Jeffrey Freed is a former teacher who works exclusively with ADD and gifted children in Colorado, USA. He sees 45 children a week and has a two year waiting list. His success is based on acknowledging that ADD children think in a different style. You can help your child by using his techniques for ten minutes a day.

If you have to remember someone from your past, can you best remember their name or the way they look? Most ADD and gifted children are picture thinkers who learn by remembering the way things look and by turning words into mental pictures (see scientific evidence, next page). When asked to remember a person, they will flash an image, remembering even the most minute detail. Most teachers are word thinkers who store information in names and words rather than images. They can easily recall a name but struggle with the face or details.

Picture thinking children tend to have difficulty with colouring or handwriting, be good with building toys, need to like their teacher in order to do well in class, be easily distracted or daydream a lot, need constant reminders to do certain things, be a perfectionist to the point that it gets in the way of trying new things and have a good sense of humour.

Picture thinkers (also called right-brained) pick up skills more easily by having them demonstrated than explained. They prefer drawing and creating to writing and thinking. They can be perfectionists and creative geniuses, and can hold images in their heads for prolonged lengths of time, for example as architects or builders.

Our schools which are primarily worlds of words, full of people who are generally logical and reliable, enjoy talking and writing things down, work well in a group, find it easier to grasp spelling, grammar and foreign languages, excel in timed-test situations and like making and following rules.

Picture thinkers have a powerful memory which is not always obvious. They may be terrific at remembering where Dad mislaid his car keys. Cramming on the night before the exam works well for them because their learning style allows them to speed-read the material, then to recall it with ease and accuracy. Human calculators, like Dustin Hoffman's "Rainman" character in the casino, are picture thinkers. They have the ability to visualise and hold numbers in their minds. Don't ever try to play poker with a picture thinker!

These methods will work best for picture thinkers with an IQ over 125 who are frustrated and doing poorly in school. Instead of calling them learning disabled we can find a way to use their strengths.

ADD children like a good challenge. They tend to trip up more on easy tasks, during which their minds wander and they lose their powers of visualisation. Tty seventh grade algebra with a fourth grader: "this is so hard, there is almost no chance of someone your age getting it right, so don't worry if you make a mistake". Once your child is confidently doing seventh grade maths, he'll find it less intimidating to go back and fill in the gaps.

Set aside ten minutes a day to do exercises like the following with your child. Find a time when he's not too tired, and a quiet place (no television or siblings). Don't worry if he's crawling under the table. Choose a subject he is interested in. When ADD children find work interesting and relevant, they seem not to have ADD at all.

The trick with picture thinkers is to teach them to use their visualisation skills. For example, get the child to close his eyes and make a "movie" of your instructions - "get up from the table, go down to the car, open the passenger door three times and the driver's door once, come back upstairs", and so on If your child can play back the movie or repeat the instructions back to you, he's visualising. Your child can learn auditory instructions, if he learns to turn them into a picture.

Start with a slightly harder word than he can usually spell. Write the word in very large letters on white paper using a different colour for each syllable. Hold the paper at least a food away from your child. Tell him to look at the word until he can see it in his mind - at least twenty seconds. Then turn the paper face down and ask your child to spell the word out loud. If the child is successful, ask him to spell it out backwards. True picture thinkers will find this almost as easy. Let him know how clever he is. Work on three or four words a day.

This exercise is for a seven-year-old who is already uncomfortable about reading. Find a book your child is familiar with that is a year or two below his current grade level. Ask the child to read it out as much as he can, slowly using your finger as a visual guide. Point directly under the word you want your child to read. This method keeps your child's eye focused on one word at a time and slows down the process, allowing time for visualisation to occur. If the word is dog, what does the dog look like? If he isn't getting a picture, encourage him to close his eyes and visualise the word and a dog in his mind. Tell him that when he comes across a word he has a chance of missing, he should allow you to read it for him. This

At the end, review the words you read to him. The next day, begin by having the child read the passage entirely by himself.

Many ADD children struggle with tables and easy addition. Picture thinkers do not respond to drill, repetition and timed tests. For a twelve year old picture thinker who hates maths, try this technique. First, take the pencil out of his hand. When they are concentrating on writing, they're not visualising. Then start with a simple number - "take your time, and go into your head to solve these problems" - for example, "divide 8 in half ... now add 3 ... now double that number." You play scribe anad write down the answer (14). "Now, divide 14 in half ... add three ... square that number." Write down the answer (100), and so on. This exercise tests your child's ability to add, subtract, multiply and divide. After a few successful sessions like this, your child will have enough confidence to try more difficult maths at school.

This is the hardest task for the picture thinker. For middle and high school students having trouble, try the "writing and weaning" technique". If your child has an assignment due, you can model the correct way to do it by writing it not for him but with him. Sit down with paper and pencil or computer and "coproduce" the paper. Show how to break down an assignment into steps, to get him over the hurdle of getting started. Perhaps "first, I'd like you to read this chapter ... think about what you'd like to put in your report as you go ... make a few notes if you like. Then let's sit down and you can just tell me what you remember". You can write or type while he talks. Ask "tell me more about that" or "what do you mean by that". Each time you work with your child, wean him of your help, for example, by insisting that he insert several sentences of his own in the next essay.

Picture thinkers will never become good handwriters. The computer can make it easier for them to express thoughts and ideas on paper. Encourage them to visualise the computer keyboard, a little at a time, to make typing easier.

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.

thinking in pictures

state dependent learning

movement programs

exercise for adults

more tips for adults

handwriting

food colours impair learning

zinc deficiency

suicide prevention

Dr Oliver Sachs

autism

"for the good of the child"

What's on

dyspraxia

While reading Jeffrey Freed's book (cover story), I thought 'this is my son'. Maths coaching homework used to be a prolonged session of grumbling and procrastination. After three sessions using Freed's confidence-boosting maths methods, I don't even see the maths sheets - they are finished within minutes - no help needed from me. There are other methods in Freed's book, such as "writing and weaning" which I have used in the past - and they worked.

Last week I worked with a mother from Nagoya University who is translating my first book, 'Different Kids', into Japanese. She says we have to change the title because in Japan, 'different' means 'wrong'. My agent, who was also raised in a traditional Asian family, says 'ADD is a very foreign subject in the Asian countries. In Asia, a child with ADD would be considered lazy and problematic, and in many cases parents would be blamed for not raising their child properly'. Are things so different here? They can be. See "For the good of the child", page 7 (?).

In my research project on the effect of food on children's behaviour, now nearly finished, most of the mothers unexpectedly reported dramatic changes in their children's learning. They reported 'actually wanted to do homework', 'bringing home readers and reading them to me instead of us having to read it to him', 'more interested in school' and 'spelling improved greatly'. According to previous research, food chemicals can affect learning ability without behavioural changes, see p0.

The Child Disability Allowance Assessment Tool (CDAT) is under review (again). The government would like our opinions on the wording and effectiveness of the assessment tool (application form); the inclusion of additional indicators for childhood behaviours and special care needs; and a review of the lists of recognised disabilities which confer automatic entitlement to the CDA.

Old houses with flaking, lead-based paint contribute to children's lead levels through dust. In the USA, there are more than a million children under the age of six with blood lead levels between 100 and 300 micrograms per litre. These doses are enough to impair mental development. A study in New Jersey arranged for cleaners to wet-mop floors, sponge walls and suck up dust with a powerful vacuum cleaner in toddlers' homes every few weeks for a year. Within a year, children's lead levels had fallen by 17 per cent, and in homes cleaned more than 20 times, by up to 34%.

- Pediatrics, vol 103, p551.

Cueing:

'Most teachers don't cue properly when there's a change. If the teacher tells the children, "Take out your maths books now and turn to page 17," a handful of kids are probably only going to hear "turn to page 17."

Then, those children have no clue what's going on; they think they're supposed to turn to page 17 in their Reading books and before you know it, they're totally lost. Whether a child has ADD or an auditory lag or whatever - a simple "Boys and girls, can I have your attention? Please take out your maths books and turn to page 17." Is probably all the teacher need do to get everyone on task and making the change. Simple, but I doubt there are many teachers that consistently cue before changes.'

The sound of a fairly loud noise - from music to cheering at a sports event - is enough to give some people vertigo. The condition, known as superior canal dehiscence syndrome (SCDS) has been identified by Lloyd Minor and his colleagues at the Johns Hopkins Centre for Hearing and Balance in Baltimore, Maryland. About 2 per cent of the population are predisposed to develop the condition because they have abnormally thin temporal bones directly above the ear's upper balance canal. A slight injury or even coughing can break the bone which means that noises aren't processed properly and instead create strong vibrations, leading to vertigo. The condition can be treated by repairing the cracked bone.

The vast majority of drugs have never been tested on children, yet children are not simply miniature adults. They react to chemicals quite differently. For example, adverse effects have been reported in children taking cisapride which helps gut contractions and is given every year to thousands of young children with reflux. Some children who were given unsuitably high doses suffered dangerous heart problems. The manufacturer now plans to test the drug in children. In the USA, drug companies will be granted a six-month extension of their patents in exchange for comprehensive paediatric data. In the UK, a newly formed British Forum for Use of Medicine in Childhood announced their aim to improve research, development and training in paediatric pharmacology.

- New Scientist, 20/2/99

Hollywood movie director John Huston tells a story about legendary star Marilyn Monroe during the filming of The Misfits. Since Monroe believed that she would keep her stunning beauty only if she got enough sleep, she took large doses of sleeping tablets. The day before filming and while half-sedated she would have her lines read out to her, over and over. The next day, Monroe would take barbiturates to counteract the sleeping tablets. When she arrived on the set, she would know her lines - the main words in them, how long they were and the exact rhythm of each line. But she would get the tenses all wrong. She wouldn't know whether a given line was in the past, present or future.

This curious anecdote is probably an example of the effects of state dependent learning, a little-understood condition of the brain whereby information that is learned in a certain state, whether medicated, drunk or sober, is best remembered in the same condition.

It is possible that certain kinds of information learned while on stimulant medication may not be easily recalled when off the medication and vice versa. In her book Fed Up, Sue Dengate recounts the experiences of a businessman who visited Indonesia while undertaking a trial of Ritalin. Previously fluent in Indonesian, he found that when he tried to give directions to the airport taxi driver, he couldn't remember a word. When he stopped taking Ritalin, his fluency returned. Results of early studies suggest effects are small, but state-dependent learning is one of ten important questions about the effects of medication to be investigated in a massive study currently underway at the US National Institutes of Mental Health.

Is there any place for "old-fashioned" motor programs? An increasing number of schools think so. As one teacher said:

A new book by Barbara Pheloung, co-author of Overcoming Learning Difficulties, reviews motor programs in a number of Australian schools. Children with learning difficulties were withdrawn from class three days a week in a three year program at Oxford Falls Grammar School in Sydney. During each half-hour session they practiced activities like crawling, rolling, throwing and catching, balance, left/right activities, hopping and skipping. Children also attended remedial class. A control group attended remedial class without the sensory integration program. Children attending the SI program for a year made more gains than the control group.

In the final year, all the kindergarten teachers took their classes on the program. The children who were good at the activities enjoyed doing them and achieving. Children who found it difficult at the beginning became as capable as others through the constant repetition. The small number of children who obviously weren't improving were easily identified by teachers and referred for professional help. But it isn't only young children who can benefit from movement prpgrams.

Program organiser John Newberry describes the results: "Within three weeks, parents reported the boys were more tractable at home, had stopped fighting with Mum and chucking tantrums. They had started to succeed at something they enjoyed. They were supposed to be doing home exercise programs as well, although that was spasmodic. There was enough progress in terms of the observable changes - self-confidence, self-esteem, physical abilities ... That group of boys are the Year 12s now. They have mostly done quite well. There are no genius scholars but they have got back into the mainstream classrooms and they have coped."

The estimate of prescriptions dispensed through community pharmacies in Australia for dexamphetamine (Dex) and methylphenidate (Ritalin) in the years 1990 to 1997 is as follows:

Year Dex Ritalin

1990 9,940 13,400

1991 13,880 16,610

1992 26,630 23,190

1993 47,210 31,040

1994 82,390 46,540

1995 127,850 64,460

1996 168,940 78,380

1997 207,300 83,700

The HST may be used with a wide range of students including those with cerebral palsy, spina bifida, arthritis, head injury, learning difficulties, specific handwriting difficulties and those in rehabilitation.

Twenty hyperactive children (18 boys, 2 girls, average age 10 years) were given a diet free of artificial food dyes and other additives for 3 days then given a disguised blend of nine food dyes or a placebo. Their learning ability was tested before the challenge and at intervals up to 3½ hours afterwards. The food dye challenge significantly impaired performance on a learning task. The effect took over half an hour to become evident, reached its maximum by 1½ hours and lasted at least 3½ hours. No difference was seen in social behaviour.

Three studies suggest a possible relationship between ADHD symptoms and zinc deficiency.

A young man in Britain held his toothbrush in his mouth while washing his hair in the shower. When he threw his head back to rinse, he had a sudden coughing fit and swallowed the toothbrush. Ignoring what had happened, he went to work, only to come down with excruciating stomach pains that evening. He was rushed to hospital, where he needed emergency surgery.

- from Jill Margo's Man Maintenance, Penguin 1996. Watch for "The Chainsaw" in the next issue

The complete 100 page manual from the Keep Yourself Alive (KYA) program (funded under the National Suicide Prevention Strategy) is available for download free of charge from the AusEinet site as an Adobe Acrobat .pdf file.

Primarily aimed at professionals, the manual underpins the 4 videotapes and the 7 hour workshop program, but provides a useful resource in its own right. It covers Signs, Crisis Management, Therapeutic Intervention and what to do after a suicide (Postvention).

While most patients slept too much, in some patients the cerebral mechanisms for sleep were destroyed and they were totally unable to sleep. Sometimes these insomniac states were accompanied by a frenzy of body and mind, a state of ceaseless excitement and movement until death from exhaustion a week or ten days later. This was the first time sleep had been shown to be a physiological necessity for life.

Children sometimes showed abrupt changes of character and became impulsive, provocative and destructive, with tantrums and rages. Although many patients seemed to make a complete recovery, after years or even decades of perfect health, the majority of them developed post-encephalitic syndromes covering a wide range of behaviours including impulsive and emotional hyperkinetic-tourettic symptoms.

Dr Sacks defined hyperkinesia as "increased force, impetus, speed, violence and spread of movement; usually associated with excess of 'background' movement ... and often with impulsiveness, impetuosity, irritability, insomnia, etc."

Despite trials of medication, including the L-DOPA trials made famous in the movie Awakenings, Sacks emphasised the effects of the external environment, the "circumstances and vicissitudes" of each patient's life on their symptoms. He concluded that:

• happiness, freedom and good relationships made his patients better

• stress, isolation and boredom made them worse.

These effects were at least as important as the effects of drugs according to Dr Sacks. He found his patients had a reduced tolerance for insufficient sleep or rest. They also had an intolerance of stress such as pain, disability, frustration, anxiety and anger and a need for strategies to manage their problems. But more important than all of them was:

"the establishment of proper relations with the world, and - in particular - with other human beings, or one other human being".

How similar this sounds to findings by Canadian researcher Weiss and Hechtmann in 1986, when they asked adults who were studied as hyperactive children what had helped them most. The majority chose a significant person, usually a parent or teacher who had helped them and "believed in" them.

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 transforms the amino acid tryptophan into hormones and neurotransmitters like serotonin. 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.

'This time last year we faced with great trepidation the first year of high school for the first of our ADHD girls. Dutifully, we attended orientation day, listened with interest and then enquired what the policy with the school was for the administration of Dex. We were told that our daughter was not allowed to have her Dex at school and we would need approval for her to have it on the grounds. This was December 1997.

Now, in December 1998, we have an emergency bottle of Dex at school for those days when the tablets are left at home. We are incredible lucky to have had the committed teaching staff of a learning support unit, where eleven girls have one teacher and for most lessons a School Services Officer. Our daughter also has a one-on-one teacher for two hours a week

After a series of false starts where the school tried to make Michelle fit into the school and ignore her particular problems, a meeting was set up between the school, the family and the paediatrician. This meeting eventually gave the school the knowledge to deal with Michelle in new and innovative ways. Time Out and Suspensions are not part of her management. Behaviour management is dealt with on the spot by the teacher who sees inappropriate behaviour. This involved asking her if she has had her medication, if not, her medication is given and she is supervised for 20 minutes until it words. Then and only then does discussion take place about the current problem, never without medication are her actions discussed, this has resulted in her always identifying her action and her always seeing a way to rectify the problem.

At the time of the above school meeting, we also applied to the Special Education Resource Unit for a laptop for Michelle to use both in school and at home. The school didn't hold out much hope for the provision of the laptop, as some other more identifiable disabilities have a higher priority. Nevertheless, midway through Term 4, Michelle became the proud owner of a laptop.

As a direct result of all parties acting for the good of the child, we have had the school adapt their policies and re-think their educational processes in regard to Michelle (she also has 30% more time to complete tasks, reports, exams, etc).

As a result, she entered high school at year 8 level and within one school year she is finishing year 10. This has been so successful that at speech night she is expected to gain a number of academic certificates. The support offered by the staff have allowed Michelle to progress through three years' work in one. As a family, we are looking forward to seeing her through Year 11, with this continued support. Additionally, our youngest daughter is also joining her elder sister at high school next year and yes, she also has ADHD.

Now, for all you curious people, thinking where is this wondrous school, Michelle goes to Gepps Cross Girls High.

Do not think that your school cannot help your with your child: stand your ground.

Demand to have a Negotiated Curriculum Plan.

Demand to see a guidance officer.

Do not allow the system to overrun you or your family or your parental instincts.

Do make lots of noise about the education of your child and please at all times remember that our children are the future and only the very best is good enough. Finally, we would like to thank Debra Basset (Special Education Co-oridnator), Jo Armstrong and all the other Special Education Staff. Without their dedication we would not have the successes of this year.'

ADD Parents Support Group

The focus of this conference will be the effects of chemical exposure on children, including Multiple Chemical Sensitivity (MCS), Chronic Fatigue Syndrome (CFS), Attention Deficit Disorder (ADD) and other disorders where there has been a toxic or environmental association. Guest speakers will include Dr Gunnar Heuser, assistant Professor of Medicine at the University of California, Los Angeles School of Medicine since 1970, a member of the National Association of Physicians for the Environment and a member of the Society for Occupational and Environmental Health.

The Sunday Expo will be a free information day where support groups will be invited to present table displays and, where possible, presentations including discussions with the public.

April 17 Tertiary students and adults with LD and/or ADHD skills development workshops, Uni of Western Sydney, Milperra, 02 9772 6229

June 6-8 AusEinet (Australian Early Intervention Network for Mental Health in Young People) international conference Adelaide, contact Lesley Woods, ph 08 8274 6060, fx 08 8274 6000, http://AusEinet.flinders.edu.au

August 13-15 Conference: Chemical Effects on Children University of New England, Armidale NSW, contact Tracy Brown, phone/fax-02 6772 0066, email: acespade@northnet.com.au

, http://www.ozemail.com.au/~actall

 Networking

Children with motor dyspraxia know what they want but appear to be clumsy and disorganised. They are likely to have one or more of the following problems:

A child with verbal dyspraxia knows what he wants to say but is unable to sequence the sounds needed for speech. Some children have difficulty pronouncing sounds, others have difficulty sequencing words. Some children have difficulty co-ordinating their lips, tongue and palate to make sounds. Expressive language is often delayed. These children need lots of intensive speech therapy in order to learn how to plan, sequence and produce speech sounds.

Problems often include

Assessments and therapy are available from occupational therapists and physiotherapists for motor dyspraxia and from speech pathologists for verbal dyspraxia offer assessments and management for motor dsypraxia. You can find free therapists in local community health centres or private therapists listed in the yellow pages. Children with developmental dyspraxia can expect a big improvement with therapy.

'Dyspraxia is a severe condition (not just a "clumsy child") with major implications for the child, family and all support services' according to Dr Paul Hutchins, senior Paediatric Consultant at the New Children s Hospital Educational and Research Centre. He recommends the 22-minute video Have you heard about dyspraxia? as 'an exceptional and essential resource'.

Sandy is an ADHD university student from Hong Kong using dietary management. She would like to correspond with others using diet: eschau@hknet.com

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 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.

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

TCE is a chemical which often finds its way into drinking water in the USA. A component in degreasing solvents commonly used by manufacturers, TCE - properly know as trichloroethlyene - is in many cases dumped illegally onto the ground or discharged into streams, ultimately contaminating water supplies. Drinking water contaminated by TCE has been reported in Japan and in Milan in Italy as well as the USA.

Low-level effects of TCE on behaviour may occur before any obvious sign of illness. An individual is defined as being exposed when there is evidence that a recognised contaminant found in air, drinking water, soil, food or surface water has been ingested, inhaled and/or absorbed through the skin. Long-term chronic exposure of any intensity or high-dose acute exposures can produce long-lasting or permanent effects characterised by cognitive and behavioural changes. Short-term, very low-level exposures are far less likely to produce any health effects.

In one study, 54 people from communities in Boston, Ohio and Minnesota were examined. They had suffered low-level, chronic exposure to TCE in their drinking water for years. Memory and attention test performance were the feature most likely to be impaired. Irritability was noted in 40 out of 54 individuals.

Children may be affected differently than adults. In one family, all four children performed below average on academic tests and language tasks, although their mother's school performance had been average. In a study of Michigan families exposed to TCE in drinking water, 10 adults complained of fatigue, somnolence, lack of energy, numbness and tingling, headache, dizziness and tremor. Among 12 children, 9 had major behavioural difficulties, including poor learning, aggressive behaviour and poor attention span.

Many studies have demonstrated the neurotoxicity of organic solvents, which form at least a quarter of all chemicals with known neurotoxicity. The effects of solvent exposure have been investigated by Professor Roberta White, research director of the Boston Environmental Hazards Centre at Boston University's School of Medicine, for the last 16 years. Professor White finds that the attentional system is one of the first to be affected by exposure to neurotoxicants prenatally or in childhood (including lead as well as solvents) and has seen ADHD clinically a number of times in such children. "It seems to me that the effects are often magnified or more pronounced in a child who is genetically at risk for ADHD or any other cognitive developmental disorder and then is exposed to chemicals that affect the central nervous system," she comments.

Solvents account for about a quarter of 167 chemicals identified as having behavioural or neurological effects by the American Conference of Governmental Industrial Hygienists in 1984. Of other chemicals with demonstrated neurotoxic effects, polychlorinated biphenyls (PCBs) have been implicated in a number of studies.

Like TCE, PCBs also turn up in waterways. In the early 1980s, psychologists studied more than three hundred children whose mothers had eaten two or three meals of fish a month from the Great Lakes, known to be contaminated with PCBs. In some cases, the women had eaten no fish during pregnancy, but PCBs accumulate in body fat and are passed on to babies through the placenta and breast milk. Differences between the children of fish-eating mothers and non-fish eating mothers were evident from birth. Researchers found persistent evidence of neurological impairment, including weak reflexes and impaired cognitive functioning. Years later, children of women with the highest PCB levels showed

• lower scores in verbal and memory tests and

• oppositional behaviour.

The behavioural toxicity of environmental factors like chemicals and heavy metals is a relatively new area of research. Although the National Health and Medical Research Council's 1997 report on ADHD considers the cause of ADHD be unknown, exposure to environmental factors such as lead is acknowledged as a possible contributing factor. The findings of such research may have benefits for parents who for years have been bedevilled by a lack of understanding from the community and accusations that they themselves cause their children's bad behaviour through poor parenting techniques. -by Sue Dengate

Further reading:

Children suffering from ADHD who are treated with stimulants show almost no improvement in academic achievement and social skills, according to an expert panel convened by the US National Institutes of Health..

Stimulants such as Ritalin have been hailed as a breakthrough in the treatment of ADHD, allowing disruptive children to concentrate in class. Psychiatrists assumed that this would mean improved educational performance. But that's not what the NIH panel found. One of the studies considered followed the progress of ADHD children on Ritalin for 14 months. "The evidence is not very impressive," says Samuel Guze, a psychiatrist at the Washington University School of Medicine in St Louis, Missouri. "They start lower than average and they remain lower than average," says Naomi Brelau, director of research at the Henry Ford Health System in Detroit, Michigan.

The NIH panel is not opposed to using drugs to control ADHD. But one expert who gave evidence to the panel argues that drugs such as Ritalin only treat the symptoms rather than addressing the underlying cause of the condition. Rosemary Tannock of the Hospital for Sick Children in Toronto suspects that ADHD is fundamentally misunderstood. She has tested ADHD children using a battery of tests that measure their reaction time. "These kids are ubiquitously slow," she says. "It doesn't fit the picture of hyperactivity and impulsiveness."

Tannock thinks the children have problems with tasks that require them to store some pieces of information while simultaneously manipulating others, and has anecdotal evidence that an extremely structured classroom setting can improve their educational performance. She advocates trials to test the effective of changing the classroom setting, but cautions that this treatment will almost certainly be more expensive than drugs.

Dietary management does not produce a magical change within an hour the way medication can. But what do studies show of long term effects?

Following up after two years on families avoiding additives and salicylates, U.S. researchers found 13 out of 14 mothers described their children's behaviour as having improved since the end of the study. Typically, they reported marked improvement in schoolwork and a steady, gradual increase in self-control.

In a British study which used the Few Foods diet, 92% of children in the study were still continuing with the diet when last seen. Researchers commented that being on an acceptable diet did seem to make a remarkable difference in the lives of many of these families.

A study of 6000 institutionalised juvenile offenders found antisocial behaviours were reduced by nearly half following the introduction to a diet low in processed foods. Not everyone improved equally. About 20 per cent of the delinquents accounted for nearly 50 per cent of the bad behaviour. Behavioural improvements started within a few weeks of beginning the diet and continued improving over a period of nearly five months, when they stabilised at the reduced level.

effects of chemicals

long term effects of Ritalin

optimism

handwriting

parents and marijuana

leaky gut

management tips for adults

long term effects of diet

zinc deficiency

Editorial

It has long been assumed that children who concentrate better on Ritalin will do better at schoolwork and because people like them more, their social skills will improve. Not so, say the experts. Long term Ritalin use makes little or no difference to children's academic achievement and social skills. More details on this shock report from a special panel convened in Washington by the National Institutes of Health on page 2.

In issue 16, we published an article on the effects of solvents from a paper in the Lancet. Behavioural and learning problems were associated with small, chronic, longterm exposure to doses formerly considered to be safe. The problems sounded so similar to what we encounter that I wrote to the principal researcher Professor Roberta White about a possible connection with ADHD. Her response led to the article on page 1.

We all want our children to be happy, but are they? The Happiness and Optimism pilot project report on page 0 suggests that many are not, but the situation can be changed.

What do you do if you discover marijuana in your teenager's schoolbag? As a number of readers have raised this question, we approached the specialists for some answers, see page 0.

More evidence for an association between ADHD and food intolerance as new research in the Lancet supports the old theory of increased gut permeability, page 0.

Finally, thank you all for your marvellous support. It is your comments which keep us volunteers going, like this one: "as a family therapist I find your newsletter invaluable and encourage parents of ADD/ADHD children to subscribe". Best wishes for a Merry Christmas and happy school holidays from all of us at OITH!

- Sue Dengate, editor

Children who take Ritalin to treat ADHD are at no increased risk of heart failure, says the American Heart Association (AHA). The association has been investigating a handful of sudden deaths among children taking the drug, which is prescribed to about 1.5 million children in the US. Some doctors have been giving children on the drug routine electrocardiograms. But the AHA says that only children from families with histories of sudden death or specific heart problems should be monitored, and then just as a precaution. - New Scientist, 21/11/98, p5

Mental health information for rural and remote Australia for the cost of a local call, Mon-Fri 1.30-4.30 AEST

Guinea pigs which show a reluctance to explore or respond to their surroundings and are much less likely to interact with other animals have been bred by researchers in Paris. The guinea pigs have the same abnormality in their cerebellum, the part of the brain responsible for coordination, as is found in some autistic people. An animal model for autism could lead to understanding the condition better.

- New Scientist 31/10/98, p25

An Australian study has shown that as little as 2% of young smokers quit. This appears to be due to dependency on nicotine. The success rate of nicotine patches in teenagers who want to quit is currently being studied, as these have proved successful method with adults.

Renee Bittoun, Smoking Research unit, University of Sydney (at the CAMHS conference)

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

Should people who take Prozac be warned that combining Prozac with the recreational drug ecstasy can cause death? Drug companies argue there is no need to warn customers about effects of illegal drugs. But some scientists insist that users need to know that Prozac (and some other drugs) interfere with a liver enzyme called CYP2D6 which is needed to metabolise certain drugs such as ecstasy. To make matters worse, between 3 and 8 per cent of the population have a genetic defect which makes them particularly poor at metabolising some drugs. For these people, mixing Prozac with ecstasy may result in a full-blown overdose.

- New Scientist 12/7/97, p20

The H.O.P.E. (Happiness and Optimism in Primary Education) project is a response to the evidence that increasing the resilience or hardiness of a young person can prevent the development of problems including depression and anxiety. It makes more sense to provide young people with coping skills rather than waiting for problems to emerge, and then intervene.

The program was run over a period of 10 weeks (90 minutes weekly) with 8 students in Year Seven.

1. Students self identified as being ‘not as happy as they would like to be’ and completed a test of self esteem (Piers Harris) and a test of coping strategies (Adolescent Coping Scale).

2. Teachers identified students they considered low in self esteem or perceived to be unhappy who might benefit from the program.

3. Parents were contacted and given details of the program. Parents who agreed for their children to take part were asked to fill in two questionnaires, similar to those the children had completed.

H.O.P.E. is based on a model of Cognitive-Behaviour Therapy with a primary orientation will be toward cognition and behaviour, stressing the role of thinking, deciding, doing and questioning.

• Thinking Skills: individuals are helped to recognise and challenge negative or distorted thinking and to develop positive self-talk.

• Multiple Intelligence: individuals are helped to recognise and use their own particular skills and talents based on the work done by Gardner.

• Personal Strengths: individuals are helped to recognise and reinforce their existing strengths and personal resources.

• Keeping Calm: individuals are taught to keep calm by using self-management, stress reduction, coping strategies and self-regulation.

• Problem Solving: students are encouraged to define their problems, consider solutions to their problems and use step by step approaches in carrying out and evaluating the solution

• Support Networks: adolescents are helped to acknowledge the importance of developing a support network and encouraged to seek help, when necessary to maintain their emotional well being.

• Interpersonal Problem Solving: individuals are helped to consider how growing older and more responsible can lead to disputes with peers and adults during the period of adolescence.

• Keeping the Peace: during the program individuals are helped to examine the value of empathy in keeping the peace. They are encouraged to understand that getting along with people is easier if we can acknowledge and see things from the other person’s perspective.

What did we find?

Anecdotal results only from the participants are available at this stage.

• The sessions were a highlight of the week for everyone including the presenters. Students said they looked forward to the group a great deal.

• Through regular ‘home-work’ students realised that skills they learned were actually meant to be used in the outside-the-group world.

• All students said that they felt more confident about themselves personally and in their relationships with others

• All students felt that the program had helped them become better problem solvers and that they had learned useful skills. They became aware of their particular intelligences

• Every student is now able to think of positive things that are happening in their lives (this was not possible for any of them prior to the program).

• Students have developed strong friendship networks within the group and provide caring support for one another.

My only area of concern has been that most of the students commented that their parents have not said anything to them about noticing changes. It is possible that parents have noticed changes and just not commented or perhaps they have not noticed. The same comments were true about teachers. I am planning to run more sessions in the new year and this time I plan to do more work with teachers and parents.

British researchers made headlines around the world when they suggested a possible connection between the measles mumps rubella (MMR) vaccination and autism in 12 children in a February issue of the Lancet, a highly-regarded peer-reviewed British medical journal. A flood of outraged letters to the Lancet followed. Everyone agrees that the association between MMR and autism has not been proved. However, what has been shown by Dr AJ Wakefield and his colleagues is an association between an inflamed or dysfunctional intestine (characterised by diarrhoea, abdominal pain, bloating and some food intolerance) and behavioural changes in some children.

In the Lancet a month later, Wakefield and his colleagues provided an update, saying
"we have now investigated 48 children in with developmental disorder in whom the parents said 'my child has a problem with his/her bowels which I believe is related to their autism'. Hitherto this claim had been rejected by health professionals with little or no attempt to investigate the problem. The parents were right. They have helped us to identify a new inflammatory bowel disease that seems to be associated with their children's developmental disorder."

Severe constipation with acquired megarectum was noted in almost all affected children. The behaviour of several of the children improved when their intestinal pathology was treated. Most parents noted behavioural improvement after the bowel preparation for colonoscopy, and improvement which was maintained if recurrent constipation could be prevented.

The same bowel disease in children was linked with non-IgE-mediated food allergy and ADHD, asthma or atopic dermatitis in the July issue of the Lancet by researchers Dr A Sabra and colleagues from Georgetown University Medical Centre in Washington.

Both groups of researchers suggest that increased intestinal permeability allows passage of antigens into the blood. The finding of bowel conditions in ADHD has opened unanticipated lines of investigation concerning the interactions between ADHD symptoms and intestinal permeability. These reports may change the nature of current treatment of ADHD. Underlying intestinal disease is often overlooked in children with ADHD.

Further reading: The Lancet: Wakefield AJ and others, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children, Lancet, Feb 28 1998, (351), 637-641, Wakefield AJ, Murch and others, Authors reply Lancet March 21, 1998, Sabra and others , letter, Lancet July 18, 1998.

• Don't feel chained to conventional careers or conventional ways of coping. Give yourself permission to be yourself. Give up trying to be the person you always thought you should be--the model student or the organised executive, for example--and let yourself be who you are.

• Remember that what you have is a neuropsychiatric condition. It is genetically transmitted. It is caused by biology, by how your brain is wired. It is NOT a disease of the will, nor a moral failing. It is NOT caused by a weakness in character, nor by a failure to mature. It's cure is not to be found in the power of the will, nor in punishment, nor in sacrifice, nor in pain. ALWAYS REMEMBER THIS. Try as they might, many people with ADD have great trouble accepting the syndrome as being rooted in biology rather than weakness of character.

• Try to help others with ADD. You'll learn a lot about the condition in the process, as well as feel good to boot.

• Establish structure. Structure is the hallmark of the non-pharmacological treatment of the ADD child. It can be equally useful with adults. Tedious to set up, once in place structure works like the walls of the bobsled slide, keeping the speedball sled from careening off the track.

• Make frequent use of:

- lists

- colour-coding

- reminders

- notes to self

- rituals

- files

Colour-coding deserves emphasis. Many people with ADD are visually oriented. Take advantage of this by making things memorable with colour: files, memoranda, texts, schedules, Virtually anything in the black and white of type can be made more memorable, arresting, and therefore attention-getting with colour.

The HST may be used with a wide range of students including those with cerebral palsy, spina bifida, arthritis, head injury, learning difficulties, specific handwriting difficulties and those in rehabilitation.

We sought advice from a centre specialising in habitual behaviours. The centre offers one-to-one counselling and skills training in relation to behaviours of habit, including drug use, anger management, stress management and assertion training.

The bottom line regarding teenage use of drugs is harm minimisation. We all know that prohibition can encourage rebellion and increase the very behaviours we are trying to stop. We have to acknowledge that drug-taking is an acceptable part of our culture, eg. cigarettes, caffeine and Ritalin. Every drug has benefits and costs. If you increase the dose, you increase the risk of undesirable side-effects.

Maybe the best we can do is to say:

The following table shows a range of possible reactions by parents and their consequences.

Suspected use Not my child Anxiety Search their room. Talk to the young person.

How can I find out? Disbelief Look for signs. Ask the young person calmly.

Curiosity Ask friends, friends' parents. State your reasons for asking.

Read mail. Be prepared for a "yes".

First known use I must stop this! Self doubt Call in the "big guns" Talk to the young person about

I can't cope. Anger eg. experts the advantages and

What did I do? Inadequacy Restrict freedom/punish/ disadvantages of drug use.

How did this start. Disappointment protect Seek to understand and

express feelings.

Regular use I failed as a parent Guilt Hide the drug use from friends/ Be consistent

Who will help me Embarrassment family Spend time together.

control this? Anger Increased restrictions Increase communication

What will my friends Concern Increase controls Discuss and engage in

/family say? Determination Do more for the young person, alternatives,

Optimism eg lend money, do chores Encourage responsibility for

Fear Make up excuses and consequences and decision cover up making.

Seek professional help.

Long term use My family will never be ideal. Resignation Alienate the young person. Encourage open discussion.

I can't understand the Frustrations Tolerate unacceptable Encourage mutual young person Loss behaviour. understanding/ tolerance.

I have to let go. Abandonment Rescue from consequences. Lessen the harm.

I have to change this. Rejection. Give in to excessive Let go controlling behaviour.

Acceptance demands. Encourage responsibility.

Ambivalence Seek professional help.

Love/Hate Move to parenting an adult rather than a child.

Keep communication channels open.

From Coping with Drug Use: a practical guide for parents from Queensland Health, phone 1800 177 833 freecall outside Brisbane. Many thanks to Amity Community Services 8981 8030, freecall country NT 1800 422 599. Information in other states available from: 02 9361 (freecall country NSW 1800 629 683), 02 6205 4545 (ACT 24 hour helpline), 08 8274 3333 (13 1340 free call metro and country SA), 08 9442 5000 (1800 198 024 freecall country WA), 03 6228 2880 (freecall country Tas 1800 811 994), 03 9416 1818 (1800 136 385 freecall country Vic).

Three studies suggest a possible relationship between ADHD symptoms and zinc deficiency.

A young man in Britain held his toothbrush in his mouth while washing his hair in the shower. When he threw his head back to rinse, he had a sudden coughing fit and swallowed the toothbrush. Ignoring what had happened, he went to work, only to come down with excruciating stomach pains that evening. He was rushed to hospital, where he needed emergency surgery. - from Jill Margo's Man Maintenance, Penguin 1996 - watch for "The Chainsaw" in the next issue

The complete 100 page manual from the Keep Yourself Alive (KYA) program (funded under the National Suicide Prevention Strategy) is available for download free of charge from the AusEinet site as an Adobe Acrobat .pdf file.

Primarily aimed at professionals, the manual underpins the 4 videotapes and the 7 hour workshop program, but provides a useful resource in its own right. It covers Signs, Crisis Management, Therapeutic Intervention and what to do after a suicide (Postvention).

While most patients slept too much, in some patients the cerebral mechanisms for sleep were destroyed and they were totally unable to sleep. Sometimes these insomniac states were accompanied by a frenzy of body and mind, a state of ceaseless excitement and movement until death from exhaustion a week or ten days later. This was the first time sleep had been shown to be a physiological necessity for life.

Children sometimes showed abrupt changes of character and became impulsive, provocative and destructive, with tantrums and rages. Although many patients seemed to make a complete recovery, after years or even decades of perfect health, the majority of them developed post-encephalitic syndromes covering a wide range of behaviours including impulsive and emotional hyperkinetic-tourettic symptoms.

Dr Sacks defines hyperkinesia as "increased force, impetus, speed, violence and spread of movement; usually associated with excess of 'background' movement ... and often with impulsiveness, impetuosity, irritability, insomnia, etc."

Despite trials of medication, including the L-DOPA trials made famous in the movie Awakenings, Sacks emphasises the effects of the external environment, the "circumstances and vicissitudes" of each patient's life on their symptoms. He concluded that:

• happiness, freedom and good relationships made his patients better, and that

• stress, isolation and boredom made them worse.

These effects were at least as important as the effects of drugs, says Dr Sacks. He found his patients had a reduced tolerance for insufficient sleep or rest. They also had an intolerance of stress such as pain, disability, frustration, anxiety and anger and a need for strategies to manage their problems.

But more important than all of them was "the establishment of proper relations with the world, and - in particular - with other human beings, or one other human being".

How similar this sounds to findings by Canadian researchers in 1986, who asked adults who were studied as hyperactive children what had helped them most. The majority chose a significant person, usually a parent or teacher who had helped them and "believed in" them.

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.

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 transforms the amino acid tryptophan into hormones and neurotransmitters like serotonin. 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.

VIC

Dr Rick Jarman, consultant paediatrician with the Centre for Community Child Health and Ambulatory Paediatrics at the Melbourne Royal Children's Hospital recommends that fragile X DNA testing should be considered for all children with specific learning difficulties, attentional problems and global delay. For more information about Fragile X syndrome, see:

http://www.ozemail.com.au/~fragilex/

Betty Smith has thirty years' teaching experience and a special interest in dyslexia. Her book "Success Stories in spite of early learning problems" is designed to provide hope and inspiration for the up to 15% of our population who are intelligent but find academic learning difficult. Such people often fail in the school situation. These stories show how talented they are and their value to society. Containing more than 100 stories, the book is an entertaining and inspirational read.

For example, Kerry Packer: "I was academically stupid - I loathed school and my way of surviving was sport. A serious illness caused missed schooling and I was helplessly behind everyone else. I became a bit of a laughing stock because of it."

Warringah Council has produced a leaflet called "Learning and Attention Problems: selected resources" which includes 23 books about learning and attention problems, 2 audio cassettes, 9 videos and 6 books on self-esteem held in the five branches of the Warringah library. More information from

library@warringah.nsw.gov.au or website warringah.nsw.gov/lib-home.htm. Show this to your local library!!

March 6-5 Brisbane seminar on ADHD. Details from PO Box 1661, Milton, QLD 4064

April 17 Tertiary students and adults with LD and/or ADHD skills development workshops, Uni of Western Sydney, Milperra, 02 9772 6229

June 6th-8th Early Intervention in the Mental Health of Young People international conference, Adelaide, 08 8274 6060

Wilderness and adventure therapy like that used by Outward Bound has shown benefits for adults and adolescents for many years. In Australia, the Brief Intervention Program (BIP) for adolescents at Austin and Repatriation Medical Centre in Heidelberg, Melbourne has successfully incorporated wilderness and adventure into an evaluated intensive day-program treatment for adolescents with a range of severe emotional, behavioural, social and psychiatric problems.

During the 10 week course, a group of 8 teenagers aged 13-18 take part in a an outdoor experience nearly every each week, ranging from 1-day bushwalks, caving, ropes-courses, rock-climbing and abseiling to 4 or 5 day hikes, white-water rafting and cross-country ski-touring and snow-camping. Activities are structured and sequenced in an integrated way with other therapies including group and individual therapies, work experience and psychodrama. A clinic psychologist and an occupational therapist are the principal group therapists in conventional therapies as well as being 'duel trained' to provide the wilderness and adventure therapy components.

Many child and adolescent mental health services and youth welfare agencies are starting to use such approaches, making the current scarcity of knowledge and experience in wilderness and adventure therapy extremely concerning. Consequently the Association of Wilderness and Adventure Therapists was established in 1996 with the aim of promoting standards of training and practice of wilderness and adventure therapy.

We at ADASA (The Attention Disorders Association of SA) are considering mounting a pilot early identification and intervention program for kids (ages 3-6) with ADHD, ODD & Conduct Disorder, in collaboration with the Mental Health Unit of the SA Health Commission. One of the first things we need to do is to establish whether anyone in Australia is already researching this area, and or running such a program. Could you let me know ASAP if you have heard of Aussie research in this

area, or currently running programs? Thanks. tayneu@iaccess.com.au

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