, B. et al, 2002, The researchers predicted that, although the 111, 268-278.) Participants in this study differ from those of comparison boys in an 13. The majority of these boys (195) had relative to the "objective" ratings provided by teachers. In other words, they expected to treatment program. The remaining 73 boys find that ADHD boys had "positive illusory self-concepts". Furthermore, they expected the greatest inflation would be found in those domains that were most problematic for the boys. Thus, for boys with ADHD who also had significant learning problems, their specific areas. It was predicted that boys expected to show the greatest inflation. For competence to the greatest extent in the expected in the behavioral and social domains. For ADHD boys who were depressed, no domain-specific predictions competence to the greatest extent in the feelings about themselves on the general teacher-ratings for these boys greater than for non-ADHD comparison boys, it was also greater than the discrepancy for ADHD boys without aggressive-behavior problems. For overestimate their competence relative to found for ratings of academic competence.
boys without significant learning difficulties, children in the two groups. Results indicated themselves similarly to the way in which their teachers had rated them in all domains. The situation for ADHD boys who also were teachers had rated them in the academic, boys were the only group to underestimate their physical appearance, rating themselves as less attractive than their teachers rated significantly higher than that for comparison boys in every domain. In other words, their behavioral domain, but to a lesser extent domains, their self-ratings were not inflated.
On the global self-worth scale, they had significantly lower scores than boys without groups did not differ in an absolute sense.
Thus, the ratings made by boys with ADHD were SUMMARY AND IMPLICATIONS
comparison boys, indicating that ADHD boys did not regard themselves as either more or The major findings of this study were: ADHD boys overestimated their self-perceptions noted above, however, comparisons to the more than comparison boys in scholastic, teacher ratings indicated that, for boys with social, and behavioral domains relative to ADHD, these views of themselves are overly positive and do not reflect the opinions of examination of ratings provided by boys in their teachers that are presumed to be more the different subgroups indicated that they overestimated their competence the most in those domains in which they were most impaired. Thus, even though they did not comparison boys in an absolute sense, boys not be assumed that these findings apply to with ADHD perceived themselves to be far all boys with ADHD. Thus, many boys with more competent than their teachers did. The depressed -- will regard themselves quite negatively, rather than overestimating their several areas, including their feelings of may be especially true as boys with ADHD move into adolescence, and replicating this study with a teenage population would be an important extension of this research.
argued that these inflated self-perceptions serve a self-protective role for boys with We also do not know what the implications of these findings are for the immediate or longer-term adjustment of boys with ADHD.
with daily struggles and difficulties. This competence create more trouble for these boys because it eliminates the motivation to work on their difficulties? Or, does it protect themselves" in an effort to avoid feelings of despondent? Questions like this can only suggest these findings may represent either be answered by following boys over time, and examining their ongoing adjustment in themselves favorably to others), or the fact provided by others that were the focus of this study. This is difficult work, but the results of such a longitudinal study would be extremely interesting and informative. What are the implications of these results for treatment? There is a lack of clarity on this Dr. David Rabiner, PhD, Duke University, USA suggested that if ADHD boys overestimate their families with children with intellectual situation. Proponents of this view argue families whose children have disabilities – accurate appraisal of their abilities and how resources problem, we should solve the one expressed concerns that such "humility training" could be damaging to boys' self- Having got all that off my chest, I hope you esteem. Clearly, there is no simple answer enjoy reading the articles in this Newsletter. We have included a number of articles about medication since we are getting a number of person is an individual and you should always follow the advice of your doctor who As with any study, it is important to be knows you best. If you would like to see careful not to generalize the results of this information about anything in particular, research beyond what is reasonable. First, please contact us on our e-mail address.
the findings obtained apply only to boys with ADHD, and whether ADHD girls show the competence is not known. Second, it should



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