ADD?

You can go into your pediatrician and ask for a connors check list for ADD.
But from what you have been describing I think it warrants looking into ADD… Also look into if something has happened to her recently that perhaps has triggered this behavior? Is she having any upsets at school or in other areas of ehr life that could be causing some of the lying?

The following is some of the things that the connors has on the check list but in much more descriptive detail. There is one to fill out for the family and one for the teacher.

Hyperactivity

Overactive

Fidgets

Leaves seat when expected to sit

Appears not to listen

Easily distracted

Forgetful

Inattention

Poor organisation of tasks

Poor attention to detail

Appears not to listen

Easily distracted

Forgetful

Does not concentrate on tasks

Impulsiveness

Lack of social awareness

Talks excessively

Interrupts

Intrudes into games or conversations

Unable to take turns or wait in a line

NB. The hyperactivity may lessen with time

Considering all the years of research that have gone into this phenomenon, the diagnosis of ADHD is remarkably subjective. There is really no way to tell FOR SURE if your child “has it”. I am personally very skeptical that lists of behaviors can be used to diagnose a disease, but that is what is used (i.e. Connors checklist). There is a whole school of thought that what is called ADHD is a catch-all category for a lot of different kinds of problems. I think the evidence supports this, since the number and variety of different approaches to “ADHD” is phenomenal, and no one approach appears to be ultimately effective in dealing with these behaviors.

I can say for our part that we never were interested in getting a diagnosis, we just wanted to find out what would work. We were totally opposed to any medical solutions, so we focused entirely on very simple nutritional options (high protein, low sugar, etc.), lots of sleep, and an intensive behavior program to address the problem issues. We have been very successful in raising two “ADHD”-type children in this way. (The second was a LOT easier having figured out how to handle the first!)

I think it is also important to remember that LOTS of kids go through lying phases around this age. It is frustrating, and needs to be dealt with, but isn’t necessarily a sign of psychopathology! It is perhaps part of lacking empathy for others that leads to the use of lying as a survival strategy. Our approach (and we dealt with lying in all three of our boys around this age) was to make every effort to assure that lying was not perceived as beneficial. It took a lot of time and reinforcement, including weekly family meetings and behavior programs, as well as some very firm, no-nonsense discussions about trust and what happens when it is lost. But eventually, we got there. Our oldest is 19 and is extremely honest (sometimes to a fault!), and has developed a lot of empathy for others, even though I worried at 6 that he was a budding sociopath!

So I’m not saying don’t worry about it. I am saying start looking for effective interventions. Let’s say she IS diagnosed ADHD - will that stop her from lying? I don’t think there is a medication for that. It’s down-and-dirty, cause and effect, logical consequences, personal responsibility talk that has to occur. It is a project, but it will be worth it in the end. I would start off by learning to say, “I don’t believe you” when you think she is lying. If she protests, say, “I’m not saying you are lying. I am saying I don’t believe what you are saying. Partly this is because you have lied to me before, so my trust is low. If I find out that you are telling me the truth, my trust will go up. But for now, I am choosing not to believe what you are telling me, because it doesn’t make sense to me.” She will be mad when you start this, but stick to it until she starts telling the truth more often. You could also create rewards for telling the truth in difficult situations (not to get out of the consequences of her actions, but some positive thing could happen as well).

That’s just a couple of ideas to get you started. There are lots of things you can do about lying and lack of empathy. It may literally take years, but your child’s future will be positively affected by your hard work. Hang in there, and let me know if you want any more specific ideas.

–- Steve

[quote=”Steve”]Considering all the years of research that have gone into this phenomenon, the diagnosis of ADHD is remarkably subjective.
–- Steve[/quote]

No more subjective than the diagnosis of say, depression, schizophrenia, multiple sclerosis, “white coat” hypertension, just to name a few. There are objective ways of measuring symptoms consistent with ADHD but you’ve got to rule out a whole host of other problems, physical and psychological, before you can really make the diagnosis. That means parents who are concerned should get their kid to a specialist, especially one that doesn’t also tout particular treatments but just makes the diagnosis and refers you to someone else for treatment decisions.

There are no objective ways to measure the “symptoms” of ADHD, because the criteria themselves are utterly subjective. Look at the preceeding list: “Easily distracted”; “Forgetful”; “Fidgets”; “Talks Excessively”. These are not objective measures! How much talking is “excessive”? When is someone “forgetful” relative to “normal”? There is no way to make an objective determination of almost any of these criteria.

I agree that other psychiatric diagnoses are similarly subjective, and some medical diagnoses are subjective as well. This is all fine and good to recognize, but it doesn’t solve the problem at hand. The original writer wanted to KNOW if her child “has ADHD”. Clearly, there is no way to KNOW this as a fact, any more than we can KNOW if someone “has” depression or schizophrenia. I have no objection to devising a way of naming these phenomena so we can talk about them, but you are not going to convince me that there is any objective method of diagnosing these “diseases”. I have personal experience doing mental health assessments, and I know the process by which psychiatric diagnoses are arrived at. I have seen charts of people that have been given 7 or 8 or 10 different and sometimes conflicting diagnoses from different doctors or hospitals or mental health workers over a number of years. I have gotten diagnoses changed because they didn’t seem to generate treatment to meet the needs of the client. I have participated in long, philosophical arguments over which diagnosis “fit” a particular person.

So my point is this: an ADHD diagnosis or the lack thereof is a matter of opinion. That opinion may be more or less informed by research and experience, but it remains an opinion, not an observable fact. What IS observable is the behavior of lying (for example). And it is observable whether the lying increases or decreases when certain interventions are attempted. I have always found it most valuable to approach every situation from this viewpoint - does the planned intervention work? While diagnosis (even subjective ones) can sometimes assist in planning useful interventions, the interventions can function TOTALLY INDEPENDENT of the diagnosis. And the point is to help change the undesirable behavior, rather than putting a label on it. If the label helps a person deal with it, then go ahead and label, but don’t try to convince me that the ADHD diagnosis is in any way objectively verifiable. It is not, and will not be until an objectively observable set of criteria can be established that don’t require value judgements from the observer, like “often” and “excessive”. I don’t anticipate such a set of criteria in the near future, because they don’t exist for any other psychiatric diagnosis I am aware of.

I’ll get off my soapbox now. My real point in the above was not to spend so much time figuring out “what she has” and to spend more time on “what can I do about it”. I hope that point is not missed among the philosophical disagreements about objectivity.

–- Steve

http://www.medscape.com/viewarticle/463181?mpid=20190

Subtypes in ADHD: A Newsmaker Interview With Mary
Solanto, PhD

Robert Kennedy and Robert Glassman

Oct. 17, 2003 — Editor’s Note: Attention deficit-hyperactivity disorder (ADHD) has become an important
area in child and adolescent psychiatry. Much of the new research has delved into the various diagnostic
subtypes, response to treatment, and cognitive styles of both children and adults diagnosed with ADHD.

To discuss this new research, Medscape spoke with Mary Solanto, PhD, an associate professor of
psychiatry in the Division of Child and Adolescent Psychiatry at Mt. Sinai School of Medicine and director
of ADHD Clinic at Mt. Sinai Medical Center in New York City.

Medscape caught up with Dr. Solanto at the annual meeting of the American Academy of Child &
Adolescent Psychiatry in Miami Beach, Florida.

Medscape: You presented a poster here in Miami on ADHD subtypes. Can you tell us about it?

Dr. Solanto: We are doing a lot of research trying to understand what may be critical differences between
the two most recognized types of ADHD. There are kids who are predominantly inattentive, who’ve only
been recognized recently in the DSM-IV, and then there is the more commonly recognized child with
ADHD that is also hyperactive and impulsive. There seem to be many differences in the behavioral
functioning of these children and possibly in the kinds of deficits they’re likely to experience. We’re
evaluating these children on a whole array of neuropsychological measures. What we reported on were
some differences on the WISC [Weschler Intelligence Scale for Children] and we looked at whether there
were differences on measures of processing speed, which is how quickly a child can respond to a task
and complete it, as well as measures of distractibility.

Parents and teachers often report that kids with this inattentive type are very sluggish, they’re very slow to
accomplish many things, homework among them. And other kids often observe that they are very slow to
respond interpersonally. You ask them a question and you don’t even know if they heard you, and they
are looking around and daydreaming. [Their peers] may not have patience for that kind of behavior.
These kids can suffer socially as well.

What we showed on the WISC was that there was a much higher proportion of kids with this inattentive
type who did very poorly on the processing speed index. They were more likely to have a big discrepancy
between their verbal functioning and their processing speed. They were also more likely to have a big
discrepancy between their verbal functioning and their freedom from distractibility index on that test. That
seems to verify the kinds of behaviors that we observed interpersonally with these kids, and it also
provided a way for them to be assessed in a more formal manner to differentiate which type of ADHD
they may have.

Medscape: Has anyone else done similar studies?

Dr. Solanto: There have been some reports in the literature of longer reaction times of these kids in
laboratory tasks. There was also one other study that suggested a difference in processing speed. This
is the first time where it has been demonstrated on commonly used tests that are used in psychological
evaluations. What we want to do now is see if we can understand more about why processing is slower
for these kids. Is it occurring on the input side, in terms of their ability to orient to a stimulus and process
that stimulus, or is it occurring on the output side where they are processing the task and then deciding
or executing a particular response? Other tests in the battery will hopefully shed more light on what is
causing the longer reaction time. Another possibility is that they take longer to retrieve information and to
call up the appropriate information for the task at hand. We’ll also be looking at that as a potential
mediator.

Future studies will look at whether these children respond differently to stimulant medication than
children with a combined type or perhaps they may require a different dosage. We are also collecting
fMRI studies to look at whether different portions of the brain are activated in children with the two
subtypes, particularly when they are doing a task that requires inhibitory control. We have data that will
hopefully help to elaborate differences between the subtypes and ultimately construct treatments that are
more targeted for their particular deficits.

Medscape: Is this a particular age group or is it the spectrum of children and adolescents?

Dr. Solanto: That’s an interesting issue. Studies show that the age of onset or at least the age at which
children with the inattentive subtype are recognized is much later. They often do not come to clinical
attention till ages 9 to 11, and it may be hard to document that there were symptoms before that. It has
been proposed that the criterion for onset should be higher for the inattentive. Why this should be the
case isn’t entirely clear. It could be that demands on attention don’t increase so that these children don’t
look impaired in the classroom until they get to be 9 years old because they are not behaviorally
disruptive, they don’t have other problems. Their problems are primarily on structured tasks that require
concentration and focus. It is possible that this is a subtype that does not have an onset until later. In the
study, the children were matched for age, so that wouldn’t account for differences. The age range for both
subtypes was 7-12 years old.

Medscape: Could you tell us about your ADHD clinic and some of the things you do in the program?

Dr. Solanto: We see the whole range of ADHD at the program at Mt. Sinai. Children, adolescents, and
increasingly, more adults, who sometimes recognize in themselves the symptoms that their children
have, because as you know ADHD is highly heritable. Often they can see they have experienced
difficulties similar to [those of] their child and sometimes, with a little encouragement, they will come
forth for an evaluation for themselves.

In the clinic, we provide follow-up treatment in the way of medication [and] individual behavior therapy,
which is done by coaching parents and teachers in how best to respond and how to manage these
behaviors.

We also have a group that teaches adults time management and organizational skills that they may have
not developed because of the impairments associated with ADHD, which is very hard to acquire later on
without specific coaching. Not even medication will fully address that. It may help them learn these new
strategies, but it is something they have to work at and have help with. The groups have done pretty well,
they seem to have a positive impact. Next we will evaluate the whole process in a more rigorous fashion.

Medscape: Adult ADHA seems to have a new focus, in the literature and even in the press. People are
making it seem like it is a new diagnosis, which it isn’t. Can you address that?

Dr. Solanto: The follow-up studies have shown as many as half of kids with ADHD will continue to have
many symptoms in adulthood, if not the full-fledged disorder. We knew these people were out there, they
had to be given the results of these longitudinal studies. They might not be recognized by mental health
professionals because they often have many other symptoms and problems that by time they reach
adulthood take precedence. Many are depressed or have problems with anxiety, and often those are the
conditions and the problems that are recognized if they go for consultation, and unless one takes a very
careful history beginning at childhood, one may overlook the fact that there were certain ADHD symptoms
that are present very early on and have continued into adulthood. So it’s good that there is now much
more publicity about it, there are some books that are very helpful to adults in helping recognize
problems they may have had. There are actually very few specialized centers, even in Manhattan, that do
evaluations and treatment of adults with ADHD.

Medscape: I notice that the researchers in the field of ADHD are a small group and there seems to be
a great deal of collaboration. Do you work with other researchers in other areas in New York as well
as in the rest of the country?

Dr. Solanto: It’s really important to exchange ideas and share findings and instruments that are used for
diagnosis, as well as strategies for intervention. We’re working with adults to develop organizational
skills. For example, Howard Abikoff, at New York University, has developed a superb program to teach
children how to better organize themselves and has gotten really excellent results. There is an exchange
of ideas and approaches that benefits everyone involved, and it is great to do that at a meeting like this,
especially one that is provided in such a gorgeous environment.

Reviewed by Gary D. Vogin, MD

Robert Kennedy is site editor of Medscape Psychiatry; Robert Glassman is a freelance editor for
Medscape.

I just had to jump in on this discussion as I’m wondering as the individual poster if my 13yro could have “inattentive ADHD”. After 5yrs of Consistant/similar difficulties at home and school…this question is being raised.
But like Steve….I’m not “big on the meds”. I’m HOPING other interventions will help.
But first I have to get a DX of some kind to even have the school listen. After 1.5 yrs of trying to seek some kind of interventions/help from the school I finally got some help this year as the problem is worse then ever.

Problems? Very Disorganized which is reflecting in his grades. I had a eval done to rule out a LD. All test and sub tests came in at a mid to above average range.
He Lies….IE: “no I don’t have nothing I should be doing for school”..well a week later I get notification that he flunked a test that he should of been preparing for at the same time he said he nothing to be doing for school.
ummmm…3 weeks to do a project and waits to the last 3 days and crams it all in..and then it’s done “half way”.
Occassional Disciplinary problems…Carrying on and such in the cafiteria…nothing major though.
He does have a Agenda book the school hands out every year for the kids to use to get stuff done…but my son says “it’s retarded” and hasn’t used his in 2 yrs :roll:
I’m doing all I can to help him…but jeeeezzzzz each year is getting worse and worse.
Finally the school called yester day and put him on a list of 5 other students in his grade that weekly summaries of thier accademics and behaviors are sent home to the parents. (for the simple fact as he tries to push me out as much as possible)
For his last physical..we prearranged drug testing to make sure he wasn’t on drugs..that is how bad it’s gotten. Now my son didn’t know this..he thought it was to check his Iron and such..which was done….NO DRUGS and everything else was NORMAL.
Just Frustrated. I’m still trying to “figure things out”. But I can say..if ADHD (Inattentive) is the problem…it took me 5 yrs to get the help I’m getting now..A dx would help to get him assistance alot quicker.
Take Care all,
Binky[/u][/b]