Q: After reading your question about generic Adderall in the last issue I did some research. Apparently there are two manufacturers and people find they respond differently depending upon the manufacturer of the generic. Is this possible?

A: (From Dr. Hallowell) Yes, different generics of all meds can change a patient's response. And, of course, response to a generic can differ from a response to a brand name. Ritalin, for example, tends to work better than all generic methylphenidates. So work with your doctor to monitor your response if you change to a generic, and ask your pharmacist to consistently fulfill with the same generic if you like it.

Q: My 20 year old son has met a very nice girl. He has ADHD and takes Concerta, which has been very effective for him. Should he disclose his ADD and the fact that he takes medication to her? I'm worried that he might be stigmatized in her mind.

A: Just as he might not disclose past family difficulties right away, he should only disclose the ADD once he feels comfortable doing so. But since ADD can significantly impact relationships he should certainly let her know once they are serious, and make sure she becomes educated about what ADD is. She could read Delivered from Distraction to find out more. Remember, ADD is only an issue if it gets in the way of your life and remains untreated.

Q: Do you have any information about the shame of ADHD and dyslexia?

A: Dr. Hallowell addresses shame in chapter 32 of Delivered from Distraction. I would also go to the ADDitude Magazine web site and do some searching there.

Sometimes science experiments start in one way and end up going in a completely different direction. This is the case with work that was initiated by Walter Mischel, a Stanford professor of psychology who started a series of tests back in the late '60s to try to discover the mental processes that allowed some people to delay gratification while others couldn't seem to do so. A really interesting article has just been written about his work by Jonah Lehrer in the May 18th New Yorker (link at end of this article). The work seems to have many implications for kids with ADD and their parents.

Mischel's original test had to do with how long kids could stay in a room, unattended, without eating a marshmallow. If they couldn't wait any longer for the adult to return (their sign that they could now eat the marshmallow), they were asked to ring a bell.

But as Mischel followed up on the experiment, he realized that there was a strong correlation between the ability to delay gratification and success later in life. Kids who rang the bell quickly, it turns out, were more likely to have behavioral problems, much lower SAT scores, have difficulty maintaining friendships, and problems paying attention and combating stress.

Mischel is now a professor at Columbia. He and a number of other researchers have not yet mapped the pathways in the brain, they have discovered a number of really interesting things about the inter-relationships between delayed gratification and success. For example, for many years psychologists has assumed that raw intelligence was an important variable when predicting success in life. Mischel suggests that intelligence is really at the mercy of self control. If you don't have the self-control to do your homework, for example, your intelligence doesn't shine through. This fits with patterns observed in kids with ADHD - many are very intelligent but still have significant issues at school.

The most important parts of Mischel's work for parents of kids with ADD is actually what he is doing now as he explores whether or not self-control can be taught. He is exploring ways to help kids place their attention elsewhere (i.e. not on the marshmallow) in order to help them delay gratification. He has found that some pretty simple techniques can help kids "manage" their attention in ways that allow them to delay gratification. In the case of the marshmallow, he taught kids a number of effective techniques - think of it as a cloud, not a marshmallow; think of it as a picture with a frame around it; sing a song to distract yourself.

He believes that kids can practice and learn delayed gratification (though he is conducting experiments about this right now to verify the long-term effectiveness of this) and that parents can help them make those delaying tactics second nature, particularly if they are practiced daily. Some ideas might include: a money jar for spare change, which is taken in once a year to exchange and use for special treats; not snacking before dinner; holding out to open Christmas gifts with everyone else; doing some chores before playing; saving an allowance vs. spending it. Parents could also teach younger children delaying tactics - specifically ways to alternately occupy themselves when there is something they want. By learning to consciously change what they are paying attention to they can learn to be more willful about how they allocate their attention. Now, perhaps, we have additional reason to make sure our kids don't snack right before dinner!

For the full article, "Don't: The Secret of Self-Control", go to the link below.

Working memory (WM) is the ability to hold on to information "online" for a brief period of time. When people have WM deficits is often experienced as "attention problems," e.g. problems focusing on reading, remembering what to do next, problem solving, etc. Adults will often call these weaknesses in WM "senior moments." Typically people with higher working memory capacity (WMC) are more able to sustain goal-directed thought and behavior in the face of distraction, interference and shifts in conscious focus. In a 2006 study from the University of North Carolina and University of Maastricht in the Netherlands124 undergraduates pretested on memory span tasks were each given a PDA personal digital assistant). Over a 7 day period, the PDA signaled each student 8x/day and at that time each student was to report whether their thoughts had wandered from their current activity and to describe their psychological and physical context. The study showed that people with lower WMC experience more mind-wandering than those with higher WMC. Furthermore, whereas higher WMC subjects' thoughts remained steadily on task regardless of the challenge or effort, lower WMC subjects' minds wandered more under greater challenge and effort.

Working memory can be improved with specific types of training, which is a great summer activity for kids or adults. Training includes daily practice over a five week period, and all the practice can be done in one's home. To read about the recent research in WM you can visit a web site hosted by Cogmed, which has created an evidence-based program (i.e. has research to show it works). The Hallowell Center offers this program, but Cogmed can provide you with the name of a provider near you if you are interested.

Rebecca Shafir at the Hallowell Center knows a lot about Cogmed and about working memory. Feel free to call her if you have any questions about this area. She can be reached at 978-287-0810.

Did you know that when forced to multitask, the overloaded brain changes where it processes information? It moves processing from the hippocampus, which is responsible for memory, to the striatum, which manages rote tasks. What this means is that while you are multi-tasking it is really hard to learn a new task. (Now, think about how your kids do their homework, or how you attack your day at the office. Scary, huh?)

Or here's another way to look at distraction - David Meyer, director of the Brain, Cognition and Action Laboratory at the University of Michigan, believes we are in a much worse crisis of distraction than we realize. He likens it to an epidemic - with real health ramifications. He believes it's like the early stages of the smoking epidemic, when people didn't understand the severity of the problem because they couldn't see what was happening to their lungs. Today, they can't "see" what is happening in their brain.

Both of these ideas come from a long, but interesting, article in New York Magazine about the topic of attention. Author Sam Anderson takes time to reflect upon the negatives as well as the positives of our distracted lives. He ends on positive notes - distraction that leads to synthesis of information in new ways; nomad societies in which those who are most aware of everything that is going on around them are also those who are best nourished; the digital generation who can already master more things at once than their parents.

If you are interested in reading further, go to this link. And, of course, if you want to read Dr. Hallowell's ideas about how you can make your life less beholden to multi-tasking, grab a copy of CrazyBusy: Overstretched, Overbooked, and About to Snap!

Hallowell Center Now Offering Neurobehavioral Assessment, Guidance and Treatment:

Dr. Carol Montgomery of the Hallowell Center in Sudbury is directing a new program at the Center that provides help for those with cognitive/behavioral impairment related to neurological disorders, including:

• Traumatic Brain Injury
• Cerebral Palsy
• Stroke and Vasular Disease
• Lyme disease
• Toxin exposure
• Anoxia/hypoxia
• Aneurysm
• Dementia
• Autistic disorders
• Seizure disorders
• Multiple Sclerosis
• Tumor

The Hallowell Center in Sudbury is uniquely qualified for neurobehavioral assessment due to its many years of experience with individuals who have difficulty with emotional and behavioral control that can impact family dynamics, work effectiveness, household management skills and ultimately self-esteem.

Neuropsychological evaluations are customized to meet the needs of the patient and referring physician. Evaluations can address behavioral and emotional concerns, such as heightened irritability, anger outbursts, problems with lethargy and motivation, safety and judgment issues and impulsive behaviors or cognitive concerns. Cognitive concerns might include memory decline, organizational skills, focus and concentration or word finding.

If you would like more information on this program please call Christine Sorgi at (978) 287 0810 x101.

Fidgeting May Help Focus Kids with ADHD

A very small research study done by Mark Rapport at the University of Center Florida suggests that fidgeting may help kids with ADHD use their short-term memory better, resulting in better focus. In other words, fidgeting may work for kids the way caffeine works for adults.

An ADD Success Story

The May 25 edition of The New Yorker Magazine included an article about Ari Emanuel (brother of Rahm). Ari has both ADHD and dyslexia and this page- long article talks about his school experiences (miserable), his persistence (excellent) and his success (also excellent). It's a good, quick read about one very successful person's life with learning disabilities. Go to this link.

Great Tips for College Students Looking for Jobs

If you're a college student, do you know the right way to ask for a reference? Do you have a professional web presence right now? Do you know how to identify your skills for a potential employer?

If you are a college student (or know one) who is still struggling to find work, either for the summer or post college, we have two great resources for you. The first is a newsletter geared to college students that outlines how to look for a job, as well as provides great ongoing resource information. The second is a free one-hour phone session for students during which they can ask their questions of search professionals (and hear the questions of others). That session takes place on Tuesday, June 9th at 8:00 pm EST.

Both the newsletter and the free phone session are put together by Robin Roman Wright and Carol Christen, of the Hallowell Center . They provide personalized career advice to people at all stages of their career. For further information, please click here.

New Online Place for Moms with ADHD

Terry Matlen has decided that moms with ADHD don't have enough chance to share their ideas and experiences, so she has created a new web site and blog for them. The site will provide organizational tips, and a community for moms. Go to www.momswithadd.com

June 29 - July 3: Cape Cod Institute seminar on Strengths-based approach to ADHD across the lifespan. Phone 888-394-9293 or go to this link.

July 13-18: Summer Enrichment Camp for Families. For families with kids entering grades 5-12. Call 800- 533-5262 or go to this link.

Summer Wellness Groups at the Hallowell Centers: Go to the Hallowell Center home page and then your office of interest for more details.

email: morlov@hallowellconnections.com

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

web: http://www.drhallowell.com