Psychiatric nurse Eben Assan knows about difficult teenagers. Eben works at a mental health facility in Melbourne, where sixty percent of all referrals have behaviour problems. It is the 20 to 30 per cent with serious behaviour problems who reach Eben, and his approach was developed "as a result of desperation to find a way of firstly, engaging the group and also doing some work with them". We all know from 1,2,3 - Magic that there are two main reasons for discipline not working.

Conduct disorder is the second most common form of psychopathology, after depression, affecting about 9% of males and 2% of females under 18, and accounting for about 50% of the work in child and adolescent facilities. [See article on p4 for more about conduct disorder.] About 30-40% of those referred to the service fail to attend. Of those who stay in the service, about 22% drop out.

Teenagers with CD feel as if they are playing to an imaginary audience. Everything they do is for display because they feel that everyone is looking at them. They feel powerful because "my parents have given up on me, they can't stop me; I can tell the teachers where to go; I can do anything I want and I won't go to prison". The more people look at them, the more powerful they feel, the more they act to the audience ... and so on.

This involves engaging and being engaged. You cannot force these teenagers to do anything. They have to ask. When you first meet them, talk about yourself. You might be able to engage them by revealing something of yourself, showing you are human, telling a story about your interests outside teaching, for example. In effect, you are saying: "I'm like you. I do other things outside school, I like some things that you like". These kids complain that teachers have too much power and push them around. Teachers are seen as authority figures who need to be brought down. If they see you as being just like them, then they don't need to bring you down.

Establish a relationship. You have to demonstrate, "I take you as you are". Be genuinely interested in them. If they want to talk about selling drugs or stealing a car, listen and ask interested questions.

to them and yourself. Everyone else has failed them, so why do you think you can succeed? Sell yourself as unique.

Don't pick on minor things like swearing. although you can make a personal statement, for example, "I personally don't like swearing because it doesn't add anything more to what you are saying". They won't respond to an order if they don't know you. You must be prepared to back down. Know your limits. You must be genuinely interested in working with these kids. Working with teenagers like this can be exhausting. In schools, a system like this will work best if it is adopted by the whole school.

From "Challenging the challenge - a calm approach: working with adolescents with challenging behaviours" presented by Eben Assam at the 1998 Child and Adolescent Mental Health Conference.

Provisions for learning disabled students such as coloured paper, larger font, or readers would generally not benefit non-disabled students. The one provision which is most requested and is most likely to been seen to advantage disabled students is extra time.

Extra time by itself is considered less useful for students with learning disabilities than the use of reader/writers, but this issue is worth considering because the concept of unspeeded examinations is firmly supported by research and would avoid 'unfair' claims.

The term unspeeded refers to examinations which avoid time pressure by providing more time than is needed for all examinees to complete the questions, for example, if most students are likely to finish in two hours, then three hours are allocated.

Traditionally, time limits for examinations are used for administrative convenience even though a test of knowledge and achievement rather than speed is usually the aim of the examination.

Comprehensive research about alternative assessment methods has been carried out by Willingham and co-workers at the University of Princeton in New Jersey, who found that increasing the speed of tests significantly reduces the validity of the scores of hearing impaired, learning disabled, physically disabled and visually impaired students.

They concluded that double the amount of testing time was a generally appropriate time limit for most disability groups, with blind examinees requiring nearly three times the testing time. This is far more than the 5 to 10 minutes per hour sometimes permitted in Australian schools.

Students with learning disabilities are more likely to benefit from a reader/writer than from extra time. However, learning disabled students who will benefit from unspeeded examinations include those who:

Non-disabled students are also relieved of intense time pressure and have the opportunity to display their knowledge and achievement so there are no grounds for complaints of disadvantage.

Research would be needed to set reasonable guidelines, for example, time needed for an essay of a specific word count.

- from a paper about special examination provisions presented by Sue Dengate to the ACACA conference in July 1998. Thanks to John Cook from the NSW Board of Studies. Further reading - Parr, P., Levi, N. and Jacka, K. Unspeeded Examinations: An equitable and practical method of assessment, University of Western Sydney, 1996, available from the LD Coalition office, phone 02 9540 3300

A link between regular cannabis use and psychosis was recently established by the University of Melbourne's Early Prevention and Intervention Centre (EPIC). The Centre has conducted a series of world-first studies on young people aged 16 to 30 who have used cannabis and had an episode of psychosis.

There is a strong suggestion that young persons who continue to use cannabis once they have had an initial episode of psychosis are more likely to have another episode", says Dr Jane Edwards, deputy director of EPIC. She says that for young people at risk of psychosis, "any use of cannabis is potentially problematic."

The finding support a 1996 study by German professor Dr Martin Hembrecht, which found that a third of those surveyed began using substances in a problematic way before the onset of any psschotic symptoms, while seveon ouyt of 10 started using them after the onset of psychotic symptoms.

Oppositional teenagers

ODD
CD

Five more management tips

Reading program

Diet and crime

When I was invited to attend the Child and Adolescent Mental Health Conference in Sydney, thanks to the NSW Department of Health, I thought most of it would be irrelevant to my ADHD interests. I was wrong! See report, back page, and the front page story.

Behaviour problems are the most distressing all the features which can be associated with ADD, so we've continued the theme on page 1 with articles on oppositional defiance and conduct disorder. Experts differ in their recommendations, behaviour management p0, and medication, p0, diet p0.

This newsletter has long supported dietary management as part of multi-modal treatment of ADHD, sometimes in the face of strong criticism. I have been stunned by the response to my latest book, Fed Up. The first print run of 6000 copies sold out in 8 weeks. We mothers know that some foods affect our children. Now it appears that mainstream opinion leaders including a new book by US psychiatrist John Ratey, a new US medical advisory board (p0), and research (p0 and p0) are catching up with us.

- Sue Dengate, editor

People with dycalculia struggle have difficulty understanding 'manyness'. A new test assesses their dyscalculia by asking how many dots in a visual display. Most people could instantly put a number to a group of three dots, for example on dice, but dycalculics seem to resort to counting. The tests also ask which of two numbers is larger because dyscalculics find this very hard.

- New Scientist, 12 Sept 1998, p21

Throughout the world, up to 3 per cent of any community are considered to have an intellectual disability, but in some regions, levels now approach 20 per cent. This is often paralleled by a much greater incidence of milder, 'sub-clinical' intellectual dysfunction. In some African cities more than 90 per cent of children now have blood lead levels than can cause intellectual problems. The reason is the presence of environmental agents that destroy intellectual potential, such as heavy metals or radiation, and the absence of nutrients necessary for the proper development of the brain, such as iodine or iron. There are also synergisms between the two. For example, iron deficiency can speed up the body's uptake of lead.

Out of 100,000 adolescents, two to three thousand will have mood disorders out of which 8-10 commit suicide. - Kids Helpline newsletter, June 1998

Embracing and other physical contact such as touch or hugging can help lower blood pressure and cholesterol, regulate heartbeat, strenghten the immune system and even lull hyperactive children, claims the American Hugs for Health Foundation. The foundation offers this prescription for a healthier and happier life - four hugs a day for survival, eight for maintenance and 12 for growth.

About 2000 people were poisoned by cooking oil contaminated by polychlorinated biphenyls (PCSs) and dibenzofurans in Taiwan in 1979. These chemicals persist in human tissue and children born to exposed mothers well after the event were affected through transplacental exposure and breast milk. They suffered a permanent five-point IQ decline, attention deficits, developmental delay, behavioural problems and a range of other adverse effects.

- Science, 1998, vol 241, p334.

The main features of this disorder are:

• irritability

• non-compliance

• defiance

Oppositional behaviour is interactional and does not manifest itself in all situations, for example, if the adolescent is not frustrated. ODD adolescents seldom carry out serious antisocial or delinquent acts (such as stealing or truance) and their conduct can be normal in some situations (for example, at school, in social situations).

Individual counselling is seldom useful because these youngsters do not believe there is anything wrong with them. They resent being taken to counselling and, if forced, this can create new problems.

Medication does not have a place in treating oppositional disorder unless oppositionality is present at the same times as other disorders (such as ADHD) or if oppositionality is the manifestation of another condition such as depression.

Dr Rey suggests that the basic treatment should take place in the family context. Parent management training has been shown to be effective. In this approach, therapists educate the parents on techniques for handling the adolescent's oppositionality and defiance.

Several points should be kept in mind when dealing with oppositional defiance.

• Parents need to learn to give children several choices rather than just telling them to do something, These young people need to feel they have control over what they do. Involving them in decision-making may achieve this.

• Some adolescents become oppositional if they feel their parents are too intrusive or unnecessarily controlling. Giving young people personal space may avoid some of these problems. Adolescents need privacy and emotional elbow room.

• Parents need to identify important issues compared to matters which are trivial and not worth the fuss. Parents are sometimes afraid that if they give in their child will get out of control and walk all over them. They can end up nagging, saying no all the time, or trying to set even more limits and controls. Therapists can help parents identify what is really worth a fight and what is not.

• Some parents may just give in and think their child is too strong-willed for them. This can happen easily in single-parent families. Change is difficult and requires time. Parents need to be advised about ways of gradually setting boundaries between them and the children and taking charge of the situation.

• Remember, adolescence is a preparation for adulthood. Teenagers need to have an increasing degree of freedom and responsibility.

• Dead-end discussions about good and bad behaviour are not useful and lead nowhere. Limits are more acceptable when expressed in terms of safety rather than bad behaviour: eg. "It is too dangerous for your to travel on your own at night. I am happy for you to go to the movies but I need to be sure you are safe. I can pick you up or you can come home earlier."

A negative, angry pattern of interactions (arguments, screaming, prohibitions) can become almost the only way in which parents and child relate. They bring out the worst in each other.

Parents need advice on how to break that cycle by finding areas of common interest for them and their child (for example, a father may invite his son to got fishing with him and discover his son enjoys it. This can provide position warm and enjoyable experience shared by both on which change may be built.

Conduct disorder describes a pattern of behaviour characterised by:

• breaking rules

• deceit

• lack of respect for the rights of others.

Adolescents with this disorder also have constant conflict with parents, teachers, peers and society as a whole. Although a high proportion of juvenile delinquents have conduct disorder, isolated antisocial acts do not warrant this diagnosis.

It is widely accepted that conduct disorder is often the result of a poor family environment. Parental neglect, inconsistency, physical or sexual abuse, harsh discipline, poor supervision etc are all associated with this condition.

Genetic factors (for example, antisocial personality in parents), low intelligence, a difficult temperament the child and the presence of ADHD also increase the risk.

About one-third of adolescents with conduct disorder will grow up to have an antisocial personality. Overall, the earlier the onset of antisocial conduct (for example, before the age of 10) or the greater the number and variety of antisocial behaviours, the more likely it is that problems will persist into adulthood.

Predictors of a better adult outcome include

• above-average intelligence

• absence of a learning problem

• having a caring, affectionate relationship with at least one adult

• having friends who don't get into trouble

• experiencing achievement in some activities (for example, sports)

• later onset of symptoms (in adolescence)

• no other mental disorders present (such as ADHD, depression)

• remaining at school until the age of compulsory schooling or longer

Dr Rey suggests that many treatments produce short-term relief of symptoms but none of the therapies available is particularly effective in the longer term. Improvements usually wear off quickly.

Once the bad habits of conduct disorder are established they become resistant to change. Individual counselling is difficult and ineffective in many cases because these young people lack remorse and believe they have done nothing wrong.

They are not used to receiving sympathy from adults and often react by refusing it or by being angry with the counsellor or may attend therapy to avoid a more unpleasant consequences.

The more promising treatments are problem-solving skills training, parent management training, functional family therapy and multisystemic therapy.

A close working partnership between the family and therapist offers the best chance of success. This needs to continue for a lengthy period of time.

On some occasions, treatment can be done while the child is at home, but because of the severity of the difficulties or because parents are unable to set consistent limits on the child's behaviour the youngster may need to be placed in a residential setting..

Facilities with a small number of children at any one time and that can offer treatment for a substantial period, for example, longer than one year, are likely to produce the best results. There are few services that provide this.

Children with ADHD often have comorbid ODD. Sometimes, medication for ADHD does not help with the ODD. The children behave as long as everything goes their way, but with frustration, or a refusal of some request, there will be a major temper outburst and defiance.

In an open trial, 50 children whose ADHD was treated by standard medications but whose ODD remained a major problem were also treated with Buspirone, an antianxiety agent, for a minimum of 6 months up to 2½ years. Dosage varied from 15 to 60 mg/day. Two children were dropped from the study because of side effects. Of the remaining 48 children, 4 showed no improvement, 4 were mildly improved, 17 were moderately improved, 15 showed excellent improvement and 8 were rated as outstandingly improved. Ratings were made by parents, since ODD symptoms were much more prevalent with family than at school.

- from a letter by Dr MD Gross of Chicago Medical School to the Editor published in J Am Acad Child Adolesc Psychiatry, (1995) vol 34, no 10, p1260.

The children remained at home in the care of their parents while following a restricted diet. The health and behaviour of all nine children improved.

Although parents were advised to minimise temptation from visible food for other family members, only one mother used the diet with the whole family - and the husband's debilitating panic attacks improved.

Two brothers and their fellow gang member abandoned the diet, two of whom re-offended and were placed in care while the third moved home and accepted enzyme-potentiated desensitization (EPD) treatment. Altogether four children used EPD treatment, all of whom were then able to tolerate previously reactive foods. Seven children continued to improve in health, behaviour and school performance over 6 months. In the following 18 months, two more re-offended but with much reduced frequency and violence than before the project. After 2 years, five of the nine subjects had not re-offended. Researchers concluded, "the [dietary] approach appears to work within an ethical, efficient, effective, economical and preventative paradigm without harm".

6. Educate and involve others. Just as it is key for you to understand ADD, it equally if not more important for those around you to understand it--family, job, school, friends. Once they get the concept they will be able to understand you much better and to help you as well. 7. Give up guilt over high-stimulus-seeking behavior. Understand that you are drawn to high stimuli. Try to choose them wisely, rather than brooding over the "bad" ones.

8. Listen to feedback from trusted others. Adults (and children, too) with ADD are notoriously poor self-observers. They use a lot of what can appear to be denial.

9. Consider joining or starting a support group. Much of the most useful information about ADD has not yet found its way into books but remains stored in the minds of the people who have ADD. In groups this information can come out. Plus, groups are really helpful in giving the kind of support that is so badly needed.

10. Try to get rid of the negativity that may have infested your system if you have lived for years without knowing what you had was ADD.

- from Fifty tips for ADD adults on the internet by Drs EM Hallowell and JR Ratey, two US psychiatrists with ADHD. Authors of Driven to Distraction and Answers to Distraction, available from Silvereye Educational Publications, phone 02 4987 3457, email:silvereye.hunterlink.net.au

Alcohol and drugs

Nearly half of all Australian women who abuse substances have a mental disorder, as do a quarter of males aged 18-34, according to the National Survey of Mental Health and Well-Being. More than 10 percent of those surveyed in the 18-34 age group had a an alcohol abuse disorder and almost 5 per cent abuse drugs. Individuals scored high on the abuse scale if they developed tolerance, took a long time to get over the effects, spent a lot of money on drugs, found their habit affected their job and caused health problems. Regular drug and alcohol consumption often leads to a 'vicious cycle' of self-medication followed by a period of withdrawal characterised by feelings of anxiety and depression. The prompts the user back to intoxication to alleviate the symptoms, says Professor Wayne Hall from the National Drug and Alcohol Research Centre. - WE Australian, 12-13 Sept 1998, p29

Neuro -Immune Dysfunction Syndrome (NIDS)

A new US Medical Advisory Board has formed at accelerate research on NIDS , which includes;

NIDS Medical Board comprises distinguished researchers and clinicians in there disorders. Chairperson of the board, Dr Michael Goldberg visited Australia recently to address medical practitioners about this research. "We can no longer patiently wait for the normal five to ten year period of traditional research ... A child's brain continues to evolve from birth for at least ten years. Research time is critical for children suffering from these disorders."

"Mood, especially irritability, is the symptom most affected by diet"

Foods and food chemicals implicated in reactions include natural and medicinal salicylates, natural and added monosodium glutamate, natural amines and added colour as well as flavour and preservatives, and wholefoods (especially which have produced a definite physical or behavioural reaction in the child or first degree relative at some time), such as milk, wheat, egg, peanut, fish and soy. Non-food items which have been implicated in behavioural reacations are perfumes, fumes, inhalants commonly implicated in allergy, infections and stress. Many researchers report that most subjects react to more than one test item.

Professionals can now be aware of dietary treatment as an option for some children. They can be supportive of parents who wish to consider diet, particularly as motivation is important in the diet implementation.

Breakey concludes: "Rather than saying diet is too hard, or it is easy (just excluding the well known suspect foods)", diet can be most effective with the help of a dietitian, preferably one experienced in this specialised area.

The brain activity in ADHD and unaffected men was monitored while they completed a task. Participants heard a series of numbers, one every 2.4 seconds, and were asked to add the last two digits they heard. Looking at positron emission tomography (PET) scans, Emory University researcher Julie B Schweitzer saw two major differences between the groups. First, the ADHD individuals maintained high levels of blood flow, whereas the controls displayed deactivation in the temporal gyrus region, indicating some kind of learning. The ADHD group also activated brain areas used for visual tasks. Researchers found that instead of repeating the numbers to themselves as some of the controls did, many of the ADHD group had visualised the numbers.

I have ventured forth from the den of my room, and have spent less time skulking around the Net and more time socialising ...

Thanks to the diet, I am going to try again to pass Year 12 next year, so I can go to university and do a degree in journalism. It's quite interesting to trace the time in my life when I started doing badly in school. It was the exact time that I moved to the city, started eating more junk food like meat pies, ham etc. I continued to do worse and worse in school until I dropped out of Year 13 last semester. Now, I can be confident of having my old powerhouse brain back again.

Biochemisty of autism

There is a feeling that the number of cases of autism is rising, that it is part of a modern 'plague' in developmental illnesses which includes attention deficit syndrome, hyperactivity and dyslexia. Autism is characterised by a complete withdrawal from social contact, a lack of speech and a general unawareness. Many autistics are retarded but some have normal IQs. In the milder form of autism known as Asperger's syndrome, the symptoms may be no more than extreme physical and social clumsiness - the so-called eccentric boffin syndrome.

Patients who have improved after suffering severe autism talk about how their minds fail to pull the world together in a coherent way. The withdrawal, the uncomprehending tantrums, the fascination for simple or repetitive stimuli all follow from not being able to make sense of the world. One sufferer said she could not see faces, just collections of noses, eyes and mouths. Words were just strange noises. She found people, with their looming presence and unpredictable movements, too threatening and so lost herself in safer activities such as watching motes of dust floating in the air.

In Britain, biochemist Paul Shattock, himself the father of an autistic son, has stumbled on a possible mechanism to explain why autism may be caused by dietary substances leaking through the gut wall and eventually reaching the brain. He has discovered that the levels of a breakdown product of inoleacrylic acid are higher in the urine of autistic children. Very little is known about the acid except that it is a byproduct of the pathway that tranforms the amino acid tryptophan into hormones and neurotransmitters like seratonin. Shattock does not know why autistic children may make more indoleacrylic acid, or whether it is a cause or effect of autism, but he intends to pursue his theory.

Oct 10 Social Skills workshop for children/Teens with learning difficulties (also Dec 5 and March 13), University of Western Sydney, Milperra, phone 02 9772 9229

Oct 11, 18, 25 Spalding reading method teacher courses, Sydney (Cherrybrook), phone 02 9894 5711

Oct 13 Autistic Spectrum Disorder Workshop, including Semantic Pragmatic Disorder, Tourette's Syndrome, ADHD, Hurstville, Dr Tony Attwood, phone 02 9540 3011, Cost $150

Nov 6-7 Depression in Young People national seminar, Adelaide, contact Einet

Nov 21 Managing behaviour in difficult-to-handle young children, Dr Paul Hutchins & Dr Jessica Grainger, Uni of Western Syndey, Milperra, 02 9772 9229

In the USA Nov 13-15

1st National ADD Advanced Meeting, Palm Springs California.

Contact: FH@futurehealth.org.

Topics: Attention Differences & Directions, Gifts, Alternative & Mainstream Approaches & the Neurobehavioral Continuum: for professionals focusing on ADD/ADHD, Autism, Tourettes, Aspergers and Peak Performance, assessment, treatment, empowerment, scientific & professional topics Confirmed Speakers include Thom Hartmann, Lynn Weiss, Lynda Thompson (co-author, The ADD Book), topics to include: assessment: brain imaging, diagnostic criteria, populations: ADD/ADHD: child, adult, women, gifted, couples, comorbidities; autism, tourettes, neuro-behavioral continua, professional topics: practice management/ development, insurance, advocacy, legal issues Interventions: treatment, medications, nutrition, exercise, education, therapies, optimal functioning coaching strategies, neurofeedback, Complementary alternative approaches Positive models: gifts of ADD/HD, creativity, non-pathological models, self-esteem

SA Many teacher training courses offer no education about ADHD, and others devote 5 or 10 minutes of a three year course to the topic. WHen ADHD is metnioned it is often with out-of-date misinformation which tends to reinforce the mistakes and the prejudices put out by the media. ADASA intends to apprach tertiary institutions to rectify this situation. DEET has already been informed of the problem. Nayano Taylor-Neumann ADASA 08 8221 5166

WA The Learning Base clinics in Perth offer pre-apprenticeship literacy and numeracy skills for Year 9 or 10 boys, in particular, who want to work with their hands but who need help with specific literacy and numeracy issues to help get them into a job. One young man who wanted to be a butcher was able to learn to spell the various types of meat he was dealing with because he was interested and could see the need to learn. "We try to find out what they are good at and then use that as a basis to extend their skills," says Victoria Carlton, who runs the clinics. In as little as seven weeks, students could be given the skills they need to get them into a traineeship or apprenticeship.

NSW A special education teacher in NSW explains, 'thanks to screening every student who goes into the school for visual processing disorder, at the school where I worked for a while volunteer reader/writers go into every examination for about 60 kids from year 7-12 and have done for some years. Parents are referred by the teacher to the parent support group and on to a diagnostician.' If this isn't happening at your school, then your child may be disadvantaged. We suggest you write to the Chairperson of the Board of Studies in your state, explain that this is happening in some schools in NSW, and ask why it isn't available locally.

QLD After more than 10 years of study, Griffith University researchers have improved the reading speed of visual dyslexics by up to 25 per cent in some cases. Applied psychology lecturers Dr Elizabeth Conlon, Dr Trevor Hine and Dr Mark Manning have devised a treatment program based on colour. "The whole idea of using coloured lenses and overlays has always been controversial. The previous claim that a single colour suits everyone has just proved too simple," says Dr Conlon. "For most individuals who suffer dyslexia and visual stress, there is a particular colour used in tinted glasses or plastic page overlays which will bring their reading up to speed'.

The third Child and Adolescent Mental Health conference was held in Sydney in July. It was attended by 400 health professionals and 60 carers/consumers, including adolescents. Sessions included schools and mental health, children with special needs, disruptive disorders, conduct disorders, personality problems, development disability, suicide prevention, early intervention, depression, medication use in young people (3 papers almost entirely about ADHD because they are the biggest user group), family therapy, wilderness and adventure therapy, autism, psychosis, anxiety disorders and a consumers' forum. Because ADHD is the biggest cause of referrals to mental health services for under 18 year olds, ADHD and co-morbid conditions were well covered.

Presenters ranged from distinguished psychiatrists and paediatricians to parents and consumers. A highlight was Agrivaine MacLachlan's dynamic address about her experiences. Agrivaine spent years as a psychotic in the street kid/punk rock scene and is not afraid of the 'f' word. Her address was moving but definitely not boring.

Consumer participation was capably organised by Adelaide ADHD parent and OITH reader Beth Smith. Part of the value of the conference was meeting others and we had plenty of opportunity to do this.

One result of the national mental health conferences is the formation of a national association. Beth says, "we need a national mental health group because lots of smaller national groups with single issue focus, eg ADD, Autism, Tourettes, are too small to have to strong political voice that is needed to bring about change in legislation and funding."

There is now a national mental health website: <http://auseinet.flinders.edu.au>) and mailing and discussion list. The focus will be on Early Intervention for Mental Health in Young People. Argument, criticism, discussion, clinical information and any other matters you may wish to promote are expected. To subscribe simply email majordomo@auseinet.flinders.edu.au, and in the body of the message put: subscribe einet.

The fourth national CAMHS conference will be held at the end of next year in Brisbane. We'll keep you posted. There will be more highlights from this year's conference in our next issue.

- Sue Dengate

ADDnet committee: Acting president Beryl Gover ACT 06 290 1984, Secretary Rosemary Borg phone 07 3817 2429, Treasurer Jan Clark TAS 03 6425 9403, Ros Mitchell NSW 02 9411 2186, Geraldine Moore VIC 03 9650 2570, Sue Dengate NT 08 8981 2444, Nayano Taylor-Neumann SA 08 8222 5159, Tracy Willet WA 08 9401 6282

If you or your children have diabetes or gestational diabetes, the Southern ADD Support Group would like to hear from you. Write to Kath Pascoe, PO Box 352, Happy Valley SA 5159

ORDER IN THE HOUSE! production team

Editor: Sue Dengate

Subscriptions: Margie Turner

Cartoons: not to be copied for profit: Joanne Van Os (copyright)

Typesetting: Peter Ezzy

Acknowledgements: Thanks for advice, encouragement or contributions to Dr John Ellard, Dr Chris Green, Dr Paul Hutchins, Dr Loretta Giorcelli, Dr Sheila Metcalf, The Serfontein Clinic, Dr Velencia Soutter, Dr Anne Swain, Joan Breakey, Ian Wallace, Maria D'Iono, Damien Howard, Katherine Tiffen, Marion Leggo, Rosemary Borg, Deborah Harding (Qld), Annette Aksenov, Nayano Taylor-Neumann, Beth Smith (SA), Jan Clark (Tas), Joy Toll and the LD Coalition of NSW, Ros Mitchell, Julie Appleton, Anne Dibb, Lee Gallagher (NSW), Geraldine Moore, Marina Dalla Rosa (Vic), Tracy Willet (WA); Jane Miles, Sue Armstrong (NT), the many parents who have written, phoned and sent encouraging comments and groups who have sent newsletters. Dr Howard Dengate and Peter Stauffer for paying the phone bills, the kids from the Don Dale Detention Centre for folding newsletters, and CLARE MARTIN'S electorate office for photocopying.

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American researchers are considering the prospect of neonatal tests to reduce the risk of producing a manic-depressive child. 'Is this, I wonder, tantamount to culling a potential Isaac Newton or a Spike Milligan?' asks writer Robbie Vickers.

- from a review of Mood Genes by Samuel Barondes, New Scientist 13/6/98, p43

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

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.'

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

Neem products : ask for Liceguard at your local health food store or pharmacy, or phone/fax the national distributor on 02 6688 6150

Giftedness has traditionally been associated with high academic achievement but since the 1980s, the concept that gifted students can also have learning disabilities has gained acceptance. A similar trend is occurring with ADHD. It is difficult to consider a student's giftedness when confronted with a student who is in constant motion, being verbally and physically abusive and defiant of teacher authority. In the face of such misbehaviours, it is understandable that a teacher may not see the child's gifts and talents. The giftedness is masked by the ADHD.

Conversely, the behaviour and attitudes shown by gifted and creative students may be misinterpreted as ADHD. With few exceptions, the behaviours associated with ADHD may also be associated with giftedness (see table).

1. Poorly sustained attention in almost all situations. 1. Poor attention, boredom, daydreaming in specific situations.

2. Diminished persistence on tasks not having immediate consequences. 2. Low tolerance for persistence on tasks that seem irrelevant.

3. Impulsivity, poor delay of gratification 3. Judgement lags behind development of intellect.

4. Impaired adherence to commands to regulate or inhibit behaviour in social contexts. 4. Intensity may lead to power struggles with authorities

5. More active, restless than normal children. 5. High activity level; may need less sleep

6. Difficulty adhering to rules and regulations. 6. Questions rules, customs and traditions.

Gifted children may spend from a quarter to a half of their classroom time waiting for others to catch up. Their specific level of academic achievement is often two to four grades above their actual grade placement. Such children often respond to slow-moving class situations by off-task behaviour, disruptions and other attempts to amuse themselves. This is often the cause of a referral for ADHD.

Children with ADHD usually have a very brief attention span in virtually every situation except for television and computer games whereas children who are gifted can concentrate comfortably for long periods on tasks that interest them and do not require immediate consequences.

Many gifted children are highly active, and as many as one quarter may require less sleep, but their activity is generally focused and directed. This permits them to spend long periods of time focusing on whatever truly interests them, which may not coincide with the expectations of teachers or parents.

Children who are gifted routinely maintain consistent efforts and high grades in classes when they like the teacher and are intellectually challenged, although they may resist repetition of tasks perceived as dull. In contrast, the academic performance of children with ADHD can vary dramatically on a day to day basis. They can achieve 95% one day and 35% two days later on a test of the same material, yet when questioned by the teacher can retrieve an enormous amount of detail.

Children with ADHD are known to underachieve on standard IQ tests and at school. When identifying giftedness in this group, the critical factor is the presence of a discrepancy between the student's potential and their performance. Recently, teacher nomination has become an accepted practice in identification of gifted students. Obviously, teacher nomination is particularly important when dealing with ADHD or any other situation which interferes with test-taking. In this case, teachers' knowledge of both ADHD and giftedness will enable discrimination between these two conditions. The aim is to help gifted ADHD children to achieve their true potential.

Barkley, R Handbook of ADHD, Guilford, 1990

Mendaglio, S and others 'Gifted/ADHD case illustrations of coexisting conditions', paper presented at the 11th world conference on gifted and talented children, Hong Kong, 1995.

Webb, J and Latimer, D, 'ADHD and children who are gifted', ERIC Digest #522, 1993

Research by Dr Nora Volkow, director of nuclear medicine at the Brookhaven National Laboratory in Upton, New York, used positron emission tomography (PET) to find

the distribution of Ritalin in the human brain was 'almost identical to that of cocaine ... we've given it to cocaine users and they say it's almost indistinguishable' says Volkow. Cocaine is one of the most addictive substances of abuse, and Volkow explains 'if we don't treat them, they will turn to substance abuse' as a form of self-medication. Although 10 to 30 per cent of cocaine abusers take cocaine because they have ADHD, 'when we give them Ritalin, the cocaine problem is revolved.'

After finding that stimulant-taking rats were more likely to choose cocaine, pharmacologist Dr Susan Schenk at Texas A&M University in College Station joined Dr Nadine Lambert, a psychologist with the University of California at Berkeley for the adolescent survey. They found that, as well as being more likely to abuse cocaine, adolescents who had used Ritalin were more likely to smoke.

Other researchers do not agree. Psychiatrist Lily Hechtman at the Montreal Children's Hospital compared people who had taken Ritalin for 3-5 years with an ADHD non-Ritalin group and non-ADHD group. She found no differences in substance abuse between the groups.

A conference this November, hosted by the US National Institutes of Health, will focus on research findings regarding the effects of Ritalin.

Who'd be a parent?

Respect in times of stress 8

Five management tips

ADHD and marijuana

Reading program

Solvents

Are you food sensitive?

Five years ago, our readers wanted to know about ADHD: 'what is it?'. Now, we notice more interest in treatment options: 'what can we do?'. Psychologists, teachers, doctors and paramedicals now know about ADHD and help is available. Hailed as the most comprehensive parenting manual available in Australia today, Dr John Irvine's Who'd be a parent? is a good example of new-look advice to parents, with plenty of information about ADHD, see page 0.

The susceptibility of people with ADHD to illegal drug use is always a worry to parents. In this issue, see articles on cocaine (p.0) and marijuana (p.0).

My son has been lucky to have a number of exceptional teachers. His all-time favourite took over an uncooperative class with a high proportion of difficult individuals and created happy, productive children with high self-esteem. She used virtually all the management techniques in Brooks' The self-esteem teacher. The strategies work equally well for creating happy families. I can't recommend it highly enough (p.8)

There is now less expectation that medication will be a single magic cure. Management, educational programs (p.0), Efalex (p.0), diet and other methods are increasing in popularity. A Southern reader reported, 'I looked at lots of group newsletters and decided to subscribe to yours because it has the most information about diet.' There are two new books about dietary management out this month. Yes, one of them is mine (see p.0).

- Sue Dengate, editor

- New Scientist, 13/6/98, p11.

More than 250,000 Australians use sleeping medication for six months or more. Be careful! Prolonged use results in tolerance to the drug, nervousness, tension, trembling, sweating and disturbed sleep. "So the very medication that starts helping you sleep if taken one or two nights a week eventually disturbs your sleep if taken for too long', warns Melbourne clinical psychologist and sleep specialist Dr David Morawetz.

- The Weekend Australian Living IT, 13/6/98, p15

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. Teacher praise and disapproval are not sufficiently strong reinforcers for ADHD children and 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.

- Hudson A 'Classroom instruction for children with ADHD' Aust J Early Childhood (1997),22 (4):22-27

A novel for high school students who love reading, try The Beach. It's about a group of young backpackers who drop out on a secret beach in Thailand. Gripping. They'll read it in one gulp.

- The Beach by Alex Garland, Penguin, 1996.

A reader comments, 'so far I've only read the first chapter and I've learned heaps' about the new book for teachers, 'Attention Deficit/Hyperactivity Disorder: Medical, psychological and educational perspectives'. Specially produced by the Australian Association of Special Education, the book is edited by Professor Jeff Bailey, director of CHERI (Children's Health and Education Research Institute) and senior lecturer in Education at University of Southern Queensland special education Dr Don Rice.

- Available from Deborah Pearce, CHERI, New Children's Hospital, PO Box 3515, Parramatta NSW 2141. $19 incl p&p. Ph 02 9845 3017, fx 02 9845 3082, visa and mastercards accepted.

Lead is the only environmental factor associated with ADHD symptoms in the NHMRC report. A new study questions effects on the foetus. Researchers exposed pregnant rats to the same levels of lead as ingested by humans from lead water pipes or leaded house paint. At 13 weeks, the rat pups showed an abnormal immune response which may be associated with susceptibility to viruses and perhaps asthma.

- New Scientist, 23/5/98, p7.

The Innovations Spell Checker offers spell checking on up to 80,000 words in English (not American), will search for missing letters, and 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).

1. Be sure of the diagnosis. Make sure you're working with a professional who really understands ADD and has excluded related or similar conditions such as anxiety states, agitated depression, hyperthyroidism, manic-depressive illness, or obsessive-compulsive disorder.

2. Educate yourself. Perhaps the single most powerful treatment for ADD is understanding ADD in the first place. Read books. Talk with professionals. Talk with other adults who have ADD. You'll be able to design your own treatment to fit your own version of ADD.

3. Coaching. It is useful for you to have a coach, for some person near you to keep after you, but always with humour. Your coach can help you get organised, stay on task, give you encouragement or remind you to get back to work. Friend, colleague, or therapist (it is possible, but risky for your coach to be your spouse), a coach is someone to stay on you to get things done, exhort you as coaches do, keep tabs on you, and in general be in your corner. A coach can be tremendously helpful in treating ADD.

4. Encouragement. ADD adults need lots of encouragement. This is in part due to their having many self-doubts that have accumulated over the years. But it goes beyond that. More than the average person, the ADD adult withers without encouragement and positively lights up like a Christmas tree when given it. They will often work for another person in a way they won't work for themselves. This is not "bad", it just is. It should be recognised and taken advantage of.

5. Realise what ADD is NOT, ie., conflict with mother, etc.

- from Fifty tips for ADD adults on the internet by Drs EM Hallowell and JR Ratey, two US psychiatrists with ADHD. Authors of Driven to Distraction and Answers to Distraction, available from Silvereye Educational Publications, phone 02 4987 3457, email:silvereye.hunterlink.net.au

Efalex and pycnogenol

We continue to hear from readers who say that Efalex is worth a try. It doesn't work for everyone, and some children get worse (oppositional, withdrawn, or 'won't eat'), but a number of readers have noticed that after days or up to three weeks, their children are calmer. Pycnogenol seems to work for a fewer number. Both are expensive.

I wish this book had been available when I had my first child. The worst problems I was experiencing didn't even appear in parenting manuals then. This one has them all listed with heaps of sensible and sympathetic suggestions. Whether you're looking for a specific problem or just browsing, you'll be entertained and learn from this book. For example:

This book would make a great gift for new or old parents. And can you be without it yourself?

Who'd be a parent? by Dr John Irvine, Pan McMillan, 1998, RRP $19.95, in all good bookstores

Children's illiteracy is a 'major public health problem' according to the U.S. Public Health Service's declaration in 1997. An estimated 40% of American children are poor readers and half of those have severe problems. An Australian survey in 1996 found that nearly 30% of students in Years 3 and 5 did not reach a set standard on reading. If a child hasn't learned to read well by age 9, most likely they will remain poor readers for the rest of their lives. With that failure often comes a lifetime of disappointment and privation - and burdens for society, according to reading researchers.

A long-established reading program from the U.S. is now gaining popularity in Australia. Unlike other multi-sensory methods such as Lindamood-Bell and Slingerland which are for learning disabled children, the Spalding method acknowledges the increase in the number of pupils with specific learning disabilities and is designed for the ordinary classroom.

Developing the eyes, ears, voice, hand and arm muscles and the right and left sides of the brain concurrently, Spalding encourages the growth of the mind's power to reason, imagine and remember. It begins by teaching kindergarten pupils the 45 sounds of the English language. In 2 to 3 months the children are taught to recognise, name and write the single letters and the 2-, 3- and 4-letter combinations called phonograms which represent the 45 sounds. With the help of 70 phonogram cards which show all the possible sound combinations in English produced by, for instance, 'ea' as in 'eat', 'head', 'break', the youngsters can master all the basic aural and visual patterns in words.

Spalding teaches as much phonics as the children need. Once these skills are fully in place the pupils can concentrate on reading comprehension and writing to develop the love of reading which is responsible for lifelong learning. The emphasis is on teaching reading effectively to all levels of students, thus avoiding the need for remedial programs later on.

Staff at three exclusive girls schools, Ascham, Presbyterian Ladies College and Tangara, are enthusiastic about the program. Mrs Sallie Norsworthy, Headmistress of PLC, says 'Spalding ... is proving to be even more effective for more children ... most girls have already achieved a spelling age of one to five years ahead of their grade expectation'. In the US, a 'Spalding School' has held the highest ranking on US national and state assessments of Reading and English Language for the last eight years.

In Australia, Spalding courses offered are teacher training 1 & 2, and a parents' introduction. See What's On.

Research suggests:

* Two cannaboids found in marijuana affect chromosomal structure. 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 such children, the pride in learning self-control, self-discipline and new skills for new stages of life has been taken away.

Robb and Letts' book is full of suggestions which sound so simple you wonder if these authors really understand ADHD, but they claim to be successful. The authors recommend observing your children, paying attention to them, teaching them the consequences of their actions, social and other skills. In one anecdote, an Asperger's girl named Margaret 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.'

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.

Symptoms of exposure to solvents can include behavioural and learning problems 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:

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 students of the opportunity to learn. 'They are gifted and talented in their own right but their skills don't lie in physics classes, for example. They are graphic artists, skilful musicians, skilled at manual labour and construction, talented cooks and clothing designers. 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.

July 23-26 Child and Adolescent Mental Health conference, Sydney

Sept 3-5 1st international Neurocare conference, special guest lecture by neurologist Dr Oliver Sacks, Adelaide, ph 08 8357 8909

Sept 25-27 Montessori National Conference, Freemantle, WA, fx 08 9385 2424, email zbeehive@cc.curtin.edu.au

Spalding teacher courses, phone centre 02 9894 5711 unless indicated otherwise:

Darwin: July 7-16

Sydney (Waverley) 6-10 July, 13-17 July

Tamworth 24-26th July, 14-16 August, 4-7 Sept, ph 0267 664420

Orange 26 Sept-4th Oct, 02 6392 0300

Sydney (Cherrybrook) 11,18,25 Oct

Tasmania (Gagebrook) 22-26 June, ph 03 6233 7415

Melbourne (Burwood) 16, 23 July ph 03

The brain activity in ADHD and unaffected men was monitored while they completed a task. Participants heard a series of numbers, one every 2.4 seconds, and were asked to add the last two digits they heard. Looking at positron emission tomography (PET) scans, Emory University researcher Julie B Schweitzer saw two major differences between the groups. First, the ADHD individuals maintained high levels of blood flow, whereas the controls displayed deactivation in the temporal gyrus region, indicating some kind of learning. The ADHD group also activated brain areas used for visual tasks. Researchers found that instead of repeating the numbers to themselves as some of the controls did, many of the ADHD group had visualised the numbers.

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?

Increasing recognition of dietary management

Although the Feingold diet was officially discredited in 1980, more recent research suggests that diet may contribute to behaviour problems in some children. The official NHMRC recommendation (1997) is that if diet is to be instituted, it should be under the supervision of a qualified dietitian, preferably with experience in this area. The Dietitians' Association of Australia recommend a low-chemical elimination diet and state that a patient's request for investigation of diet is sufficient indication for dietary investigation, as refusal usually results in patients seeking advice from fringe or unorothdox practitioners.

Two books aimed at helping families sort out food sensitivities have hit the shelves this month. Dietitian Joan Breakey has a special interest in the effects of food on children's behaviour. She has researched and practised diet therapy for over twenty years, including as a dietitian for Child Community Psychiatry in the Division of Youth, Welfare and Guidance and as adviser in Nutrition to the Department of Health in Queensland. Are you food sensitive? outlines her unique 'diet detective' method where families can create their own diet, designed to make food manageable for sensitive families. The book is packed with useful hints about individual foods and food sensitivities drawn from Joan's many years of experience.

The second book is by Sue Dengate, author of the best-selling Different Kids. 'Kids have changed', says a school principal in Fed Up. "They come to school angry or unhappy and stay that way all day ... you have to look at food.' Fed Up provides support for families who would like to know more about the low-chemical elimination diet or who have seen a dietitian and come out saying 'where do I start?'.

ADDnet NEWS

Brought to Australia by ADDnet, US psychologist Dr Robert Brooks gave talks in Tasmania, Melbourne, Sydney, Newcastle and Brisbane in May. Following is a summary of the main points in his presentation Fostering family closeness and respect in times of stress to an audience of 400 in Newcastle.

See enclosed order form or contact ADDnet treasurer Mrs Jan Clark, PO Box 514, Ulverstone, Tas, 7315.

ADDnet committee: Acting president Beryl Gover ACT 06 290 1984, Secretary Rosemary Borg phone 07 3817 2429, Treasurer Jan Clark TAS 004 293 332, Ros Mitchell NSW 02 9411 2186, Geraldine Moore VIC 03 9650 2570, Sue Dengate NT 08 8981 2444, Nayano Taylor-Neumann SA 08 8222 5159, Tracy Willet WA 08 9401 6282

A number of children aged from 13 months to 14 years have experienced dramatic itchy skin rashes up to 30 hours after eating instant noodles, pies or party pies. The rashes are intensely itchy and follow a course, eventually covering the whole body and lasting 5 to 10 days. As they may be associated with a new additive, we would love to hear from anyone who has experienced this. Phone 08 8981 2444.

ORDER IN THE HOUSE! production team

Editor: Sue Dengate

Subscriptions: Margie Turner

Cartoons: not to be copied for profit: Joanne Van Os (copyright)

Typesetting: Peter Ezzy

Acknowledgements: Thanks for advice, encouragement or contributions to Dr John Ellard, Dr Chris Green, Dr Paul Hutchins, Dr Loretta Giorcelli, Dr Sheila Metcalf, The Serfontein Clinic, Dr Velencia Soutter, Dr Anne Swain, Joan Breakey, Ian Wallace, Maria D'Iono, Damien Howard, Marion Leggo, Rosemary Borg, Deborah Harding (Qld), Annette Aksenov, Nayano Taylor-Neumann, Beth Smith (SA), Jan Clark (Tas), Joy Toll and the LD Coalition of NSW, Ros Mitchell, Julie Appleton, Anne Dibb, Lee Gallagher (NSW), Geraldine Moore, Marina Dalla Rosa (Vic), Tracy Willet (WA); Jane Miles, Sue Armstrong (NT), the many parents who have written, phoned and sent encouraging comments and groups who have sent newsletters. Dr Howard Dengate and Peter Stauffer for paying the phone bills, the kids from the Don Dale Detention Centre for folding newsletters, and CLARE MARTIN'S electorate office for photocopying.

ORDER IN THE HOUSE! does not endorse any particular school, service, business, treatment or theory. Articles and announcements are for information only.

Subscription price (four issues) $10

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Monthly newsletter The Diet page $10

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American researchers are considering the prospect of neonatal tests to reduce the risk of producing a manic-depressive child. 'Is this, I wonder, tantamount to culling a potential Isaac Newton or a Spike Milligan?' asks writer Robbie Vickers.

- from a review of Mood Genes by Samuel Barondes, New Scientist 13/6/98, p43

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

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.'

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

Neem products : ask for Liceguard at your local health food store or pharmacy, or phone/fax the national distributor on 02 6688 6150

With thanks to Ted Milliken, psychologist, Jeremy Muir, NTU Disability Officer, OITH readers, Wendy Ridley, special education teacher, Fiona Shanahan, Master Coaching, Mary Temple, psychologist and research from the University of Western Sydney Special Education Unit.

self-esteem

Marijuana

Bribability

In the USA

Further reading: Straus MA and others Spanking by parents and subsequent antisocial behaviour of chidlren. Archives of Pediatric and Adolescent Medicine 1997;151:761-767

Ref: Young-Loveridge, J 'A personal perspective on challenging behaviour: ADHD? Aust J Early Childhood (1997),22 (4):1-5 in the December 1997 themed edition which contains seven articles about ADHD including one by OITH editor Sue Dengate.

Further reading: Arnett PA and others 'The effect of Ritalin on response to reward and punishment in children with ADHD' Child Study Journal (1996), 26(2),51-70

Payne, CH 'Youth Allowance', NT Board of Studies Newsletter (1998),1:3

Further reading: White RF and Proctor SP 'Solvents and neurotoxicity' The Lancet, 349, 1997:1239-1243

Behaviour ratings 'generally improved' on diets 'essentially free of additives'