We know education is the first essential step in the process of learning how to manage the individual challenges of ADHD. We also know that ADHD Coaching builds hope by educating clients about their own ADHD. Research provides the validated scientific information that allows individuals with ADHD to understand that the challenges of their ADHD are not fabricated excuses for not being responsible or not completing different tasks.
This research is important, highly, credible, substantiated scientific information conducted by some of the world's most credible organizations like the NIMH and the Office of the US Surgeon General. Research by these leading world health organizations substantiate the existence of ADHD as an explanation for an individual's challenges of the past and help alleviate a great deal of the pain caused by the self-blame related to "lack of awareness" about their disorder.
A well - trained ADHD coach is able to provide key research to their clients in a concise and memorable format. The coach knows that presenting this crucial information in ways that are easy to understand, will help his/her clients understand the science of their ADHD and begin the healing process.
Presenting this type of important information begins the essential process of education that leads to a new awareness. The ADD Coach Academy Coaches have creative, simple models that dramatically enhance the ability of individuals with ADHD, who are at different levels of understanding about their own ADHD, to immediately grasp the information in meaningful ways. Once the research is understood it allows allow individuals to eliminate the blame associated with feeling broken because of past poor performance and redirect their energy towards towards identifying what they do well and doing more of it !
Although some media coverage questions the validity of the ADHD diagnosis, medical professional groups such as the American Academy of Pediatrics (AAP), American Academy of Child and Adolescent Psychiatry (AACAP), and American Medical Association (AMA) have recognized the strong scientific evidence for this disorder. "ADHD is one of the best-researched disorders in psychiatry, and the overall data on its validity are far more compelling than for most mental disorders and even many medical conditions," according to the American Medical Association Council on Scientific Affairs.
Multiple studies have been conducted to discover the cause of the disorder. The exact causes of ADHD remain elusive, but research indicates that at least three separate yet interactive brain regions have been associated with the condition. Research also clearly indicates that ADHD tends to run in families. More than 20 genetic studies have shown evidence that the disorder is largely an inherited, neurologically-based condition. ADHD is a complex trait, and complex traits are typically the result of multiple interacting genes. Problems in parenting or life situations may make ADHD better or worse, but they do not cause the disorder.
Without early identification and appropriate treatment, ADHD can have serious consequences that include school failure and drop out, depression, conduct disorder, failed relationships, underachievement in the workplace, and substance abuse. When appropriately treated, persons with ADHD can lead productive and satisfying lives.
National Institute of Mental Health Publication No. 3572
The Multi modal Treatment Study of Children with Attention Deficit Hyperactivity Disorder
The MTA study included 579 (95-98 at each of 6 treatment sites) elementary school boys and girls with ADHD, who were randomly assigned to one of four treatment programs:
(1) medication management alone
(2) behavioral treatment alone
(3) a combination of both, or
(4) routine community care
In each of the study sites, three groups were treated for the first 14 months in a specified protocol and the fourth group was referred for community treatment of the parents' choosing. All of the children were reassessed regularly throughout the study period. An essential part of the program was the cooperation of the schools, including principals and teachers. Both teachers and parents rated the children on hyperactivity, impulsivity, and inattention, and symptoms of anxiety and depression, as well as social skills.
The children in two groups (medication management alone and the combination treatment) were seen monthly for one-half hour at each medication visit. During the treatment visits, the prescribing physician spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child's ADHD-related difficulties. The physicians, in addition, sought input from the teachers on a monthly basis. The physicians in the medication-only group did not provide behavioral therapy but did advise the parents when necessary concerning any problems the child might have.
In the behavior treatment-only group, families met up to 35 times with a behavior therapist, mostly in group sessions. These therapists also made repeated visits to schools to consult with children's teachers and to supervise a special aide assigned to each child in the group. In addition, children attended a special 8-week summer treatment program where they worked on academic, social, and sports skills, and where intensive behavioral therapy was delivered to assist children in improving their behavior.
Children in the combined therapy group received both treatments, that is, all the same assistance that the medication-only received, as well as all of the behavior therapy treatments.
In routine community care, the children saw the community-treatment doctor of their parents' choice one to two times per year for short periods of time. Also, the community-treatment doctor did not have any interaction with the teachers.
The results of the study indicated that long-term combination treatments and the medication-management alone were superior to intensive behavioral treatment and routine community treatment. And in some areas—anxiety, academic performance, oppositionality, parent-child relations, and social skills—the combined treatment was usually superior. Another advantage of combined treatment was that children could be successfully treated with lower doses of medicine, compared with the medication-only group.
Mental Health: A Report of the Surgeon General 2 contains an informative, thoroughly researched chapter on ADHD and includes recommendations for treatment. " The practice parameters state, 'the cornerstones of treatment are support and education of parents, appropriate school placement, and pharmacology.' These practice parameters evolved out of research relating to two major types of treatment: pharmacological treatment and psychosocial treatment, particularly behavioral modification, as well as multi modal treatment, the combination of psychosocial and pharmacological treatments."
Most often, the first treatment used should be psychosocial, including behavioral therapy, social skills training, support groups and parent and educator skills training. Psycho stimulant medications, including methylphenidate, are the most widely researched and commonly prescribed treatments for ADHD. Numerous studies have established the safety and efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD. NIMH research has indicated that the two most effective treatment modalities for elementary schoolchildren with ADHD are a closely monitored medication treatment and a treatment that combines medication with intensive behavioral interventions. In the NIMH Multi modal Treatment Study for Children with ADHD (MTA), which included nearly 600 elementary school children across multiple sites, nine out of ten children improved substantially on one of these treatments.
Failure to provide appropriate treatment for certain disorders—including ADHD--also poses a risk to brain integrity and function. The brain is a very flexible--or "plastic"--organ that needs certain stimulation in order to mature properly—to make the correct connections. In the same way that covering one eye [and eliminating visual stimulation] during a critical phase of development leads to life-long visual impairment, failure to receive and properly process cognitive and emotional stimuli during critical periods when the brain is undergoing rapid growth and maturation may result in damage with lifelong consequences. Therefore, a child who cannot pay attention, and who cannot learn, is at risk of having his or her brain and development adversely affected; and many children with ADHD develop learning delays and academic failures that lead to early school drop out. Children with ADHD who are untreated may be at increased risk for some medical and social problems such as reckless driving, drug and alcohol abuse, smoking, academic failure, difficulty in making relationships, and trouble with the law.
I would like to be sure that we focus carefully on two questions that deserve answers:
1) Are diagnoses being made effectively and are appropriately diagnosed children receiving properly selected treatments that will help them gain an upward trajectory in life? Too many children with ADHD are being ignored and remain at high risk for other lifelong problems, including depression and substance abuse.
2) While it is also well known that many children are being given medications for a variety of disorders, it is clear that not all of those children ought to be taking medications. Are some of our children, particularly active boys, being over diagnosed with ADHD and thus are receiving psycho stimulants unnecessarily?
Little evidence of over diagnosis of ADHD or over prescription of stimulant medications has been verified in research. Indeed, fewer children (2 to 3 percent of school-aged children) are being treated for ADHD than suffer from it. Treatment rates are much lower for girls, minorities, and children receiving care through public service systems. Medical and public awareness of the problem of ADHD has grown considerably so that people, who were under diagnosed in the past, are being identified and treated. Most researchers believe that much of the increased use of stimulants reflects this better diagnosis and more effective treatment of a prevalent disorder.
These are very difficult and serious problems that we must address through better access to treatment and further research. The enormous advances occurring in the brain sciences will contribute to an increased understanding of the etiology and pathogenesis of ADHD and other brain disorders. As a neuroscientist, I am in awe of the leaps in knowledge we have taken in this arena, and I am most anxious to see these advances used to increase our understanding of the biological basis of ADHD, including finding biological markers that can lead to definitive, objective methods of diagnosis.
Accurate diagnosis and evaluation, however, is possible with our current state of knowledge. NIMH supports the largest and most long-term study to date of children with ADHD. Children received 14 months of treatment, and an extended follow-up for 6 more years is currently underway. Results have demonstrated that methylphenidate with careful medication management was safe and effective for the length of the trial, and was more effective than intensive behavioral treatments in relieving symptoms. The combination of medication management and intensive behavioral treatments was particularly advantageous when children with ADHD had symptoms of other disorders as well.
1 U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, M.D.: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, national Institute of Mental Health, 1999, Chapter 3, page 146. Posted: September 26, 2002
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1 Barkley, RA. International Consensus Statement on ADHD, January 2002, signed by over 70 leading scientists. Clinical Child Family Psychology Review, 2002, Jun 5(2): 89-111.