Why one size doesn’t fit all when it comes to ADHD

There’s often a pattern when it comes to the many different treatments of ADHD. Each one shows improvement in some children, but not in all. Each treatment needs to be carefully regulated by parents and pediatricians to make sure none of the treatments overlap in a way that could be dangerous to the child. Some of these treatments target specific symptoms of ADHD, but not the others.

These precautions, in conjunction with the different forms of ADHD, mean one thing: there is no one “cure” for ADHD because there is no one expression of ADHD. Each child’s treatment will depend on all sorts of factors such as:

  • Type of ADHD
  • Health
  • Allergies
  • Learning Style
  • Other Disabilities
  • Safety at Home
  • Good Nutrition

And this list is by no means exclusive. My point is that it’s not fair for parents to be judged for not trying a new “miracle cure.” The children I’ve worked with in different schools and in tutoring generally thrive under multiple sources of assistance. Some of the management strategies may surprise you, too. Most benefit from a mix of medication, a balanced diet, and these non-medical treatment sources:

  • Exercise – In the article, “Taking Away Recess Bad for ADHD Kids, Experts Say,” Thomas Lenz, an associate pharmacy professor at Creighton University in Omaha, Nebraska,  says that exercise and ADHD medications act on the brain in very similar ways. In addition, according to NOVA’s article, “The Science of Smart: A Surprising Way To Improve Executive Function,” exercise is one of the best ways to improve executive function struggles, a symptom most children with ADHD struggle with.
  • An Organized Home – Children with ADHD often struggle to pick up basic organizational skills and habits such as having one spot for homework or knowing how to follow a basic evening routine. ADDitude Magazine’s article, “Help Your ADHD Child Organize Homework,” stresses that it’s important for parents to work with their children to develop healthy organizational skills as they grow so they’re more prepared to carry those skills into the world with them.
  • Cognitive Behavioral Therapy (CBT) – CBT is often an effective treatment for individuals with OCD, but experts are finding that it can be helpful for children with ADHD as well. U.S. News Health’s article,  “Cognitive Behavioral Therapy Can Help With ADHD,” says, “CBT for children with ADHD is aimed largely at improving their behavior through praise and rewards that motivate them to calm down enough to cope with school or other challenges.” The article states that while CBT won’t cure ADHD, it helps children learn thinking and self-management skills. If mastered, these skills can last far beyond any medication.

Different Kids, Different Needs

Parenting a child with ADHD is not an easy task by any means. It’s time consuming all the time, and it takes a lot of trial and error. A certain diet and medication that works for one child will probably not work for the next. And on top of that, children’s dosages and treatments will need to constantly change as their bodies and brains grow.

If you’re the parent of a child with ADHD, don’t let people guilt you into only one form of management for your child. No matter how much they promise you “just need this one treatment,” odds are that your child will have his or her own needs that are mixed and multifaceted. The best you can do is try, and when one treatment doesn’t work, don’t consider yourself a failure. Simply move on to the next and know that you’re doing your best. Your attempts to meet your children’s needs will encourage his or her teachers and other supporting adults to do the same, and as a team, you’re giving your kiddo the best chance he’s got. And isn’t that what every parent wants?

Do you have experience with ADHD management? What are you thoughts on the issue? What was successful for your, or what wasn’t? Please share your thoughts in the Comment Box below. And don’t forget, you can sign up for my newsletter for extra resources on neurological disorders, education, and spiritual encouragement. As always, thanks for reading!

CBIT Explained, Part 3: Who should take CBIT?

In this blog series, Steve Pally, administrator of the TSFC Forum (www.tourettesyndrome.ca), explains the basics of CBIT, or Comprehensive Behavioral Intervention for Tics. See part one here and part two here.

CBIT is ideal for individuals who feel they have one or more bothersome tics (not a tic that bothers someone else, but rather a tic that causes the individual discomfort, distress or difficulty).

CBIT also requires a self-aware individual. Self-awareness in children matures at about the age of 10 (+/-2 years), at which time they become aware when they tic or are about to tic (the premonitory urge).

Unfortunately, trained and certified CBIT therapists are limited in number and can be difficult to locate. By contacting a local TSFC affiliate (or, if you live in a place such as New Jersey, the NJ Center for Tourette Syndrome), you may learn if a CBIT therapist is practicing in your area. If there isn’t, let your own doctor or therapist know that CBIT training is available. When more people alert local medical professionals that CBIT therapy is needed, the number of competently trained CBIT therapists will increase.

References:

1) Cook CR, Blacher J. Evidence-based psychosocial treatments for tic disorders. Clin Psychol: Science and Practice. 2007;14(3):252–67

2) http://www.cdc.gov/ncbddd/tourette/treatments.html#CBIT

3) NJCTS Webinar April 23, 2014 Dr. Lawrence W. Brown MD, Pediatric Neuropsychiatry Program, The Children’s Hospital of Philadelphia

4) Behavior Therapy for Children With Tourette Disorder

5) Randomized Trial of Behavior Therapy for Adults With Tourette Syndrome

6) Canadian Guidelines for the Evidence Based Treatment of Tourette Syndrome Page 66

Major input from:

CBIT Training, Dr. Douglas Woods PhD, Professor and Department Head, Department of Psychology, Texas A&M University

IMG_0038-avatar--wAbout the blogger: Steve Pally was diagnosed with TS as an adult in his mid-forties. He has volunteered with TSFC for nearly three decades and currently co-administers the TSFC information and support Forum at www.TouretteSyndrome.ca. His interest in CBIT was sparked when he realized many of the strategies taught in a ten-week period in CBIT today were familiar to him, but took him decades on his own to discover them, as have many other adults with TS. That’s why he is eager to acquaint as many people as he can with CBIT so they can take advantage of recent developments for tic management.

CBIT Explained, Part 2: How does CBIT work?

In this blog series, Steve Pally, administrator of the TSFC Forum (www.tourettesyndrome.ca), explains the basics of CBIT, or Comprehensive Behavioral Intervention for Tics.

Studies published in peer reviewed journals have demonstrated the effectiveness of CBIT (part 1).

It’s thought to work by strengthening the neural pathways between the basal ganglia and the prefrontal cortex of the brain. The basal ganglia is the region of the brain where Tourette Syndrome is thought to originate by the spontaneous release of unwanted muscle actions, while the prefrontal cortex is the region of the brain where voluntary control over our actions occurs.

CBIT breaks the premonitory urge → tic → relief feedback cycle by implementing a Competing Response (CR), an action that’s less conspicuous than the tic itself and can be performed without any external aids or devices.

(Please note that even though behavioral therapies like those involved in CBIT can help reduce the severity of tics, this does not mean that tics are just psychological or that anyone with tics should be able to control them—tics due to TS are very much neurologically based and involuntary. CBIT is not  “Stop It” therapy, but rather “Do Something Else” therapy.)

In time, usually after a few of months of applying the CR combined with the other comprehensive components of CBIT, most children develop the ability to manage their tics to their satisfaction.

Having learned the techniques taught in CBIT, the child is then able, usually on their own, to develop their own CRs for other bothersome tics, and continue using the relaxation strategies and the knowledge gained from understanding their tic triggers to more effectively manage their symptoms throughout their lives.

IMG_0038-avatar--wAbout the blogger: Steve Pally was diagnosed with TS as an adult in his mid-forties. He has volunteered with TSFC for nearly three decades and currently co-administers the TSFC information and support Forum at www.TouretteSyndrome.ca. His interest in CBIT was sparked when he realized many of the strategies taught in a ten-week period in CBIT today were familiar to him, but took him decades on his own to discover them, as have many other adults with TS. That’s why he is eager to acquaint as many people as he can with CBIT so they can take advantage of recent developments for tic management.

CBIT Explained, Part 1: What is CBIT?

In this blog series, Steve Pally, administrator of the TSFC Forum (www.tourettesyndrome.ca), explains the basics of CBIT, or Comprehensive Behavioral Intervention for Tics.

CBIT (pronounced see-bit) is a non-pharmacological treatment for Tourette Syndrome.

It combines six strategic therapeutic components in the form of a clinically proven, comprehensive therapy to help a person with Tourette Syndrome manage their tics, including:

  • Psychoeducation: Examining what situations tend to make tics worse and what situations make tics better. A person can then use this knowledge to avoid the situations that exacerbate their tics or find ways to lessen their impact. They might also seek out situations that lessen tic activity.
  • Self-awareness training: Learning to recognize signs that a tic is about to occur. Tics are usually preceded by a premonitory urge which is the key to knowing when a tic is about to be expressed.
  • Relaxation training: Acquiring strategies for minimizing stress and managing tics. Examples include deep breathing, progressive muscle relaxation and guided imagery.
  • Tic Analysis: Identifying a person’s most bothersome tic (Note: not the tic that bothers someone else,but rather the tic that causes individual the most discomfort, distress or difficulty). A CBIT therapist helps the individual to recognize any premonitory urge or urges that precede that particular tic. They then break down the tic into its components (i.e., the precise muscle movements involved in the tic from start to finish).
  • Competing Response (CR)/Tic Blocker: Responding to the urge to perform a particular tic with an action that’s less conspicuous than the tic itself and can be performed without any external aids or devices. For example, if a person with TS has a tic that involves head rubbing, a new action might be for that person to place his or her hands on his or her knees, or to cross his or her arms so that the head rubbing cannot take place. Once a person identifies a CR for their bothersome tic, they perform the CR whenever they experience the urge to perform the bothersome tic, until the urge passes, usually in a minute or two.
  • Social support: Getting encouragement and assistance from family, friends and educators. Parents may have to advocate on their child’s behalf at school to alert teachers about a child’s needs. Positive reinforcement at home is also important for children. When a child employs the correct CR, they should be praised. If they happen to miss using the CR and the tic emerges, parents need to remind the child about using the CR, not in a punitive tone, but in a supportive and encouraging one.

CBIT does not cure Tourette Syndrome or eradicate tics; rather, it provides strategies to help manage tic symptoms and lessen their impact.

IMG_0038-avatar--wAbout the blogger: Steve Pally was diagnosed with TS as an adult in his mid-forties. He has volunteered with TSFC for nearly three decades and currently co-administers the TSFC information and support Forum at www.TouretteSyndrome.ca. His interest in CBIT was sparked when he realized many of the strategies taught in a ten-week period in CBIT today were familiar to him, but took him decades on his own to discover them, as have many other adults with TS. That’s why he is eager to acquaint as many people as he can with CBIT so they can take advantage of recent developments for tic management.

Ask Dr. Ticcy: What about relaxation techniques?

Ask_Dr_Ticcy_Logo-238x250Dr. Ticcy is a pseudonym for the Tourette Syndrome Foundation of Canada National Office, which draws on information from experts across Canada and beyond to answer questions from the TS community. Please send your questions to tsfc@tourette.ca with the salutation “Dear Dr. Ticcy.”

Dear Dr. Ticcy,

Where can I find more information about relaxation techniques?

Thanks,
F.

Dear F.,

Great question.

Relaxation is important for everyone, and can be especially helpful to someone with Tourette Syndrome. Since stress, excitement and anxiety may intensify or fuel tics, relaxation can assist with symptom mitigation. That is why non-pharmaceutical treatments like Comprehensive Behavioural Intervention for Tics (CBIT) and Habit Reversal Therapy (HRT) are often combined with relaxation therapy/techniques.

To learn more about relaxation techniques try:

1. CPRI Brake Shop Clinic

Video: http://www.cpri.ca/videos/Stress%20Techniques%20F.swf
Handouts: http://www.cpri.ca/uploads/section000162/files/handout_stress.pdf
http://www.cpri.ca/uploads/section000162/files/handout_relax.pdf
http://www.cpri.ca/uploads/section000162/files/breathing%20triangle.pdf

2. Dr. Leslie E. Packer’s website “Tourette Syndrome Plus”
http://www.tourettesyndrome.net/disorders/anxiety-disorders/relax/

3.The TSFC Forum

Try threads like these: http://www.tourettesyndrome.ca/showthread.php?7005-Teach-Yourself-Your-Child-Relaxation
http://www.tourettesyndrome.ca/showthread.php?5029-Relaxation-Techniques

4. Asking an Occupation Therapist or Another Trained Professional

Sincerely,
Dr. Ticcy

Where tics and compulsions meet: TS plus OCD

Ken Shyminsky, a former vice president of the Greater Toronto Chapter of the Tourette Syndrome Foundation of Canada, draws upon his personal experiences as an teacher and student with Tourette Syndrome to help children with TS and related disorders. He also has Tourette himself and is the founder of the website Neurologically Gifted.

Tourette Syndrome and Obsessive Compulsive Disorder often occur together.  In fact, the Centers of Disease Control and Prevention states that more than one-third of persons with Tourette Syndrome also have Obsessive Compulsive Disorder.

Often, tics and compulsions can look similar and be difficult to distinguish. Actually, to an observer it may be impossible to determine whether a behavior is a compulsion or a tic without asking the person performing the behavior and even then it may remain a mystery. The key to distinguishing a tic from a compulsion is the motivation behind the act.

As an example, lets break down a simple motor tic which could very well be a simple compulsive behaviour .  The behavior is blowing on the back of the right hand. If the behavior is a tic the person may feel a premonitory urge to perform the tic.

The premonitory urge could be a tickle on the hand, a sensation in the elbow joint prompting the movement, a sensation in the lips to purse, a feeling in the chest prompting a need to exhale a breath.  Premonitory sensations may be any feeling or urge that prompts the tic, creating the itch that needs to be scratched. The person scratches that itch and the tic is performed.

If the behavior is a compulsion, the person is prompted by a different mechanism to perform the exact same behavior.  The person may have an obsession that there may be dust on the back of the hand, a thought that they may need to blow on the back of the hand to prevent something bad from happening, a feeling of anxiety or emotional unease unless they blow on the back of their right hand. The person then performs the behavior, (not a tic), and temporarily relieves the uneasiness or anxiety.

As you see from this scenario, the behavior from the outside observer is identical. Continue reading

WEDNESDAY WEBINARS: “Cyber Safety” on October 16 & “TS Clinic” on October 30

Children and adolescents growing up today live in a cyber world consisting of instant everything, easy communication, handheld technology, widespread accessibility and often little adult oversight. This cyber world is also a risky place filled with bullying, harassment, intimidation, masking identity and sexting. A New Jersey Center for Tourette Syndrome & Associated Disorders (NJCTS) Wednesday Webinar titled “Cyber Safety Guide for Parents and Educators” on October 16 will focus on understanding how cyber bullying and other risky online behaviors impact today’s children and adolescents.

Every October is both National Cyber Security Awareness Month, as well as when New Jersey public schools observe both a “Week of Respect” and “Violence Awareness Week.” These initiatives highlight the importance of respecting others and preventing harassment, intimidation and bullying, and will be discussed during the webinar, which will be presented by licensed psychologist Dr. Graham Hartke.

Then, on October 30, NJCTS will present the “Tourette Syndrome Program at Rutgers University: A Great Resource for the TS Community of New Jersey” Wednesday Webinar. The TS Program at Rutgers offers affordable psychological services for individuals with TS and their families. Clinical psychologist Dr. Shawn Ewbank will explain how the TS Program works and how the combination of services, training, research and consultation provides a resource for individuals and families.

Dr. Ewbank will introduce the various treatments offered at the clinic, including Comprehensive Behavioral Intervention for Tics (CBIT/HRT); Exposure and Response Prevention (ERP) for OCD; cognitive-behavioral therapy for anxiety and depression; various treatment options for ADHD, behavioral difficulties and rage behaviors. This webinar will help any parent, doctor, teacher or community member who is interested in learning about available resources for children, adolescents and adults with TS and its co-morbid disorders.

NJCTS launched the monthly Wednesday Webinar series, which draws an audience from 48 states and 13 countries, in 2008. The series, offered at no cost to participants, features online seminars for parents, educators and professionals on topics of interest to the TS and associated disorders community. Professional development credits are given upon verification of attendance and completion of an exit survey. Credits are distributed by mail one week after the webinar.

You may register for the October 16 webinar or the October 30 webinar. You may also view/download past webinars, or find out more information about Tourette Syndrome and the programs and services of NJCTS by visiting www.njcts.org.

Exciting online clinical trial program for OCD

What is the OCD STOP! program? The Swinburne University of Technology Psychology Clinic in Australia has been successfully using OCD-specific Cognititive-Behavioural Therapy (CBT) for face-to-face treatment for some time.

Researchers and clinicians at Swinburne have developed an online version of this program called OCD STOP! The online program consists of 12 modules. You complete one module each week for the duration of the program. Modules contain downloadable video, audio, lessons and workbooks. To assist you work through the modules, you will receive an e-mail from a clinical psychology trained therapist each week.

You are invited to join OCD STOP! a free online psychological treatment specifically targeting obsessive-compulsive disorder (OCD). The program is completely confidential, and you can continue with other treatments.
The program consists of 12 modules, and you will complete one module per week for the duration of the program. As part of the OCD STOP! program you will get:

  • 24 hour access, 7 days per week to the online program
  • Weekly e-mail support from a clinical psychology trained therapist
  • Accurate and up-to-date information about OCD
  • Information on how to control anxiety and better manage OCD
  • Downloadable video and audio (including patient stories, expert explanations and relaxation exercises)
  • Downloadable lessons and workbook exercises
  • Continued access to program content after completion

The trial is in its final stages, so this is the last chance for those wishing to be involved to do so at no cost. If you are interested in receiving this treatment at no cost, register online now.

Multi-strategy treatment controls Tourette Syndrome-related tics

EDITOR’S NOTE: The following research article was pulled from the Psychiatry News section of Psychiatry Online and was written by Joan Arehart-Treichel.

Although youth with Tourette Syndrome tics often outgrow them, some individuals do not. And while antipsychotic medications can be helpful, they can also have undesirable side effects.

Thus, Dr. Sabine Wilhelm, an associate professor of psychiatry at Harvard Medical School, and her colleagues studied a behavioral therapy to see whether it could help adults with Tourette tics. The results looked promising, they reported in the August Archives of General Psychiatry.

The therapy is called the comprehensive behavioral intervention for tics (CBIT). It consists of several strategies — training patients to become aware of their tics, helping them consider the impact of various situations on their tics and finding ways to manage these situations, and teaching them to use different behaviors to counter tic urges.

For example, if a patient has the urge to engage in a shoulder tic, he might tense his arm muscles while pushing his elbow against his torso to ward it off. Or if a patient has an urge to lick her lips, she might press her lips together and clench her jaw to suppress the urge.

For the study, Wilhelm and her colleagues recruited 122 adults who were experiencing Tourette tics. Continue reading