Q: I live in Houston, Tx. Can you tell me who might treat ADHD in my area?

A: We get many requests for doctor recommendations and would love to answer them, but cannot responsibly track professionals all over the world. Therefore, we suggest you look at our referrals page for suggestions about how to find a doctor in your area on our main website.

Q: My 6 year old son was just diagnosed with ADHD and mild anxiety. Could you please suggest to me the best possible route to learn about how to help my young son and advise his teachers on how they can help him at school? Also, this diagnosis has been really difficult for me and I would greatly appreciate any guidance you could give me.

A: (From Melissa) As a result of your question, we've put an article on advice for teachers later in the newsletter. My personal advice to you would be to not worry excessively about the ADD diagnosis, for your son will pick up on your anxiety. Educate yourself and see if you can start to feel comfortable that there will be challenges that your son will face as a result of the ADD, but most kids have challenges of one sort or another - you've just figured this one out early. My daughter was diagnosed with ADD, dyscalculia and some reading issues in the third grade and the net result of her struggles with school is that she is more in touch with who she is than just about any kid her age I've met (she's now almost 18). She has a clear understanding that everyone has strengths and weaknesses, that good things can come with hard work but that you don't always get what you want, and has a healthy perspective that many struggle to attain by age 40! The secret for us as a family was my being a helpful advocate for my daughter for many years, my husband encouraging me to let her be herself, and trying to help her find her strengths (we spend so much time trying to fix the weaknesses that sometimes we focus on them to the exclusion of helping our kids find their strengths...and that's a mistake).

Anxiety is a common condition with ADD, particularly when a child thinks that they can't please those they respect - parents, teachers, friends, etc. So constantly reaffirming your love for him and being careful about how you say things is important (err on the side of respecting his ideas and feelings even if they are quite different from yours). Also important will be accepting that for your son some things will always be harder and that's not his fault - it has to do with how his brain is wired. Which doesn't mean he can't do stuff, just that he may choose to do it differently than you expect and/or that it will take longer. (My daughter composed some of her college application essays by laying on the floor and dictating her rough drafts to me...not the standard procedure, but the point was to get them started, not HOW they got started...)

It's important to talk with your son about his ADD and to let him know that his issues aren't due to something he's doing wrong, but rather to how his brain is wired...just like someone needing glasses isn't something they are doing wrong with their eyes, just how their eyes are wired...On the other hand, he also has to understand that since his brain works differently, he also has to be creative and persistent about figuring out what works for him. In other words, he needs to learn not to say "I can't do this because I have ADD" but rather "I may have to do this differently because I have ADD".

Q: I've heard a bit about Irlen Syndrome and using colored lenses to treat it. What's your opinion on this?

A: A study reported to the College of Optometrists in Vision Development 2 or 3 yrs back looked into Irlen Syndrome. In essence, the researcher took patients who 'qualified' for treatment with the Irlen method based on their own data and analysis (they had someone trained by Irlen do the initial testing). Then they performed a functional optometric exam and found that ALL of the study subjects had functional vision problems (tracking, eye teaming, and focusing) that typically responded to optometric vision therapy. The patients then went into vision therapy. After treatment, they were reassessed based to see if they qualified for the Irlen Syndrome. After therapy, over 90% of the patients no longer met the criteria for the Irlen Syndrome. In other words, before vision therapy they had the syndrome' and after vision therapy they did not.

That said, I think there are no doubt some patients who respond well to colored filters and lenses. The question then is what makes the most sense clinically - to look for a lens or filter that might help them, or to treat the underlying vision problem so the problem goes away? Answer supplied by Dr. John Abbondazza, a licensed behavioral optometrist in Southborough, MA.

Dr. Hallowell's new book, SuperParenting for ADD, includes specific information about what to share with a school about your child's ADD. In addition, Dr. Hallowell urges teachers (and parents) to use a strengths-based approach to ADHD and assume that the mistakes that a child with ADD makes are not intentional. For additional help, he put together these specific tips for teachers (and, of course, parents trying to help their children at home):

• Have the kids with ADD sit toward the front of the room (though not all together). Even better, have a circular seating arrangement. That way, someone is always looking at each student. It is very hard not to pay attention when someone is looking at you.
• Use touch if it is allowed in your school. If you are allowed to, touching a child on the shoulder, say, is a great way to provide encouragement and also bring his mind back into the room and the task at hand.
• Use eye contact. Your eyes can bring attention back into the room.
• Never keep kids in for recess. Exercise is essential for mental focus.
• Consider starting the day with some stretching exercises.
• Consider having the kids sit not in chairs but on exercise balls. That provides constant musculoskeletal stimulation, which is good for the brain, and also involves the cerebellum, which is good for focus.
• Emphasize proper brain care with the kids: eat right, get exercise, get enough sleep, don't overdose on electronics.
• Introduce new topics in terms of old topics already mastered. Kids with ADD overheat easily. They get frustrated quickly when they sense they won't understand something new. So, for example, when you start fractions explain right away that fractions are simply division written differently, and the kids have already learned division.
• Break down large topics or tasks into small, manageable bits. For example, a book report might be subdivided into eight steps, or a science project outlined in a dozen doable steps. Once again, this helps the child with ADD not feel overwhelmed. It is also helpful for all the other kids as well.
• Notice and appreciate successful moments. Kids with ADD often go through an entire day getting multiple reprimands or therapies without one single affirmation. Imagine how you'd feel if you went through your day like that.
• Stay in touch with parents, even if you don't particularly love them. My best advice to teachers is the same advice I give to parents: make friends with each other.
• Don't let the child or the parent use ADD as an excuse. ADD is not an excuse to get out of taking responsibility but an explanation that leads to taking responsibility more effectively.
• Don't fall into the trap of the "moral diagnosis," blaming the child's difficulties on bad character. Look deeper than that. ADD is a neurological trait, not a moral infirmity.
• Above all else, enjoy these kids. Nothing works better than that-both for the kids and for you.

Post-Traumatic Stress Disorder (PTSD) is in the news now given the unprecedented incidence of the diagnosis among our troops stationed in Iraq and Afghanistan. There is also much speculation that PTSD is at least partly driving the high incidence of mysterious syndromes, such as fibromyalgia, chronic fatigue, irritable bowel syndrome, and reflex sympathetic dystrophy (RSD), among other modern ailments resistant to traditional medical treatment.

PTSD is a condition that affects one's attention, impulsivity, and activity/reactivity levels; therefore, it can often be mistaken for ADHD, and vice versa. Similarly, PTSD often occurs along with ADHD, depression, anxiety, and/or eating disorders, but tends to be undiagnosed, therefore is left untreated.

Despite its frequent referencing, we still don't have a consensus about the nature of this debilitating condition among the professional mental health community. Currently, the formal diagnosis of PTSD, (as outlined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders), requires there to have been an identifiable life-threatening event towards oneself or another that is then followed by a series of additional symptoms that must have persisted for at least several months. The three basic categories of response necessary to qualify as PTSD under this definition are:

1. re-experiencing the trauma (i.e., distressing memories, dreams, flashbacks, etc.)
2. avoiding reminders of the trauma (which can include numbing with alcohol, drugs, food, sex, etc., as well as absent-mindedness and distractibility)
3. behavioral symptoms of increased arousal in the nervous system,

Increasingly, however, trauma specialists argue that trauma shouldn't need to be so narrowly defined. Rather, they assert that PTSD develops when a perceived (not necessarily "actual"), threat is so extreme or continuous that the instinctive responses of fight and flight don't work. Our nervous system revs up to face the threat, but then is overwhelmed and cannot. The only remaining option is to freeze, (the body's instinctive survival strategy of conservation of oxygen and energy), which then locks the arousal inside the body leading to symptoms often many years later.

This disagreement in the medical community prevents many people from getting the best available treatments for PTSD or trauma-related conditions. For example, you will be less likely to be diagnosed with PTSD if you don't have memories of a specific trauma. Some people whose memories of trauma are repressed, or whose trauma was more chronic and developmental, may not (yet) be having dreams or intrusive thoughts, but may indeed show heightened arousal, numbing, and avoidance behaviors. In addition, symptoms may change over time. For example, it is not uncommon for affected people to be in a state of fog and numbing for years before progressing into hyperarousal and panic states. Unfortunately, chronic PTSD doesn't tend to disappear on its own, but instead often gets worse over time.

Thus, PTSD is one of several trauma-related dysregulating conditions, and can lead to a life that is chaotic and crisis-driven - ("the drama of trauma"). However, the good news is that effective behavioral mental health treatments exist, and are aimed at retraining the nervous system and re-establishing self- regulation. Flexibility and resilience can be restored, with practice and specialized treatment.

If you are interested in consulting with a psychotherapist about pursuing behavioral treatment for PTSD, please contact Deborah Russo at The Hallowell Center in Sudbury at (978) 287-0810.

(Portions of the above article were taken from Healing From Trauma - A Survivor's Guide to Understanding Your Symptoms and Reclaiming Your Life, by Jasmin Lee Cori, 2008.)

I recently interviewed Rebecca Goniwich of the Hallowell Center about her area of expertise - auditory stimulation. Here is a synopsis of that interview:

Q: What is the concept behind auditory stimulation, and how does it help Hallowell Center patients?

A: There are certain "clues" that suggest that a patient my be particularly helped by auditory stimulation - things such as slow processing speed, sensory integration issues such as being sensitive to touch or sound (or, conversely, insensitive), kids who are not aware of their body in space.

Q: These are the loud talkers, and the kids that are always bumping into or avoiding things, I guess. So what, exactly is auditory stimulation?

A: It is a complementary treatment for ADHD, dyslexia, auditory processing, sensory integration and learning issues.
Sound is, literally speaking, nutrition for the brain. A well-modulated vestibular system is important for controlling the nervous system's level of arousal. For attention issues, the acoustic stimulation of listening to music through bone conduction headphones with frequency filtration enables the vestibular system in specific ways that improve our ability to maintain a calm and alert state. A specialized process called "gating" strengthens muscles within the middle ear responsible for filtering out unwanted noise, thus improving our ability to discriminate and process sounds by providing the stimulus craved by the under-attentive brain.

For auditory processing issues, we find that controlled stimulation helps patients improve the efficiency of sensory input into the brain. Specifically, the vestibular and cochlear systems are two of our three main avenues for organizing sensory input (vision being the third). Together they form an interdependent system which allows us to detect and analyze sound, control balance and movement (including eye movement), and integrate our touch, hearing, and vision. Auditory Stimulation conducts controlled exercise of the vestibule and cochlea mechanisms, thereby improving the integration and efficiency of sensory input to the brain.

Reading difficulty: Reading requires the ears and eyes to work together synchronously. As your eyes move from letter to letter, your ears (cochlea) translate each letter into a sound. The vestibular system coordinates the eye movements and aids the synchronicity of the eyes and ears. Auditory Stimulation programs improve the neurological timing and vestibular function, thereby reducing processing delays and improving synchronization. Ear/voice conditioning (expressive phase) also plays a significant role in improving synchronicity for verbal fluency.

Learning difficulties: Sound enters the ear as a myriad of frequencies and intensities. The cochlea, within the inner ear, is in charge of discerning the various frequencies. If the cochlea is not functioning well, we have poor "selectivity" and have a hard time distinguishing between the letters P and B, or T and D. Auditory stimulation programs increase selectivity ability, resulting in better classroom performance and increased confidence.

Q: How does auditory stimulation treatment work?

A: While someone can come into our offices to do this, we find that by far the most popular method is getting the program over a special iPod. This also means that anyone from around the country can use the Hallowell Center resources for this treatment.

For more information on auditory stimulation at the Hallowell Center, phone 978- 287-0810 ext 127 or visit this link. In addition, the Hallowell Center in Sudbury, MA will be hosting free open houses on Feb 26 and March 11 to answer questions about auditory stimulation ("My Sensory Solutions") and the DORE program.

email: morlov@hallowellconnections.com

phone: 508-545-2250 Hallowell Connections or 978-287-0810 Hallowell Center (medical)

web: http://www.drhallowell.com