A Psychologist-Coach’s son has/had ADHD.

ADD, servant leadership — By charlesshinaver on August 26, 2009 at 5:14 pm

This video is an example of what parents grapple with when deciding what to do with their ADHD-diagnosed child. Watch and get the facts on medicating a child.

[youtube=http://www.youtube.com/watch?v=r1hoNU02iXk&hl=en_US&fs=1&]

I am a psychologist-coach & father with a son who HAD ADHD and I have chosen to use COGMED with him and use COGMED in my practice.  It is important that you know that I have committed to this alternative way to improve working memory and thereby improve attention.  More importantly, I think you should know more of my story to get how I got to where I am today.  When you know what I know you will understand why COGMED is a potent alternative way to improve working memory and attention.

Here is the first chapter of the story:

I am Dr. Charles Shinaver.

I am married and I have three sons who are 14, 11 and 8 years old.

When my oldest son was 5 or 6 I knew he had Attention Deficit Hyperactivity Disorder – ADHD that was around 2000.  Yes, the disposition is distinctly different.

He was diagnosed with ADHD when he was 8 (2003).  These dates will matter at a later point on my blog when I begin to consider the largest multimodal treatment intervention research of ADHD to date and it’s reported results over time.  (That will not be today, but it is coming.)

We held out on using medication for ADHD because we didn’t like the reported side effects and my son was not falling behind academically or socially. However, by the time he was 8 it was time to do something.

He is now 14 and he no longer has ADHD or I would say he is no longer diagnosable.

Yes, he no longer has ADHD. No he didn’t grow out of it.  Yes some people do, kind of.   I will come back to that later in the story.

So to be clear, I am a clinical child psychologist with a doctorate and masters in child clinical psychology from DePaul University and a masters degree in counseling and consulting psychology from Harvard.  I am also the father of three sons, the oldest is now 14.

Back to my son, yes, HE HAD ADHD.  He doesn’t now.  How is that?

I used EEG BIOFEEDBACK to help him to overcome it.  That is, Electro-Encephalograph Biofeedback.  Or to put it another way, his work with EEG biofeedback enabled him to shift his brain functioning or improve his brain activity so that that he no longer exhibited symptoms to a degree that he was diagnosable.

That is how I helped my son overcome ADHD.  So you probably think I am going to tell you about EEG Biofeedback.  That is not really my focus.  My focus is broader on alternative treatments of ADHD.  More specifically there needs to be a focus on the alternatives to address the core areas of deficit in Attention Deficit Hyperactivity Disorder. Those core symptoms are inattention and hyperactivity or impulsivity.

As you may well know it is not a simple thing to address these problems.

I know both as a parent and a clinical child psychologist.

So, the nagging problems begin. I know you are likely to have experienced some of these nagging problems. I articulate them here so you know you are not alone.

I have been there before, both professionally and personally.

NAGGING PROBLEM #1:  THERAPY DOESN’T HELP THE ‘CORE SYMPTOMS’ OF Attention Deficit Hyperactivity Disorder or ADHD, or ADD.

As a clinical psychologist I watched countless kids be medicated for ADHD.  I saw them struggle with the side effects of these powerful drugs.

I am a clinical child psychologist, after all.

But here is the tough part.

I also knew that doing therapy with them or counseling them would not help these kids with their impulsivity or inattention.

How did I know?  I tried it.

Yes, as a licensed psychologist.  I did both individual and family therapy with kids with ADHD and ADD.  When we would work on issues in therapy it would allow the kids to vent of feel a sense of connection and compassion.  This could help the kids with depression or anxiety and sometimes with other problems.

There was only one problem whatever we worked on did not carry through in terms of behavior change.  Their inattention and impulsivity kept them from being able to use strategies we worked on in therapy.  It simply didn’t stick.

So, I knew that to address the ‘core symptoms’ of ADHD therapy simply did not work.  You could address other problems. You could improve parental consistency, strategy and how the family system worked, but the core problems did not improve.

Drugs appeared to ‘work’.  But there were some other nagging problems…

NAGGING PROBLEM #2:  MEDICATIONS OFTEN HAVE SIDE EFFECTS:  “the side effects shuffle”.

The first set of problems I observed up close and personally was what I call the “side effects shuffle” as he tried one medication after another.

He would try one medication and he would have to deal with a loss of appetite and weight loss.  Then my son tried another medication and we dealt with his irritability and sleeplessness, and so on and so on.  I didn’t like the impact the meds had on my son.  He didn’t either.

However there was nagging problem #3 on my mind, if we took him off the medications.

NAGGING PROBLEM #3:  WILL MY SON FALL BEHIND ACADEMICALLY AND SOCIALLY IF I DON’T MEDICATE?

Up until that point, like you I was confronted with a dilemma.  The research trials of medications did show that meds were effective in rapidly MANAGING the ‘core symptoms of ADHD’ impulsivity or inversely a lack of inhibition, and inattention.

The problem was did they really address the root cause of the symptoms or just the symptoms themselves?

I use the term managing the symptoms because they just came right back as soon as the meds wore off.  So, I couldn’t really call it ‘addressing’ the symptoms or stopping them.  It was just managing them with chemistry.

But that begs the question, were we really helping my son?

This was a rather vexing problem.

So, I had my son taking medicine from age 8 to about 10, but this was an unholy alliance for me.

The question that plagued me was this:  if you remove the meds you remove the improved attention and reduced impulsivity.  The skills we work on while he is the meds do not materialize when he is off the meds.  So this contrasted to medicating people with anxiety or depression.  In those situations you can medicate work on skills and they are still there when the person is off the meds.  With ADHD it didn’t really work that way.   Why?  They weren’t paying attention to when do use the new skills. Or they couldn’t stop their impulses long enough to try that new strategy we worked on developing.  So, this is a very distinct situation from medicating depression or anxiety, at least in my experience.

So, he took meds BUT he did not develop any new skills.  He did not learn a way to better manage his impulses.  He did not learn to better pay attention.   His brain did not make any progress or develop more ‘activity’ where it was heretofore lacking.

He simply had what I will call a ‘bullet train’ in a bottle temporary in charge of his brain (more on that in Nagging problem #4).

Besides I was teaching him that if he took a pill he could get a bullet train in his brain and he could ride it during tests, while he was working on papers, when cramming for exams in college, while running his technology company, when did it stop, ever?   Wasn’t this kind of like pro athletes who take steroids?  Well, obviously the analogy doesn’t completely hold up, but you get my point.

NAGGING PROBLEM #4:  “THE BULLET TRAIN IS IN THE BOTTLE WILL NEVER BE A PART OF ME”

As a matter of fact I found these medications and their effects so puzzling I tried one of my son’s meds one day just to see how it would affect me.

Yes, I know something I probably shouldn’t do or reveal, but it is worth you getting my perspective because I don’t have ADHD and I wanted to see how it affected me.  Besides as I have dug deep into the literature it turns out I am far from alone in doing this.

Once I took that med I was like a heat seeking-missile with laser like focus.  I cranked at getting work done that day, well, uh, and night too, well into the night as a matter of fact.  I often stay up late, but this was a totally different deal.  I was cranking the whole time non-stop.  I felt like I was on a bullet train, but there was one problem, I couldn’t get off.  I was on a “bullet train from a bottle” and I was not the conductor, I couldn’t get off the train.  I couldn’t stop the train.  I couldn’t really even slow it down.  I know, I know, with a physician properly managing the meds and me it might be the case that the train would not quite be so fast or possibly out of control, but the experience was palpable.  From judging kid’s reactions over the last decade or so I can definitely see the similarities.

Also if someone attempted to get in front of the bullet train, well, let’s just say that getting run over by a bullet train is not a pretty sight.

Yes, the word wrath might apply.  I was a pit bull with a femur in my mouth and I was not about to let go.  This feeling of being intensely focused, but not in control was very, very uncomfortable for me.  I definitely developed some empathy.

It was that day that I realized I had to find different solution for my son and our family now. No more waiting and carrying these dilemmas it was time for action.

However, many people would like the effect of riding a ‘bullet train’ through life, even if the ‘bullet train was in the bottle’ and not part of me.  Me?  Not so much.

Before I was “concerned” about the impact these meds had on kids.

Now I was massively motivated to find an alternative.

I know I am not the only one.  I had seen many other parents who saw the “side effects shuffle” and they didn’t like it either.  Boy could I understand how some of those kids might get a ‘little irritable’ after taking these meds.

After my bullet train experience I felt like I had a grasp on both the ‘benefits’ and the ‘risks’ of these meds.  Not to mention the years of clinical experience and my concerns about the research, or lack thereof which will we will get to in a minute.

Yes, you can focus and yes you can get a lot done, but that was not ‘me’ or how ‘I’ ‘normally’ focus.  Yes, I can have periods of time with intense focus, 2 hours 5 hours as a maximum when I am really on a roll, but this was like 12 hours straight, but that in itself was somewhat ‘cool’.

Yeah, the kind of ‘cool’ that scares you.

Again, I was simply not the conductor of the bullet train.  It had a ‘mind’ of its own.  It was at that point that the father in me moved into action.  The father in me saw a boy who was 10 years old (in my mind soon to be 14 – given that I am always thinking 4 years ahead) and was right around the corner from some serious temptation as he would be hitting high school.  Kids would be gearing up to get into the ‘best schools’.  Boy would there be an appeal for ‘a bullet train in a bottle’ as kids compete to be the best and the brightest.

I kept coming back to this question:

Did the ‘bullet train in a bottle’ solve this problem or was it the beginning of a whole new set of problems?

NAGGING PROBLEM #5:  THERE WAS NO RESEARCH TO ANSWER THE MOST CRITICAL QUESTION:

WHAT IS THE IMPACT OF MEDICATING AN ADHD CHILD FOR A DECADE, FROM AGE 7 TO 17 – AT MINIMUM?

This gaping hole in the research went against the grain of all my training.

We didn’t know the answer to this question and we were medicating kids like crazy.  I was medicating my own son, or allowing him to be medicated.

As a psychologist I am trained in two primary areas:  clinical work and research.

In clinical work I have the goal of getting to the ‘root cause’ of things AND facilitating behavior change.

With research I have been trained to systematically review the method of knowing from which a person bases his or her claims.  It can be a pretty annoying place to live especially in your early days post training, but you get used to it and the role of logic and empirical research assumes both its power and limits over time.  In this case research has a critical role, but we had no answer to the critical question.

On both counts medicating kids as a ‘solution’ to Attention Deficit Hyperactivity Disorder fell way short.

At best it is a short-term band-aid.

I would never get that ‘bullet train in a bottle’ to be a part of me, neither will my son, neither will your son, or daughter.  It was like adding NO2 to a car.  All of a sudden I was ‘juiced up’ and moving at a speed and with focus I simply could not summon without my ‘bullet train in a bottle’.  Now, NO2 in a car looks pretty exciting with Vin Diesel in the Fast and the Furious, but for me on an everyday basis, driving the car pool, picking up the kids after football practice, not so much.  It looks more like a serious wreck waiting to happen.

Medication doesn’t get to any root causes.  Like understanding why does his brain work this way?  Medication does not facilitate any new behavior or skills, or at least not once the meds wear off.  So, on a clinical level this is not a sustainable intervention or at least whether you can call it ‘effective’ is questionable.  (I will discuss this in detail in a later blog.)

Yet, and here is the dilemma, on one level medicating kids with ADHD or ADD works. On one level, or make that two levels:  fast and easy.  It is fast and seemingly it is easy to do.  Little work is involved for the kids or parents.  Just take the pill.

The kid after taking that medication sits still and pays better attention.  Yet, without understanding how his brain is different from other kids and how to help him to develop his brain in a way to make him more effective the power is in the pill. That seems like a recipe for a risky precedent.  It is disempowering.

Again, realize that I am not “anti-medication”.  My son was medicated at the time.  I was vexed because he was 10 and this was not a long term solution I found acceptable.  This was on a logic level and a level of training as a researcher and clinician.  It applied to all the kids who dealt with this issue. I had the blessing of working with kids who were 17.  I saw in real life where this whole convoy was going and I was concerned.

On the research logic level there was another huge problem.

Even though shorter term studies of 1 or maybe sometimes 3 years seemed to show reduced symptoms of ADHD while on medication.

There was a research question screaming to be answered.

It was a simple research question that I had not seen sufficiently answered:

What is the effect of medicating a kid for a decade, really, a decade?

Why?  We are medicating kids beginning around age 7 until at least age 17, more likely age 25 (assuming they are going to college and you want them to make it through)?

This question bothered me.  No one was asking that question in 2005.  Or at least I could not find evidence of it.  No one had answered that question in 2005, again not that I could find.

My son was 10 in 2005 when I sought out EEG biofeedback.  I had not seen any longitudinal studies for a decade or more that followed stimulant medicated ADHD kids that had addressed this issue.

Remember, I am not ‘just a child psychologist’, I am the father of an oldest son who HAD ADHD.  So, I am always thinking about 4 or 5 years ahead.  In my mind he was going to high school tomorrow and that ‘bullet train in a bottle’ seemed way to tempting.  (I will blog on that later too.)

So, my son is 10 in 2005.

I am thinking when he is 15 if he is taking this medication what will be the risk to abuse it?

What will be the risk for him to sell it?

Will other kids sell it?

Besides do I really want to teach him that the way to improve his life is through a pill?

Not to say that pills don’t have their place.  Remember, again, I had had my son medicated as I dealt with NAGGING PROBLEM #3 because I didn’t want him to fall behind socially and academically.   It wasn’t that I was totally against drugs or I would have not have medicated him.

The issue was this:  Is medication a solution for a DECADE OR MORE?

Does anyone know the effect of giving MY SON a stimulant for a DECADE?

RESEARCH SAYS:  WE DUNNO! WE HAVE NO IDEA!

Will he have learned any new skills?  Obviously, the answer is no.

My response was simple:  I have to find something else, I thought.

So, I returned to one of my primary skills:  research.

I researched until I found EEG biofeedback.

I will continue with the story on my next blog post.

Charles Shinaver, PhD

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