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Unspeeded examinations

Marijuana and psychosis

Buspirone

Editorial

Mental illnesses will replace infections and malnutrition as one of the leading causes of disability and premature death early next century, according to a World Health Organisation study. Completed over the last six years, it determines health trends into the next century. What has surprised researchers is the expected rise in neuro-psychiatric conditions including panic disorder and schizophrenia, which appear to have been seriously under-estimated by medical researchers. "While psychiatric conditions are responsible for little more than 1 percent of deaths, they account for almost 11 per cent of disease burden world-wide", the authors say. The study predicts that depression will change from its current fourth ranked cause of disability and premature deaths worldwide to become second by 2020. - Murray & Lopex, 'The Global Burden of Disease', World Health Organisation, 1998.

Nine children (one girl) aged 7-16 with persistent anti-social, disruptive and/or criminal behaviours were recruited through police records to try a comprehensive elimination diet.

In Breakey's review of 13 significant diet/behaviour studies from 1985-1995, almost all studies showed a statistically significant change in behaviour with dietary intervention. Responses could be full or partial compared to all-or-nothing earlier expectations of the effects of food. Children most likely to be affected include those with a personal or family history of "allergy", a family history of migraine, young children, and those for whom a definite food reaction has been noticed in either the child or a relative.

"...the diet has been immeasurably useful. I can now think better, clearer, and I can reason logically where before an idea would just revolve around in my head. I can now do household chores! This might not seem too momentous, but just ask anyone in my household. I actually have fun cleaning up the kitchen now!

 Issue 16 Term 2 1998

ADHD and giftedness

When the characteristics of giftedness and ADHD overlap, the student is likely to have a record of academic failure as well as a history of significant social difficulty with same age peers and possible rebellion. The student will also display many characteristics of giftedness, including cognitive abilities far beyond those of classmates whose performance on IQ tests is within the same range. Gifted students with ADHD, by their very nature, are particularly disposed to underachievement. Their level of achievement may improve with a highly structured program.

A similarity between the way Ritalin and cocaine affects the brain has been found by US researchers. They suggest that cocaine may have a bigger impact on people who were treated with Ritalin, thus increasing the likelihood they will 'develop a taste for cocaine'. Animal experiments support the claim that Ritalin may encourage cocaine use. Further, a long-term study of 5,000 Californian adolescents with ADHD found that, as adults, those treated with Ritalin were three times more likely to use cocaine, although they were no more likely to abuse alcohol or marijuana than those who did not take the medication.

Ritalin and cocaine

Editorial

About half of all close relatives of autistic children have milder symptoms including language and social problems. Researchers at Johns Hopkins Medical School used magnetic resonance imaging to look at the brains of twins with autistic symptoms. They found some areas were significantly smaller in those with autistic symptoms. These were areas involved in emotion, learning and memory, shifting attention from one task to another, planning and problem solving and language processing. These effects have been obscured by natural variations in previous non-twin studies.

Statistics suggest that 40% of ADHD children are predisposed to substance abuse during adolescence or adulthood. Of the ADHD population who are poly substance users, 67% smoke marijuana. Many behavioural changes are similar to those of ADHD: academic ability decreases; sniffles, colds, trivial illness, especially respiratory system; concentration levels decrease; depersonalisation; increased levels of anxiety; increased depression; reaction times slows; short-term memory difficulties; a lack of motivation or interest in things previously enjoyed; increased impulsivity; space and time distortion; may increase appetite.

WHAT'S HAPPENING AROUND AUSTRALIA (and the world)

Parents of ADHD children often report that their children do worse in examinations than their ability and level of knowledge would suggest. Some parents do not realise that examination provisions or accommodations are available, others would like to apply for special provisions but do not know what would be appropriate for their child. A high number of students with ADHD have associated learning disabilities which are sometimes unrecognised. Their problems may be compounded by the restlessness, inattention and impulsivity which are core features of ADHD.

The concept underlying exam provisions is that each person should be tested on their knowledge not their disability. While it is easy to understand that a person in a wheelchair should be tested on their knowledge of maths or science not whether they can reach an exam room on the second floor, it is more difficult to grasp the concept that someone who is a poor reader should be tested on their knowledge of science or maths not their spelling or ability to read the question. This concept is the basis for the federal Disability Discrimination Act of 1993 which essentially gives students with diagnosed learning disabilities the right to alternate assessment provisions in all learning and assessment situations.

The first step in applying for extra help is diagnosis of learning disability, for example, measurement of reading rates, speed and accuracy. This is best done by a professional with a special interest in psychometric testing. One student whose reading ability was tested by a private consultant was tested by the school counsellor months later. The student came in the normal range for his age group. This information was forwarded to the Board of Studies by the school counsellor and the student was denied exam provisions. Since the IQ of the student was very high, the reading should have been in the range of the IQ of the student, that is, much higher than chronological age. The statistical probability of a person with such a high IQ reading at his chronological age should have been brought to bear in the application.

People who need extra help in exams will benefit from on-going support thoughout school and for other forms of assessments. This can be tutoring, help with organisation, study skills and extended deadlines for assignments. The remedial approach is recommended by psychologists who acknowledge the tendency of ADHD students to rush through exams, often answering the wrong question. They can be helped by counselling with 'stop and think' strategies taught to them long before exam time.

Some students who have consistently underachieved throughout school do well at university and attribute their success to accommodations. In the U.S.A. educational institutions are legally required to provide accommodations for which the cost is not unduly burdensome and which do not require a fundamental alteration of any essential aspects of the program. In Australia 'reasonable accommodations' have been available in universities for some time, but such provisions in secondary schools are less well known.

The Northern Territory University's disability officer, Jeremy Muir, emphasises the need for a flexible approach, for example, discussing options with the student and trying a specific strategy. Does it work? If not, try another strategy. Students must be happy with the suggested provisions.

Some ADHD students are unaware of their learning disabilities and improve when problems are identified. The role of disability officer also includes education of staff as some lecturers are unaware of learning disabilities and surprised at the problems these students face. Others have fears of 'making it unfair', yet non-LD students may well be disadvantaged by provisions such as coloured paper or larger font.

One ADHD student who is gaining credits and distinctions in her course has a note-taker during lectures so she can listen without distraction because 'she would flounder without notes'. Other accommodations include a tutor for an ADHD student with organisational difficulties.

Which provisions are available?

All states in Australia have secondary examination boards which have published information regarding their policies on examination provisions. Provisions such as coloured paper, enlarged print, readers, scribes, computers, audio-tapes and extra time are generally available in universities but may vary from state to state for secondary students.

Students with visual perception or scanning problems will often skip a bit of the question, or answer the wrong question. They may be helped by:

The single most important aspect of exam-taking for learning disabled students is the need to read and understand all of the questions. Missing whole questions or misunderstanding through omitting important words such as not is common. If a student cannot understand the questions within a reasonable amount of time and with a reasonable amount of effort then a reader is appropriate, although controversial, in some states.

Research at Sydney University has shown that success in examinations is closely correlated with speed of writing.

A writer will be helpful for children who have problems with:

Experts recommend that readers and writers should be competent, sympathetic adults who are good spellers and writers, rather than junior students. The student and reader/writer should have an opportunity to work together before the examination. The exam session can be tape recorded to enable validation of the transcription.

Extra time alone is unlikely to help a student with predominantly hyperactive/impulsive ADHD but may help a student with predominantly inattentive ADHD. It is more likely to be useful if combined with breaks. Breaks can be recommended, for example, for five minutes every half hour, or ten minutes every hour. If possible the student can decide which is more appropriate at the time.

Some students may be able to use a word processor or spell-checker to overcome their handwriting or spelling problems.

Students who have severe writing problems will try to write the minimum, use the smallest words, and will be distracted by their writing difficulties rather than concentrating on the question. Audio-taping can be an alternative.

Students who are easily distracted will feel more comfortable in a separate room. This will also make accommodations such as special breaks easier. Some students find the flicker of fluorescent lighting distracting or certain computer screens distracting and will perform better with natural or incandescent lighting. Rooms should be checked in advance of exams for this requirement.

How to apply

Access to exam provisions varies significantly from school to school and state to state. Based on National Health and Medical Research Council statistics, 2000-3000 students may be eligible to apply for exam provisions in NSW alone. In practice, the number of children applying for special exam provisions for learning disabilities varies from a few students in one state to hundreds in another. A disproportionate number of applications are from independent and Catholic schools.

The best place to start asking is the special education teacher at your school, your child's teacher or the secondary examination board in your state. You should start thinking about this at least one year before the examination for which you require provisions and possibly more. 'Exam provisions are unfair for the others,' is the most common objection. One representative of a secondary examination board explained, 'people are not going to go to all this trouble to apply to special provisions if they don't have a problem. We must give them the benefit of the doubt.' - Sue Dengate, Darwin

Do you have any experience with exam provisions? We'd love some feedback! (08 8981 2444)

laptops for LD

Editorial

If you think that self-esteem is something warm and fuzzy you do after you have sorted out everything else, think again. Good self-esteem is the very foundation for behaviour management and success, and building it is not just a matter of saying nice things to your child. Dr Robert Brooks, considered by many to the the world's leading expert on self-esteem, deals with real life, like problem getting your child to do homework.

I showed the Brooks video What did you do that for? to an enthusiastic audience of parents and teachers. 'How can we see this man?' asked my audience. If you are lucky enough to live anywhere near Sydney, Newcastle, Brisbane, Melbourne or Ulverstone, then don't miss the Brooks seminars in May. Dr Brooks is coming to Australia as the result of hard work by ADDnet. Read more about it on page 00.

As a parent, I know just how difficult ADHD children can be. As a former teacher I am appalled by what teachers have to cope with when they have several ADHD children as well as the rest of the class. Read about the teachers' views on p00,00 and 00. And at last, a book about ADHD written by educators for educators, see review p00.

- Sue Dengate, editor

Children who are spanked once or more a week are much more likely to develop anti-social behaviour in the next two years, according to a U.S. study. This effect was particularly strong in older children. The authors estimated that if parents who spanked once per week stopped altogether, about 20% of children could benefit.

Labels such as 'distractible', 'hyperactive', 'reactive', or 'oppositional' can be replaced by corresponding labels such as 'perceptive', 'spirited', 'sensitive', or 'determined', according to Jenny Young-Loveridge, Senior Lecturer in Education Studies at Waikato University and mother of an ADHD child. She tells of a professional who wrote about her son: 'his intensity and inability to accept "no" are both highly positive attributes in many professional careers!'

Researchers recently found that Ritalin may depress responsiveness to reward while elevating reactions to punishment. They suggest that this may make a return to normal functioning less probable.

There is no doubt that a well managed, highly structured classroom is necessary for children with ADHD, according to Dr Alan Hudson of RMIT's Department of Psychology and Intellectual Disability Studies. Behavioural interventions have been found to be highly effective, although teacher praise and disapproval are not sufficiently strong reinforcers for ADHD children. Reinforcers such as stickers may still be insufficient. Teachers and parents can work together so that the child has access to home-based rewards such as television viewing or pocket money. Further reading: Hudson A 'Classroom instruction for children with ADHD' Aust J Early Childhood (1997),22 (4):22-27

Teenagers who choose to leave school early should not be called 'drop outs' according to educator Dr CH Payne. Some overseas research shows that many make sensible decisions, pursuing what they want to do, and reserving the option of further education if and when they need it. As from July 1998, young people will have to be engaged in full-time study or training to be eligible for the Commonwealth Youth Allowance. This will probably mean more teenagers choosing to remain at or return to school. More flexible and varied courses should be developed to meet the needs of this new group of school students.

'We don't know how to cope,' said one teacher with more than 20 years experience. 'Children weren't like this when I started teaching. In my first year as a teacher I had a transition class of 42 children and only one, maybe two, whom I would have considered to have any behaviour problems. I loved that class and I looked forward to going to work every day. Now I have a class of 30 of whom 10 have ADHD, learning disabilities or behaviour problems. I have to struggle with a child who spends his whole time running around the room and jumping on the tables. It's all I can do to get him to sit down, let alone to learn anything. He takes up half my time, the remaining children with problems get most of the rest, and the others have to make do with what's left. We haven't been trained to deal with children like this. We need more help. I feel overloaded all the time, I dread going to school and I'd like to get out of teaching.'

The Innovations Spell Checker offers spell checking on up to 80,000 words in English (not American), will search for missing letters, and the search mode includes phonetical checking. It also includes a calculator function. At $39 it is a lot cheaper than a word processor. Has anyone tried it? For more information, phone 1300 303 303 (order code is SISA).

Reading together program

Set up: We set up the equipment for the program in a large red box in a special place in the library so that readers and folders were available even if the coordinator was absent. This encouraged the year 7 students to run the program themselves, phoning if late and reorganising themselves if anyone was unable to attend.

The box contained

There were also blackline masters of a letter to middle primary staff requesting identification of students who would benefit from the program, and a letter to year 7 students who had been identified as suitable tutors, outlining the program. Ongoing commitment was required.

Outcomes: Supportive methods to assist poor readers (such as pause, prompt, praise) were demonstrated and the program did need to be monitored but the Year 7 students ran the program. By using Silent Reading time no-one missed out on any class work. The Year 7 tutors were competent readers who continued to read widely. It was a pleasure to watch the rapport develop between the year 7 tutors and their reading partners. The reading partners took great pleasure in acknowledging their tutors in the school grounds.

Details of this program are available from OITH.

Symptoms of exposure to solvents can include behavioural and learning symptoms such as poor short term memory, poor coordination, mood change and developmental disorders. Effects are dose-related and subclinical effects have been detected in workers who are not really ill. Some people have been affected by chronic, long-term exposure to levels smaller than those considered safe. Drinking alcohol can worsen the effects on the nervous system. Effects can be permanent. Treatment consists of avoidance of further exposure and treatment of symptoms with drugs such as antidepressants or stimulants. Occupations identified as high-risk for solvent toxicity include:

Head lice infestations are becoming more widespread as resistance develops to chemical treatments. Several readers have asked about non-toxic treatments.

Parents who are concerned about toxicity worry about warnings like the one on malathion which states that repeated minor exposure may have a cumulative poisoning effect, and that poisoning can occur through skin absorption.

In Belgium, researchers found that the only treatment with evidence of effectiveness was 1% permethrin cream, that lindane and natural pyrethrins were 'not sufficiently effective to justify their use' and that malathion and carbaryl 'needed more research'.

Parents are encouraged by health experts to minimise the use of pesticides to a single wash with the head lice treatment followed by intensive combing with a nit comb. Are there any other options? A new product containing cold-pressed oil from the Indian Neem tree which demonstrates 'no mammalian toxicity' is recommended by representatives of several schools. Canteen manager Lindy Scott says, 'Nimbin Central School introduced Liceguard early in 1996 when head lice were raging though the community. The reports I have received have been nothing but positive ... I recommend this product simply because it works where other, much more expensive products left a lot to be desired.' Ask for Liceguard at your local health food store or pharmacy, or phone/fax the national distributor on 02 6688 6150 Further reading: Vander Stichele RH and others Systematic review of clinical efficacy of topical treatments for head lice. British Medical Journal 1995;311:604-608

Statistics suggest that 40% of ADHD children are predisposed to substance abuse during adolescence or adulthood. Of the ADHD population who are poly substance users, 67% smoke marijuana. Many behavioural changes are similar to those of ADHD: academic ability decreases; sniffles, colds, trivial illness, especially respiratory system; concentration levels decrease; depersonalisation; increased levels of anxiety; increased depression; reaction times slows; short term memory difficulties; a lack of interest in things previously enjoyed; increased impulsivity; space and time distortion; may increase appetite.

Research suggests:

* Two cannaboids found in marijuana affect chromosomal structure, causing genetic mutation.

* The gene affected is the same gene implicated in ADHD. Three studies have shown that females who were heavy smokers of marijuana prior to pregnancy produced children who demonstrated significantly disturbed behaviours compared to mothers who did not smoke marijuana - the behaviours described were ADHD.

* Smoking one joint a day, three days a week for six month results in changes in brain physiology that can be detected three to five years later.

* Marijuana decreases the amount of T-cells in the blood, weakening the immune system.

* There is a higher incidence of jaw, tongue and throat cancer among marijuana users.

* Long term users may develop drug-induced psychosis. Other than those who develop drug-induced psychosis and cancer, all other effects are fully reversible with total abstinence.

The danger for children being given drugs to calm them down is that they come to believe that they do not have to take responsibility for their own actions, according to teacher Jean Robb and children's librarian Hilary Letts. For these children, the pride in learning self-control, self-discipline and new skills for new stages of life has been taken away. These authors recommend observing your children, paying attention to them, teaching them the consequences of their actions and social and other skills. You can teach an ADD child to be still:

1. Ask the child to lie down and see if he can be still by the time you count to ten - slowly. Lying still means not moving at all.

2. When the child moves, tell him which number he managed to get to before he moved and then try again and see if he can get further.

3. Take it in turns so sometimes he counts to ten while you lie still. This gives him a chance to see someone else being still.

Their book is full of suggestions which sound so simple you wonder if these authors really understand ADHD, but they claim to be successful, as with the mother of an Asperger's girl named Margaret who was cruel to animals. The mother was advised to explain to her daughter that a vulnerable animal needs her care and to think about the consequences of her actions. 'When Margaret's mother tried these things she found that they worked. She was able to talk to Margaret and Margaret was fascinated by the discussion.' If these suggestions really do work, they are worth a try. We'd love some feedback on this one, please.

A mother with ADHD reports that the self-hypnosis cassettes I'm not hyper, angry or lazy and Clear calm and healthy have helped her to sleep better, become more organised and to start an exercise program. 'I feel much better because of it'. She plays I'm not hyper to her children after they are asleep. Her ADHD son's handwriting has improved and he is doing better at school. Most surprising is that she hears her daughter repeating phrases she could only have heard on the tape, such as 'you should treat other people the way you want to be treated yourself'. Available from Positive Input, phone 00000000000000

'His mind was twitchy, like his fingers, which were always moving.'

A two-year pilot study into the effects of using laptops with LD students has been underway at Robertson State School in Brisbane. In July 1995, Apple PowerBook laptops were issued to students aged 8-12 enrolled in the special education class. Teacher Larissa Lambalot reports that students who had previously avoided writing made rapid progress as writers. She explains that writing is like any other skill - you get better at it the more you do. With laptops, LD students who previously failed to complete writing assignments now experienced success and were motivated to keep writing. This is because laptops help the children to read what they have written, and they don't have to read the same piece of text five times and still make mistakes because they can cut and paste and change things around painlessly to produce work which looks so professional that they can be proud of it.

Some students have severe fine motor problems which affect their handwriting ability. These students are easily fatigued and focus on the letters rather than the ideas they want to impart. They benefit greatly from a laptop because they can write to longer and focus on what they want to write. Some of the Robertson students have shown substantial improvement in rate and volume of writing.

Teachers report that the students have developed confidence as writers. Written tasks are generally started without argument or groan. The rate of task completion has risen significantly. Negative self talk has all but disappeared and the students enthusiastically read their writing to others to gain feedback. It appears that parents also have seen the benefits, as three families have now purchased laptops for their children. - from Apple magazine August 1997

Dietary management may not be recommended by ADHD experts in the USA, but that doesn't mean it isn't used. Twenty years after Dr Feingold first introduced his controversial theory about the connection between foods, behaviour and learning disabilities, Feingold Association president Jane Hersey has published a massive, well-indexed 473-page book about his diet. This is an entertaining read which makes you feel 'I'm not the only one' and provides a fascinating glimpse of life in the USA, although the dietary information and food lists seem out-of-date to us - food such as pineapple, dates, lemon juice, cola drinks, fast food hamburgers and amine-containing foods such as chocolate are still recommended. There is little emphasis on slow, cumulative build-up and delayed reactions which is perhaps why this association permits many foods that have been found to cause problems by Australian researchers. But there is plenty to learn, too. Years of product information research have unearthed some surprising practices by the food industry. Did you know that many cereal manufacturers add the antioxidants BHA and BHT to the inside of the bag containing the cereal which allows the chemical to slowly migrate into the contents? And examining highly publicised recent research, Hersey points out that while was sugar was not found to affect children's behaviour, the behaviour of all the children 'generally improved' on the 'essentially free of additives' experimental diets, a fact not mentioned in the press release of the Wolraich and others 1994 sugar study.

If planning a trip the States, you will be pleased to hear there is an amusement park called Sesame Place in Langhorne, Pennsylvania, which tries to avoid 'unsavoury additives' and that Disney World contains a small grocery store but you should call the Guest Relations office before you leave home if wanting to eat in the restaurants. Be warned, the local ADD support groups called CHADD do not support families using diet. Hersey recounts how a Feingold speaker was denied permission to address a CHADD group because 'it might make the members feel guilty [that they weren't using diet]'.

From amusing accounts such as 'the war with my mother-in-law' and 'how I saved Fairfax country $62,296.00' by keeping a child out of an LD class, to the reports of epileptics affected by artificially-coloured Tegretol, the real strength here is in the stories. It is heartening news to read that young adults who have grown up on this diet find it easy to say no to recreational drugs because they like being in control. If you're into diet for the long haul, this is a useful reference which will give you solid support and remind you 'it's worth the effort' every time you dip into it.

A successful ADHD adult tells us how to manage long boring meetings: doodling or word games like anagrams. ADHD people do better while doing two things at once. No need to ask these students to stop doodling. They are probably paying better attention because of it.

The Principal of a top Queensland private school has linked Australia's high youth suicide rate to inadequate education facilities for less academically gifted students. Nudgee College Principal Brother Harney said that the lack of vocational programs deprived four out of every 10 studedts of the opportunity to learn. 'They are gifted and talented in their own right but their skjills don't lie in physics classes, for example. They are graphic artists, skilful musicians, skilled at manual labour and construction, talented cooks and clothing desingers. Because vocational programmes cost more to run, governments have tended to ignore students in this area.' The hopelessness youth experience after failing school was one factor which contributed to Australia's record high youth suicide rate. Courier Mail 21/3/96

WHAT'S HAPPENING AROUND AUSTRALIA (and the world)

When the principal of East Maddington Primary School imposed a five-day suspension on 12 year old Robert Farmer for allegedly striking a female teacher, he could not have forseen the consequences. Robert's mother June Woods removed her other son, aged 8 from the school in protest and a bitter four-month battle ensued. On the day the boys finally returned to school, teachers cancelled classes and went on strike for three days because 'the boys were too dangerous'. After various offers from the education department including a behaviour mangement centre and private tutoring while at school, the boys were finally moved to another school. Allegations against the boys ranged from assault on other students and teachers to causing disruptions in class, but the lack of documented evidence highlights the need for principals to note any incidents and to follow suspension and exclusion procedures carefully. The West Australian

30/10/97, p10

A 10 year old boy who had been in the care of his maternal grandmother all his life was taken away from her by the Department of Family and Community Services on the order of a magistrate because she had refused to follow the recommendation of a doctor that he be placed on drugs to treat his condition, diagnosed as Attention Deficit Disorder. The grandmother had accepted the diagnosis, but did not want to use drugs. Instead she had hoped to minimise his disruptive, anti-social behaviour by means of a tightly controlled diet. The magistrate, describing the grandmother's conduct as "somewhat remiss' and noting that her approach had produced no significant improvement in the behaviour of the child, had ruled that this constituted neglect and placed the boy in the care and protection of the department. The grandmother appealed, and 'not surprisingly to many', won. The Courier Mail, Brisbane, 28/2/98, page 23. (The mother who sent this article commented that she was glad to have the opportunity to do a proper elimination diet because she finds a combination of Ritalin and diet produces best results).

In Pennsylvania and many other states groups of parents, educators and business people are allowed to band together to create public schools to serve a segment of the population not being adequately served by the existing school system. Called charter schools, they are funded by tax money and must not be of a religious nature. Otherwise, community groups have free rein in creating a school, as long as they satisfy the criteria imposed by the state, such as a proven need for such a school, proven community support, access to a safe facility and an educationally sound program. Some charters in Pennsylvania accommodate children at risk, some are for special interests such as performing arts, technology, environment or Gardner's theory of multiple intelligences. Most are beneficial for ADD students in that they tend to have smaller class sizes (16-20 per class instead of 25-30), and often feature more hands-on learning and physical movement in the classroom instead of sitting at a desk the whole day. Currently planned is a Montessori-type program based on child-directed learning: the child's educational program is designed together by the teacher, parent, and child; each child would receive an Individual Educational Program (in public school, IEP's are only given to gifted students or special needs students); the teacher would function more as a facilitator to provide the resources for the child's independent study and the school would rely heavily on interested parent volunteers in the classroom. It might be a good answer for some of the learning needs of ADD kids. Charter schools have detailed charters listing every aspect of their program. You can purchase copies of the charter for other groups to use as a template in creating their own schools (electronic copy $150, hard copy $100, both for $200, which is a good deal when you consider the months of research that went into creating the charter and the many hours of groundwork that a group could save by using a template). If you'd like to know more, I can give you website and e-mail addresses so you could pursue this further. - from Arlene Schar in Pennsylvania. Anyone like more details?

Q. My teenage son is planning a career in the army, will ADHD affect enrolment?

A. In Australia current treatment with stimulant medication brands an applicant unfit to serve in any of the forces. This is of great concern as the structure and activity of such a career suit the ADHD temperament. If you plan to join the army make sure you are seen to be complying with their strict criteria at least one year before the interview. Check the current situation with the local recruiting office well in advance.

Drs Christopher Green and Kit Chee, from their new book Understanding ADHD.

Q. My son is taking Dex and Catapres. Can we do the elimination diet?

A. The elimination diet can be tried while patients are on medication. The effects of diet are different from those of medication. Some patients need both medication and diet in order to control their symptoms. Most patients report that if diet has a role, then the dose of medication needed to control symptoms is less, or not needed at all. - Dr Anne Swain.

 Networking

After the Russell Barkley conference in Sydney in 1994 there was an informal meeting of support group representatives from all over Australia. Since we were all working towards the common goal of improved provisions for our children, we realised how useful it would be to keep in touch and share information. And, for lobbying purposes, that there is strength in numbers!

Since then there has been at least one committee meeting each year with representatives from all over Australia and ADDnet became an incorporated association in 1997. ADDnet provides media releases about ADHD, communicates with politicians when ADHD issues are to be raised in parliament and made submissions regarding the National Health and Medical Research Council's report on ADHD and the Child Disability Allowance.

The visit of Dr Brooks is by far the biggest event that ADDnet has undertaken. We are convinced it is one of the very best ways we can help improve the well-bring and self-esteem of Australian children, and particularly ADHD children. This has meant a lot of hard work for all of us in organisation and attracting sponsorship. We hope you'll take advantage of the opportunity to see this wise and inspiring man in action.

ADDnet protects your interests by networking and lobbying on national issues. You can support our work as an individual or group by joining ADDnet.. We have to charge a membership fee to cover incorporation but we have kept this as low as possible. For more than a year, Order in the House has been the official newsletter of ADDnet. See details below for how to subscribe to this newsletter and to join ADDnet.

If you'd like to buy or sell raffle tickets to raise money for ADDnet, contact Lyn Mulley on 02 4987 3249. First prize is a car. Last year's second prize of a computer was won by OITH reader Fiona Shanahan. - by Dale Stauffer

Here at OITH, we hard-working volunteers are grateful for readers' comments like the following:

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DO YOU WISH TO BE INCLUDED IN THE REGISTER OF ADD SUPPORT GROUPS AND PHONE CONTACTS Y/N

April 4 Health and Education Conference CHERI New Children's Hospital Westmead, phone Deborah Pearce 02 9845 3017

May 9-26 Brooks seminars on fostering self-esteem Tasmania (May 9th) ph 03 6429 3332, Melbourne (May 15)ph 03 9650 2570, Newcastle area (May 20th) ph 049 59 6604 Sydney (May 23rd) ph 02 9845 3017 Brisbane (May 26th) ph 07 3817 2429

It's official! ADHD kids are different although the cause is 'essentially unknown'. After a year's delay, the long-awaited National Health and Medical Research Council's report on ADHD has finally hit the shelves. Among the recommendations:

Although this publication gives credibility to the existence of ADHD, the media have been quick to notice that 'the long-term safety of stimulants has not been established'. There are cautions about medication for young children and teenagers, and that 'further research should examine the efficacy and safety of medications, particularly psycho-tropic medications and prolonged or continued use of stimulant medication.'

It sounds like the plot for a science fiction novel: large numbers of children develop a behavioural disorder for no apparent reason and need to take a drug which alters their brain function. No wonder teachers have been slower than parents to accept the reality of ADHD.

The teachers most likely to observe ADHD children closely are special education teachers so it is appropriate that this book about ADHD has been organised and published by the Australian Association of Special Education.

What a relief it is to see editors Jeff Bailey and Don Rice acknowledge the pain that families have been through while trying to get help for their children being told nothing is wrong, or their problems are due to poor parenting.

Written for teachers as a collaborative effort between eleven professionals, the topics range from an overview of ADHD to case studies, how parents and teachers feel and what to do about it. Particularly illuminating is an interview with a new teacher who talks honestly of her fears about an ADHD student in her class - how can she help him socially and academically, how to handle his aggression, what if the other children in the class are missing out? Each worry is considered sympathetically and constructively.

In the classroom, Dr Loretta Giorcelli considers that homework is the area most likely to cause daily tension for ADHD students and their families. Her list of 19 strategies to minimise the conflict, and other strategies for coping in the classroom are realistic and helpful.

Obviously aimed at teachers, some of this book is fairly academic. If you've been looking for a book to give your child's teacher, here it is. But have a look at it yourself first!

A consistent pattern of behavioural changes can be seen in rats fed on a diet of Lake Ontario salmon, which is known to be high in chemical contaminants such as now-banned PCBs commonly used in the 1940s. Compared to rats fed from uncontaminated Pacific salmon, or to standard laboratory rat chow, Ontario-salmon-fed rats are hyper-reactive to unpleasant events, such as electric shocks or disappointing rewards, but 'react normal when 'life is pleasant''. (In a parallel study on children of human mothers who have eaten Lake Ontario salmon, the children were also found to be hyper-reactive to negative events.) But researchers were surprised to notice that affected rats were also found to work harder and longer at certain tasks than control rats when they were sure of a immediate, satisfying reward. This unexpected finding was explained by researchers as a hyper-reactive response to a positive situation.

Rats were fed with the Lake Ontario salmon before, but not during, pregnancy. Following the rats through several generations, researchers found that the behavioural changes in adult rats fed with Lake Ontario salmon also appeared in their offspring.

Efalex contains tuna oil (containing omega-3 fatty acids), evening primrose oil (containing omega-6 fatty acids), vitamin E, thyme oil, glycerol and gelatine. In a controlled study of a group of ADHD boys aged 6-12, Purdue university researchers found more behaviour problems, temper tantrums and sleep problems in those with omega-6 deficiencies; and more learning and health problems in those with lower omega-3 fatty acid concentrations. Dr Jacqueline Stordy found 15 dyspraxic children showed an improvement in manual dexterity, ball skills and balance when treated with an Efalex-type supplement for three months.

A successful ADHD adult tells us how to manage long boring meetings: doodling or word games like anagrams. ADHD people do better while doing two things at once. No need to ask these students to stop doodling. They are probably paying better attention because of it.

The Principal of a top Queensland private school has linked Australia's high youth suicide rate to inadequate education facilities for less academically gifted students. Nudgee College Principal Brother Harney said that the lack of vocational programs deprived four out of every 10 studedts of the opportunity to learn. 'They are gifted and talented in their own right but their skjills don't lie in physics classes, for example. They are graphic artists, skilful musicians, skilled at manual labour and construction, talented cooks and clothing desingers. Because vocational programmes cost more to run, governments have tended to ignore students in this area.' The hopelessness youth experience after failing school was one factor which contributed to Australia's record high youth suicide rate. Courier Mail 21/3/96

The danger for children being given drugs to calm them down is that they come to believe that they do not have to take responsibility for their own actions, according to teacher Jean Robb and children's librarian Hilary Letts. For these children, the pride in learning self-control, self-discipline and new skills has been taken away say these authors, who recommend paying attention to your children and teaching them social skills and the consequences of their actions. For example, you can teach an ADD child to be still by asking the child to lie down and see if he can be still by the time you slowly count to ten.

This book contains suggestions which sound so simple you wonder if these authors really understand ADHD, but they claim to be successful, as with the mother of an Asperger's girl named Margaret who was cruel to animals. The mother was advised to explain to her daughter why a vulnerable animal needs her care. 'When Margaret's mother tried these things she found that they worked. She was able to talk to Margaret and Margaret was fascinated by the discussion.' If these suggestions really work, they are worth a try. We'd love some feedback on this one.

In Pennsylvania and many other states groups of parents, educators and business people are allowed to band together to create public schools to serve a segment of the population not being adequately served by the existing school system. Called charter schools, they are funded by tax money and must not be of a religious nature. Otherwise, community groups have free rein in creating a school, as long as they satisfy the criteria imposed by the state, such as a proven need for such a school, proven community support, access to a safe facility and an educationally sound program. Some charters in Pennsylvania accommodate children at risk, some are for special interests such as performing arts, technology, environment or Gardner's theory of multiple intelligences. Most are beneficial for ADD students in that they tend to have smaller class sizes (16-20 per class instead of 25-30), and often feature more hands-on learning and physical movement in the classroom instead of sitting at a desk the whole day.

Currently planned is a Montessori-type program based on child-directed learning: the child's educational program is designed together by the teacher, parent, and child; each child would receive an Individual Educational Program (in public school, IEP's are only given to gifted students or special needs students); the teacher would function more as a facilitator to provide the resources for the child's independent study and the school would rely heavily on interested parent volunteers in the classroom. It might be a good answer for some of the learning needs of ADD kids. Charter schools have detailed charters listing every aspect of their program. You can purchase copies of the charter for other groups to use as a template in creating their own schools (electronic copy $150, hard copy $100, both for $200, which is a good deal when you consider the months of research that went into creating the charter and the many hours of groundwork that a group could save by using a template). If you'd like to know more, I can give you website and e-mail addresses so you could pursue this further. - from Arlene Schar in Pennsylvania. Anyone like more details?

American psychologist Dr Robert Brooks, member of the Harvard Medical school faculty and Director of the Department of Child and Adolescent Psychology and Psychoeducation in Belmont, Massachusetts, will visit Australia next May (see insert). The following article is a brief introduction to some of Dr Brooks' ideas including his islands of competence concept. Based on his book The self-esteem teacher, strategies are designed for teachers but will work for parents.

There is increasing evidence that self-esteem is significantly implicated in how motivated and successful students are at school. A student with high self-esteem is willing to take risks and to learn from rather than to feel defeated by failure. Research has shown that teachers can make a difference.

To understand your child's feelings, describe a typical day in your child's life, but through your child's eyes. For example, how does your child feel when he (she) first gets up in the morning, sees you, goes to school? How does your child feel about herself (himself), about his (her ) abilities to succeed? How does your child experience being taught, encouraged, disciplined? Children with high self-esteem believe that their own efforts and ability determine their success, compared to children with low self-esteem who attribute success to luck or chance, thereby lessening their confidence that they will succeed in future. Such children feel that education is imposed on them, 'I don't like school but I have to go.'

To assess children's self-esteem levels, look at how children respond to failure. For example, of two children who have just failed a spelling test, one may say 'I can do better than this, next time I'd better study harder.' The other says, 'the teacher never told us those words would be in the test - he should be fired.' The child who blames someone or something for his or her failure needs to learn that mistakes can be the basis for learning and growth.

Children with low self-esteem can be perceived as swimmers drowning in a sea of self-perceived inadequacy. To counteract this image of drowning, imagine that every person in this world possesses at least one small 'island of competence', one area that has the potential to be a source of pride and achievement. In the school environment it is imperative to find ways of displaying a student's islands of competence. If students experience school as a place where their strengths rather than their deficits are spotlighted, they are likely to be more motivated to achieve and learn.

There are three categories of in-born temperament: easy, slow-to-warm-up, and the difficult children who often leave parents and teachers feeling frustrated, angry and not very competent. A teacher's own style can influence how a particular child is viewed. One boy who could be oppositional and demanding was seen as disrespectful and not interested in learning by his third grade teacher, whose teaching style was very structured. In contrast, his fourth grade teacher's flexible style lessened the boy's defiance and increased his cooperation.

Develop an alliance. Perhaps the most influential force in determining the effectiveness of self-esteem strategies is the relationship that students have with their teachers and among themselves. At the beginning of the year we should develop an alliance with students, an alliance which implies trust and cooperation in the classroom, and support and encouragement for the students' efforts, preferably permitting the individual style of each student to shine. For instance, a very active boy who needed time at the beginning of each day to settle in was recruited as the attendance monitor. At the request of the principal, he walked the hallways with a clipboard and checklist of classrooms, noting any teacher absences. This responsibility helped him to adjust to the day.

Create a sense of belonging and being special. One teacher sent a postcard to each student a week before the start of term, welcoming them to the class and inviting them to bring a photograph of themselves and a drawing for display on the first day. Some teachers schedule brief individual appointment times into their day. Feedback is that these meetings foster a sense of security in students and other students learn to respect and not to interrupt the appointment times of their classmates.

Create a classroom identity, such as a class name or logo and a diary documenting events like school camps and include a list of birthdays. .

Students who blame the teacher for a poor test grade, or become the class clown, or say they don't care about not doing homework are struggling to hide any sign of weakness, to cope with fear of failure. Although counterproductive, their coping mechanisms are the equivalent to a suit of armour. Yet the way we respond to these is often to demand that our students remove their protective armour before we have built an alliance with them. In response, they will put on an even stronger piece of armour. Dr Brooks advocates that we assume responsibility for designing learning environments that develop competencies in academic areas, minimise fear of failure, highlight their islands of strength, and hold our students responsible for their actions in a manner that is not perceived by them as demeaning, controlling, or judgemental.

Change negative scripts. How can we change the negative scripts of students, enabling us to foster a positive relationship with them that will promote learning and success in the classroom? Dr Brook believes that we must be willing to take risks and change our typical response to these students. Frequently, our response to a very active boy whose behaviour in class is disruptive is to remind him to sit in his seat, perhaps event to punish him for failing to do so. Instead, the role of attendance monitor, above, respected this boy's temperament and coping style and noticeably lessened his disruptive behaviour. In another example, an oppositional girl was failing to do homework with a belligerent, 'I don't care' attitude. This girl enjoyed interacting with and instructing younger children so she was engaged as a tutor. When she encountered a young child who didn't want to work, discussions helped the girl to change her own productivity. In order to motivate students and to help them relinquish counter productive and disruptive coping behaviours, we must provide them with opportunities to increase their self-worth. At times in providing these opportunities we must respond in totally new and unexpected ways since our typical responses will only serve to alienate students further.

Dr Brooks suggests many ways to build self-esteem. Establishing the student's own space helps. In one classroom, parents even built a loft where students could relax and read. Praise. Commonsense suggests that people welcome realistic words of encouragement and appreciation more than they do words of criticism. Unexpected or unusual expressions of appreciation, like a small note, are most remembered and are the best way to overcome the immediate verbal rejection which is sometimes the response of a difficult student. A strong parent-teacher alliance helps, and it is equally important for the teacher to receive positive feedback from the parent.

Develop responsibility. A basic ingredient of self-esteem is a feeling of responsibility for what occurs in our lives. As educators, we should strive to provide our students with opportunities to assume responsibilities in the school, such as becoming monitors or students-as-tutors. In one study the drop-out rate of young adolescents was cut significantly by involving them as tutors of younger children.

Teach how to learn from mistakes. Fear of making mistakes is one of the most formidable barriers to learning. Teachers can ask at the beginning of the year, 'Who feels they will probably make a mistake in class this year?' The teacher then raises his or her own hand.

Provide a sense of ownership through choice and opportunities for decision making. This can be as simple as 'which day do you want your maths test, Friday or Monday?' or alternatives for homework. Foster the development of self-discipline. Inner discipline is shaped by the ways in which adults set limits, guidelines and consequences for children. Discipline is not the same as punishment. Teachers who use self-esteem strategies are following a crisis-prevention rather than a crisis-management approach. Students are more likely to develop a strong alliance with the teacher and are less likely to engage in disruptive activities when they feel they are being respected and empowered.

 Parenting

'Is it ADD or DDD (Dad Deficiency Disorder)?' asks high-profile Australian psychologist Steve Biddulph. He tells the story of a truck driver named Don whose eight-year-old son had been diagnosed with ADD. Don, who had previously left parenting to his wife, decided that 'attention deficit' must mean that his son wasn't getting enough attention and worked at spending more time together. During school holidays and sometimes after school, Don took Troy in the truck with him. On the weekends, when Don had previously spent time with his mates riding classic motorbikes, Troy came along too. Within a few months, Troy had calmed down so much he wasn't ADD anymore and dropped his Ritalin. But father and son continued to hang out together - because they enjoyed it.

According to Biddulph, all through the primary school years and into mid-high school, boys should spend a lot of time with their fathers and mothers, gaining their help, learning how to do things and enjoying their company. From an emotional viewpoint, the father is now significant. They boy is ready to learn from his dad, and listens to what he has to say. This window of time - from about age six to the fourteenth birthday - is the major opportunity for a father to have influence on, and build the foundations of masculinity in, his son. Little things are important, like playing the backyard on summer evenings, going for walks and yarning about life and telling him about your own childhood, working on hobbies or sports together for the enjoyment of doing it. Says Biddulph: 'This is when good memories are laid down that will nourish your son, and you, for decades to come ... All I can do here is plead with you - don't leave it too late!'

In Biddulph's view, boys with ADD and their parents need help which should go far beyond just prescribing drugs. He points out that:

* the long term use of powerful drugs such as Ritalin has not been proven safe or effective

* that much more help must be given to boys (who make up 90 per cent of cases) in learning calming and concentration skills, and that

* ADD does not make children violent, only distractible and jumpy. Violence in children always arises from factors in the home environment.

* Other possible explanations for ADD-type behaviour should be eliminated, such as sexual abuse, upset over divorce or violence at home, erratic discipline and learning difficulties at school which make the child feel useless. The use of medication can create a window of time for family and child to calm down and start learning. This time should be spent learning new skills and getting more help. Don't depend on the drugs to do it all, urges Biddulph, work towards the long-term goal of not needing drugs at all.

laptops for LD

In Australia, the first wave of ADHD awareness started nearly ten years ago with Dr Serfontein's book The Hidden Handicap. Medical doctors, usually paediatricians, described the symptoms of ADHD and how to treat the condition with medication.

The second wave began when families and research found that medication alone was not enough. As Sydney psychologist Ian Wallace says, 'After pills, then what?' Second wave psychologists explore other ways, such as behaviour management, educational management and self-esteem building, to help our children. In this issue you can read about Ian Wallace's idea of turning ADHD weaknesses into strengths (p?), Steve Biddulph's thoughts on parenting ADHD children (p?) and Robert Brooks' hints for raising self-esteem (front page). When I read Dr Brooks' superb book The Self-Esteem Teacher I was pleased to realise that some of my children's best teachers had used these strategies.

An innovative youth counselling scheme is reviewed in the video on bullying (p?). Quite apart from the fascinating topic, I enjoyed watching this with my children as it provided a good starting point for discussion about their own school experiences. And finally, the Reader story on (p?) attracted so much comment when printed in our local newsletter, I've reprinted it for national readers. Many thanks to this mother and the many others who have shared their stories this year in Order in the House! - Sue Dengate, editor

The Mid North Coast Division of General Practice recently concluded a 12 month pilot project which aimed to improve identification, treatment and outcome of children diagnosed with ADHD. The project's major achievement was the development of a model of collaborative management of the condition involving all stakeholders - medical practitioners, the child's teacher, the school principal, parents and specialists such as speech and language therapists, psychologists and special education teachers. Four primary schools participated in the project which involved a series of five case conferences. Each case conference resulted in recommendations which were undertaken throughout the term. The linking of home, school and health professionals results in productive sharing of information and a more consistent approach. - LD Coalition news, Dec '97

A gene previously thought to be switched off at birth is showing up in inappropriate muscle tissue and can result in more active three-to-five year olds and teenagers. Called actin, it has been the subject of research by Dr Hardeman at the Children's Medical Research Institute in Australia. Dr Hardeman says that although she links the gene to increased activity, she is hesitant to say it causes hyperactivity.

Newspapers in the US are printing an advertisement for a company that can genetically engineer your children. 'How far will your child go?' it asks, and lists genetic traits which can be altered including skin colour, premature baldness, intellect, athletic prowess, stature, aggressive tendencies, musical ability, obesity, alcoholism and predisposition to disease. The ad is a fake, designed to draw attention to a science fiction movie called Gattaca, released this week. But gene scientist Theodore Freidman of the University of California says that new technologies can quickly turn science fiction into science fact. New Scientist, 25/19/97 p21

The National Health and Medical Research Council's Working party report on Attention Deficit Hyperactivity Disorder (1997) supports the existence and biological nature of ADHD. This document reviews the international research and supports the safety and benefit of stimulant medication.

A Pilbara, Western Australia, magistrate who had often dealt with a 13 year old repeat offender, offered to buy the boy 'any bike he liked' if he could stay out of trouble for 90 days. The boy, who has fetal alcohol syndrome, had been in and out of foster homes and was forced to turn to 'survival crimes' for food. Three months later the court proceedings were interrupted when the clerk placed a note in front of magistrate Antoine Bloemen stating that the boy was outside awaiting his reward.

ADDult NSW is conducting a follow-up study of those treated in the 1970s with a stimulant and/or other medications or treatments, for learning and attentional or behavioural problems. If this applies to you, please contact the ADDult office below for a questionnaire to assist with this survey. Responses may be anonymous. Phone 02 9540 3300, fax 02 9540 3266.

Bullying - both physical and verbal - is a major and growing problem in education. It affects the happiness, health and educational success of many children, can result in permanent psychological damage and can be responsible for truancy, depression and suicide. Yet many schools refuse to acknowledge they have a bullying problem, or to do anything about it.

Schools which deny they have a bullying problem are colluding with the bullies and making life impossible for the victims, according to deputy Maggie Bentley, initiator of a revolutionary scheme in Britain in which pupils counsel both the victim and the bully. Students should feel welcome, safe and happy. In order to achieve that, Acland Burghley School set up this anti-bullying program in 1993. This video documents the first three months, including training of the student counsellors, aged 12-15, and some of the sessions with their young clients. Counsellors include both bullies and those who have been bullied. As the young counsellors struggle to find answers, we see them introduce schemes of their own making. 'Do you understand that Gordon does get upset about you calling him names?' Gordon's counsellor asks a young bully. Pupils are found to 'open up' and respond positively to other pupils in a way most would not to a teacher. Reasons for bullying are often specific problems revealed during counselling. This approach can be seen by the viewer to be helping and changing the lives of both victim and bully. Comments Chancelle, a girl who was on the point of being expelled for bullying:

'Dora has made a big difference and changed my personality a lot. I haven't been so bitchy to people. I thought it's going to be really embarrassing. But it isn't. I found out that so many people go, and it's helped so many people. It's totally confidential. But I tell everyone anyway. I tell them what's happened and everything. And that's probably pushed other people to go as well.'

For schools and families, parents who watch this video with their children may find their children sharing previously untold stories of bullying - one way or another.

Your ADHD offspring is now between 17 and 20. Somehow you’ve all managed to support this young adult and he/she is now managing ADHD really well. But the process has been long and bruising and despite your best efforts, the confidence level is a bit shaky, still not comfortable socially and a bit confused about what to do next. Green Corps might be an answer for someone who would like to live away from home (‘test the wings’ both in personal relationships and just doing something different). This is a Commonwealth Government initiative. Community groups with broad-based community support nominate conservation projects. A team of 10 trainees work on these projects for 26 weeks as well as some TAFE environmental courses. They receive a training wage which they use to live off unless they are out camping somewhere in which case their living is covered. There are about 60 projects at a time each with a team leader. It sounds like it is a good way to see another part of Australia, develop relationships and work in a team to achieve common goals. If a person is in a residential project, diet can be accommodated since everyone cooks for themselves and particular foods can be added to the supermarket trolley.

Next intake is December 1st and then only two after that (March and June 1998). Then the program is finished, 3500 young people having been involved. For more information phone 800 633 844.

Statistics suggest that 40% of ADHD children are predisposed to substance abuse during adolescence or adulthood. Of the ADHD population who are poly substance users, 67% smoke marijuana. Many behavioural changes are similar to those of ADHD: academic ability decreases; sniffles, colds, trivial illness, especially respiratory system; concentration levels decrease; depersonalisation; increased levels of anxiety; increased depression; reaction times slows; short term memory difficulties; a lack of interest in things previously enjoyed; increased impulsivity; space and time distortion; may increase appetite.

Research suggests:

* Two cannaboids found in marijuana affect chromosomal structure, causing genetic mutation.

* The gene affected is the same gene implicated in ADHD. Three studies have show that females who were heavy smokers of marijuana prior to pregnancy produced children who demonstrated significantly disturbed behaviours compared to mothers who did not smoke marijuana - the behaviours described were ADHD.

* Smoking one joint a day, three days a week for six month results in changes in brain physiology that can be detected three to five years later.

* Marijuana decreases the amount of T-cells in the blood, weakening the immune system.

* There is a higher incidence of jaw, tongue and throat cancer among marijuana users.

* Long term users may develop drug-induced psychosis. Other than those who develop drug-induced psychosis and cancer, all other effects are fully reversible with total abstinence.

Completely rewritten, with 12 new chapters, everything you ever wanted to know about medication and a user-friendly presentation, this is more like a new book than a new version of Understanding ADD. Like all of Dr Green's books, solid information and insightful descriptions of ADHD behaviours are introduced in a witty style, with amusing little gems on nearly every page. As well, this is the only book by mainstream paediatricians to acknowledge recent improvements in diet therapy, but it's a shame the 5%-are-affected figure comes from out-of-date studies and some of the information is wrong - pear juice is not permitted on the latest diet and pineapple juice contains salicylates not natural preservatives.

For those who are still confused about what exactly ADHD is and is not (aggressive and violent behaviours are not ADHD), the full criteria for ADHD, oppositional defiant disorder, conduct disorder and depressive and manic episodes are reprinted from the DSM-IV diagnostic manual.

An immensely wise and practical section for adults covers big questions like sex on Ritalin (not necessarily better), how not to annoy other people ('remember that pacing, jiggling and tapping are infuriating to those who do not have ADHD'), the danger of hyperfocus ('these driving adults can become overfocused on the unimportant issues, get offside and become quite destructive') and what to say at work.

Whenever you pick up and start reading this book, you'll be simultaneously entertained and enlightened.

'Understanding ADHD' by Dr Christopher Green and Dr Kit Chee is available from all good bookstores.

The danger for children being given drugs to calm them down is that they come to believe that they do not have to take responsibility for their own actions, according to teacher Jean Robb and children's librarian Hilary Letts. For these children, the pride in learning self-control, self-discipline and new skills for new stages of life has been taken away. These authors recommend observing your children, paying attention to them, teaching them the consequences of their actions and social and other skills. You can teach an ADD child to be still:

1. Ask the child to lie down and see if he can be still by the time you count to ten - slowly. Lying still means not moving at all.

2. When the child moves, tell him which number he managed to get to before he moved and then try again and see if he can get further.

3. Take it in turns so sometimes he counts to ten while you lie still. This gives him a chance to see someone else being still.

Their book is full of suggestions which sound so simple you wonder if these authors really understand ADD, but they claim to be successful, as with the mother of an Asperger's girl named Margaret who was cruel to animals. The mother was advised to explain to her daughter that a vulnerable animal needs her care and to think about the consequences of her actions. 'When Margaret's mother tried these things she found that they worked. She was able to talk to Margaret and Margaret was fascinated by the discussion.' If these suggestions really do work, they are worth a try. We'd love some feedback on this one, please.

ADD children who struggle to fit into school often become highly successful adults, according to Sydney psychologist and ADD specialist Ian Wallace. He points to himself as an example of a child who always talked to much in class and has made a successful career out of talking. ADD children often have amazing empathy with little kids and find it easier to relate to other age ranges - older and younger - than their own age group. While this causes social problems at school, it is a handy skill for a psychologist who has to work with adults and children. Endless arguing is another feature of ADD which was a disadvantage in a classroom but has led to a profitable career for a prosecuting lawyer. Then there was the boy who filled his maths books with doodles and drawings and became a highly-paid cartoonist. And a computer expert, enjoying games like Doom and Command and Conquer, who became a highly-paid trouble-shooter for a construction company.

The mother of a teenager who attended a seminar by Ian Wallace for ADD teenagers and young adults aged 16-22 wrote: 'Phillip was really impressed with Ian's talk. He liked the idea that 'someone with ADD could get to be famous like Ian, and Ian knew lots of famous (and rich) ADD adults. His teacher rang me today and told me 'he was much more positive about getting things finished'.'

'His mind was twitchy, like his fingers, which were always moving.'

A two-year pilot study into the effects of using laptops with LD students has been underway at Robertson State School in Brisbane. In July 1995, Apple PowerBook laptops were issued to students aged 8-12 enrolled in the special education class. Teacher Larissa Lambalot reports that students who had previously avoided writing made rapid progress as writers. She explains that writing is like any other skill - you get better at it the more you do. With laptops, LD students who previously failed to complete writing assignments now experienced success and were motivated to keep writing. This is because laptops help the children to read what they have written, and they don't have to read the same piece of text five times and still make mistakes because they can cut and paste and change things around painlessly to produce work which looks so professional that they can be proud of it.

Some students have severe fine motor problems which affect their handwriting ability. These students are easily fatigued and focus on the letters rather than the ideas they want to impart. They benefit greatly from a laptop because they can write to longer and focus on what they want to write. Some of the Robertson students have shown substantial improvement in rate and volume of writing.

Teachers report that the students have developed confidence as writers. Written tasks are generally started without argument or groan. The rate of task completion has risen significantly. Negative self talk has all but disappeared and the students enthusiastically read their writing to others to gain feedback. It appears that parents also have seen the benefits, as three families have now purchased laptops for their children. - from Apple magazine August 1997

Just after moving, thanks to a referral from our Darwin paediatrician, we had an appointment for the boys with one of the leading paediatricians in the ADD field. We spent from 9 am. to 3 pm. with him. He was very interested in the boys and keen to help wherever possible. Dr P wrote an in-depth report on both of the boys and I was amazed at how accurate it was. Through his referring Brett to a speech pathologist we have established that Brett has a delayed language problem, not picked up in Darwin.

After Dr P had listened to the scenario that we were living, he advised us to double both children's medication. Nathan had been taking 2 tablets of Dex per day and Brett had been taking 1½. Now, Nathan is taking 4½ tablets per day of Dex, two at breakfast, 1½ at 11 am. at 1 tablet at 3 pm. Brett's medication was changed back to Ritalin as the Dex did not appear to be working best for him. He now takes 4 tablets per day. Ritalin being what it is, means he has some rough patches especially when the effects of the medication are wearing off.

The only side effects initially, two years ago, were the normal ones - loss of appetite, dryness of the mouth, some nausea, and difficulty sleeping. Doubling the dose had no apparent additional effects and the side effects listed above have moderated to some extent. Loss of appetite is still a problem with Nathan, less of a problem with Brett.

Doubling the dose has meant a more even distribution of the benefits. There is a continuity that encompasses less oppositional behaviour, noticeable improvement at school, particularly for Brett, and an improved disposition for both boys at home. Ritalin has a more definite cut-off point when it ceases to work. Dex, however, has a more subtle effect without the highs and lows. Essentially, the increased dose provides a more lingering effect, well into the late afternoon and sometimes into the evening. There are still disagreements and tantrums but the can generally be prevented, controlled or accepted. I feel more relaxed with the boys at home now, meaning less stress for me. My husband says that lower doses, while having a more calming effect, do not aid in thinking or logic. It is only with the higher doses that the brain's processes seem to be improved.

After visiting the paediatrician, I then had the dreadful task of find the boys a suitable primary school. I was absolutely horrified to earn that most of the public schools have 700-800 students. I spelt a couple of weeks phoning all the private schools in our area. As we had left it too late, none of them had vacancies. After some searching I found a little public school a couple of suburbs away from us with only 400 children. At the interview the principal spelled out very clearly the expectations of the boys both academically and socially if they were to attend his school.

I must say that I was very apprehensive as to how they would cope with it all. The boundaries and the consequences of not complying were very clearly explained to the boys and this has had a profound effect on their behaviour. Much to my surprise they have settled in very well. The school counsellor, class teachers and Principal have all commented that they are no trouble and their behaviour at home has also modified quite dramatically. Brett is repeated Year 1 because of the language problem while Nathan is in Year 5.

The tone of the school is very different to those in Darwin. On the first day I could not help but notice that all the children in the playground were very calm, unlike Darwin, not jostling each other and they had immense respect for the teacher on yard duty. In Darwin our children had first attended a Catholic primary school, then we moved Nathan to state primary school because of teasing and bullying. The experience of the teaching staff is Sydney schools is much higher and there is a greater sense of professionalism when handling delicate situations such as teasing, these are quickly dealt with and resolved fairly. In Darwin there was a recognition that a problem existed but it was rarely resolved. The N.ot T.oday syndrome is not evident down here. People are struggling to survive and Sydney is a big market place that is very competitive. People tend to get things done.

I have also had the boys accepted into a six-week behaviour management course with Dr Stephanie Whitmont at Sydney University due to commence in April. The course is designed for children to manage their own behaviour.

Now that the household is settled down I am actually enjoying Sydney very much. The weather is great and the boys seem much more settled here and are enjoying Sydney also. The heat in Darwin definitely influences ADD behaviour adversely. The boys have commented that they feel more comfortable here because of the weather.

We rely very heavily on dietary controls to modify the children's behaviour. A few trips to Pizza Hut over the Christmas holidays reinforced our belief in diet! When I attended my first meeting of the local ADD support group, they were all very interested to hear how diet had worked for my family and were eager to know more about the experience of others using diet in Darwin. I have now bought myself a breadmaker and make my own loaves, rolls and doughnuts. Would you believe that it is even hard harder here to find bread without 282 in it!

Despite the increase in medication, I can say this with complete confidence: it does not matter how many tablets my boys (and husband?) take for ADD. The effects of ADD are certainly less if the medication is taken, but the optimum level is only achieved with the combination of medication and diet. I am sure than many people could manage their ADD either on medication or diet alone. For our family we have found that ADD management works best with the two combined.

Although dietary management is not recommended by ADHD experts in the USA, that doesn't mean it isn't used. Twenty years after Dr Feingold first introduced his controversial theory about the connection between foods, behaviour and learning disabilities, Feingoldd Association president Jane Hersey has published a massive, well-indexed 473-page book about his diet. This is an entertaining read which makes you feel 'I'm not the only one' and provides a fascinating glimpse of life in the USA, although the dietary information and food lists seem out-of-date to us - food such as pineapple, dates, lemon juice, cola drinks, fast food hamburgers and amine-containing foods such as chocolate are still recommended. There is little emphasis on slow, cumulative build-up and delayed reactions which is perhaps why this association permits many foods that have been found to cause problems by Australian researchers. But there is plenty to learn, too. Years of product information research have unearthed some surprising practices by the food industry. Did you know that many cereal manufacturers add the antioxidants BHA and BHT to the inside of the bag containing the cereal which allows the chemical to slowly migrate into the contents. And examining highly publicised recent research, Hersey points out that while was sugar was not found to affect children's behaviour, the behaviour of the children 'generally improved' on the 'essentially free of additives' experimental diets, a fact not mentioned in the press release of the Wolraich et al 1994 sugar study.

If planning a trip the States, you will be pleased to hear there is an amusement park called Sesame Place in Langhorne, Pennsylvania, which tries to avoid 'unsavoury additives' and that Disney World contains a small grocery store but you should call the Guest Relations office before you leave home if wanting to eat in the restaurants. Be warned, the local ADD support groups called CHADD do not support families using diet. Hersey recounts how a Feingold speaker was denied permission to address a CHADD group because 'it might make the members feel guilty [that they weren't using diet]'.

From amusing accounts such as 'the war with my mother-in-law' and 'how I saved Fairfax country $62,296.00' by keeping a child out of an LD class, to the reports of epileptics affected by artificially-coloured Tegretol, the real strength here is in the stories. It is heartening news to read that young adults who have grown up on this diet find it easy to say no to recreational drugs because they like being in control. If you're into diet for the long haul, this is a useful reference which will give you solid support and remind you 'it's worth the effort' every time you dip into it.

A highly successful ADHD adult tells us that the way she manages long boring meetings: doodling or word games like anagrams. ADHD people do better while doing two things at once. No need to ask these students to stop doodling. They are probably paying better attention because of it.

Nearly 25 years ago I began teaching Special Education classes in secondary schools in South Australia. At that time children who patently did not fit in to the mainstream system, but who were obviously functioning at too high a level to be placed in Special Schools, were placed in these classes, on the advice of Education Department Guidance Officers. Many children with ADHD (which was then called 'hyperactivity') found themselves in Special Classes. Parents were often consulted about the placement but not necessarily. The programme of work in these classes was entirely up to the teachers involved.

There were many aspects of this system which could be criticised - especially that other than these classes, and remedial reading classes, there was no provision for children with needs outside the norm. Then the Education Department of South Australia began its programme of 'integration' of students with special needs. The policy of integration has in practice meant continuing reduction in provisions for students with special needs. It is now virtually impossible for a student in a DECS school to receive any special help - unless they are three years or more behind grade level in academic achievements. Students who suffer from ADHD now receive no special services at all, unless and until their behaviour becomes so unmanageable that they are removed from their home school into a 'behaviour management unit'. This action is only taken as a last resort, and such 'behaviour management' is certainly not available to any student as long as they remain at least marginally acceptable to the mainstream system. Parents have no 'court of appeal' over the treatment of their special needs children, other than under the Disability Discrimination Act. There is no law nor state which defines minimum standards for the education of children with special needs, and if a parents does make a complaint to the Disability Discrimination Commissioner, they have the burden of proving every need.

Our family has had personal experience of the effect of this [federal U.S.A.] law. Whereas in the Australian schools that my son had attended, 'special needs' was often a delicate issue, treated as somewhat shameful - in California the process of drawing our attention to the fact that Daniel was having problems in the regular classroom was approached in a caring, but matter-of-fact manner. It was simply assumed that students would have varying needs, and there was no question that the school would attempt to meet those needs, because that was mandated by federal law ... there was no question of whether anyone 'believed' in ADHD or dyslexia - these condition are named in the law. This question of 'belief' in these conditions is unforuntately often the first hurdle that a parent must face in schools in South Australia. It was accepted that if a child had special needs - and the ways of determining these needs was also mandated - then special provision would be made.

What a relief for a parent! We did not have to face philosophical arguments about the determination and aetiology of our son's 'specialness', nor the beliefs of the ill-informed - our child's needs were recognised under federal law, and the manner in which they should be met was also clearly set down in the law of the land. ... Because evaluation was mandated under federal law, local education authorities were obliged to ensure that staff would be available to both administer evaluative instruments, and to implement special programs.

The system in the United States is not perfect. But it does ensure that

* parents do not have to try to persuade reluctant teacher staff that their child's disability actually does exist

* parents do not have to waste their energy on arguments about whether special provisions for their child should be made available

* local education departments are obliged by federal law to adequately staff their systems with guidance officers or school psychologists

* local education authorities must provide accommodations for children with special needs and the staff and resources necessary to do so

* when things go wrong, there is a legal basis upon which to decide disputes, if that becomes necessary.

Q. My teenage son is planning a career in the army, will ADHD affect enrolment?

A. In Australia current treatment with stimulant medication brands an applicant unfit to serve in any of the forces. This is of great concern as the structure and activity of such a career suit the ADHD temperament. If you plan to join the army make sure you are seen to be complying with their strict criteria at least one year before the interview. Check the current situation with the local recruiting office well in advance.

Drs Christopher Green and Kit Chee, from their new book Understanding ADHD.

Q. My son is taking Dex and Catapres. Can we do the elimination diet?

A. The elimination diet can be tried while patients are on medication. The effects of diet are different from those of medication. Some patients need both medication and diet in order to control their symptoms. Most patients report that if diet has a role, then the dose of medication needed to control symptoms is less, or not needed at all. - Dr Anne Swain.

 Networking

ADDnet's major event for 1998, a visit by American psychologist Dr Robert Brooks has now been finalised. Seminars on Fostering Self-Esteem: 'The search for islands of competence' will be presented in the following areas:

Tasmania 9 May ph 03 6429 3332

Melbourne 15 May ph 03 9650 2570

Newcastle area 20 May ph 049 59 6604

Sydney 23 May ph 02 9845 3017

Brisbane 26 May ph 07 3817 2429

These presentations will include seminars for parents and teachers and children's workshops for ages 5-8 years, 9-12 years, 13-16 years and 17-18 years.

Dr Brooks has a distinguished international reputation and is considered to be a humorous and inspiring speaker.

Many thanks to Dale for her huge and successful efforts to secure sponsorship and get this major event on the road. By becoming a member of ADDnet, you can help with our aims to educate the community, relevant professionals and governments on the problems related to ADD and learning difficulties, and to encourage a multi-modal approach to treatment of ADD and LD - see 'How to subscribe' coupon. - S

A mother from Staffordshire in England (likes: cooking, listening to music - opera, classical or musicals - and walking - Scotland and the Lakes District; family has a photography business) has a 13 year old ADHD son who is helped by diet. She would love to hear from someone in Australia. Write to Sue Sproston, 43 Abbey Street, Hednesford, Staffs, WS12 4BB U.K.

Subscription price (four issues) $10

ADDnet membership $10

Monthly newsletter The Diet page $10

Total included $_________

Make cheques payable to ORDER IN THE HOUSE!

PO BOX 85

PARAP NT 0820

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1998

Mar 13-16 Adolescent Health conference, including ADD, seminar for teachers, counsellors, health workers, Sydney Children's Hospital Randwick, phone 02 9382 1687

May 9-26 Fostering self-esteem. Dr Robert Brooks. Write to Deborah Pearce, PO Box 182, Westmead NSW 2145 or see ADDnet News.

A consistent pattern of behavioural changes can be seen in rats fed on a diet of Lake Ontario salmon, which is known to be high in chemical contaminants such as now-banned PCBs commonly used in the 1940s. Compared to rats fed from uncontaminated Pacific salmon, or to standard laboratory rat chow, Ontario-salmon-fed rats are hyper-reactive to unpleasant events, such as electric shocks or disappointing rewards, but 'react normal when 'life is pleasant''. In a parallel study on children of human mothers who have eaten Lake Ontario salmon, the children were also found to be hyper-reactive to negative events. When tested at the age of four, 17 of them refused to be tested on at least one of the tests. But researchers were surprised to notice that affected rats were also found to work harder and longer at certain tasks than control rats when they were sure of a immediate, satisfying reward.

This unexpected finding was explained by researchers as a hyper-reactive response to a positive situation.

Rats were fed with the Lake Ontario salmon before, but not during, pregnancy. Following the rats through several generations, researchers found that the behavioural changes in adult rats fed with Lake Ontario salmon also appeared in their offspring.

Efalex contains tuna oil (containing omega-3 fatty acids), evening primrose oil (containing omega-6 fatty acids), vitamin E, thyme oil, glycerol and gelatine. In a controlled study of a group of ADHD boys aged 6-12, Purdue university researchers found more behaviour problems, temper tantrums and sleep problems in those with omega-6 deficiencies; and more learning and health problems in those with lower omega-3 fatty acid concentrations. Dr Jacqueline Stordy found 15 dyspraxic children showed an improvement in manual dexterity, ball skills and balance when treated with an Efalex-type supplement for three months.

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