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Articles by Dr. Billy Levin

The diagnosis and management of ADD/ADHD is NOT a hotbed of controversy!

By Drs. Nic Kloppers and Billy Levin (1.10.99)

"This condition is a well documented inherited neurological disorder manifesting with various degrees of poor attention, hyperactivity and impassivity. In some children there are physical markers ie. High arched palate, curved fifth finger, mongoloid or widely spaced eyes, "electric" hair that won't comb down, low set or deformed ears, single palm crease instead of the usual M- shaped crease, webbed 2nd toe space and a particulary large 1st toe space. The more of these features present, the more likely the child is of having ADD/ADHD. The above features prove that this is a true physical condition and not a fanciful psychological diagnosis. It is three times more common in boys, varies from mild to severe, and is seen from infancy to old age, with a tendency to improve with age. It is present in all races, at all levels of intelligence and in all social classes, with a higher incidence in the lower social classes. Research on four continents has shown that it is grossly under-recognized, poorly treated and under-treated, despite the fact that effective medical treatment, good management and appropriate remedial teaching achieves high success rates.

There is an enormous amount of misinformation published by the lay press about the causes, diagnosis and treatment of ADD/ADHD. This is in total conflict with properly conducted scientific research. This misinformation and attempts to create controversy, where none exists in scientific circles, only serves to confuse parents and teachers. There are many forms of treatment, such as homeopathy, herbal products, vitamins, trace elements, optometric exercises, occupational therapy and even acupuncture, offered to children without their advocates publishing any results of properly conducted double blind scientific trial in peer reviewed journals.

THE CAUSE

is without a doubt an inherited pattern of brain development, where either some areas of the left half of the brain are immature, causing a verbal learning problem, or the right half is too dominant, causing a behavior problem. The left half usually achieves dominance at about six years of age. Problems arise if this does not happen. Right brain dominance is often associated with Left handedness, which is very common in these children.

THE DIAGNOSIS

is made by assessing the information gleaned from parents about themselves, and about the birth, medical and developmental history of the child. Input from the teacher about the child's behavior, academic achievement and socialization is vital. Specific rating scales like the Modified Connors, completed by parents and teachers have a diagnostic accuracy of 90%.

SIGNS AND SYMPTOMS

looked for are poor auditory attention, impulsively, distractibility, restlessness, reversals of writing, overactivity, fidgets, sensitivity to critical comment, lying, poor time concept and volatile behavior. Also underachievement in one or more of Reading, Story Sums, Spelling, History, Algebra and Multiplication Tables. Subjects like Mechanical Maths, Geography, Art, Music and Computer Games are often easily mastered.

THE MANAGEMENT

should be by an integrated and educated team of parents, teachers and the doctor, who should be competent in this field as result of special study and experience. Each of them need to be fulfilling their tasks properly. The child and the significant others in his life should be fully informed on their expected roles with regards to motivation, education and medication.

MEDICATION

is a vital part of treatment in all these children except when the ADD/ADHD is mild. The aim of medication is to improve concentration and memory and reduce impulsive and hyperactive behavior, thus enabling the child to be reached by teaching and behavior modification programs. Research has shown that without medication the results of these other efforts are not good in ADD/ADHD patients. You cannot teach them till you reach them. Ritalin allows the teachers to reach them. RITALIN is the most often used medication. Research over forty years and published in more than 150 medical studies have shown Ritalin to be extremely safe and having no long term side effects whatsoever. There are sometimes minor transient side effects that are easily managed. The major problem with Ritalin is the incompetent way in which it is used. If the dosage and timing is correct, and the results are properly monitored by enlightened and knowledgeable parents and teachers using the Modified Connors Rating Scale, the results may often be miraculous!

As Ritalin takes about one hour to take effect, and works for about four hours, the most effective schedule is usually to give it at 7 am, then 11 am and often at 3 p.m. if homework is a problem. Dosage varies from one to six tablets daily, and is NOT dependent on weight or age, but adjusted according to response. The reason for this approach is that the absorption is different in different people. The effect is determined by the level in the brain, not by the number of tablets taken. Overdose usually causes the child to be too quiet and withdrawn, in which case the dose should be reduced.

Despite contrary claims in the lay press by various groups who may have their own agendas, Ritalin causes NO addiction, NO retardation of growth and NO depression. These facts have been proved by proper scientific studies. Apart from Ritalin, there are a number of other medications available which may be effective.

OTHER FORMS OF HOME MANAGEMENT

are Paired Reading programs, color overlays for reading and studying, handwriting programs, mathematical teaching programs and behavior modification. (Many of these are computer based.) Programs are home based or applicable to the school setting. In severe or neglected cases referral to a remedial school may be required.

Most ADD/ADHD children will develop stress and often depression or poor self-esteem. These problems usually resolve as they start achieving success and relationships with parents and teachers improve. For persistent problems psychological help may be needed.

For the adult patient study methods, motivational programs and time management plans are available specifically designed for ADD/ADHD, while being treated with Ritalin.

CONCLUSION:

For the correctly diagnosed patient the right medication given with right dose and timing, the right educational and behavior modification programs, the right motivation, attitude and expectations will give excellent results in the vast majority of cases. It is most important to consider the dangers of NOT using a properly designed medication regime for as long as the patient experiences benefit from it, viz.(all the "D"s) Dropout from school, Drinking, Delinquency, Divorce, Drug addiction, Depression, Driving accidents, the last three often leading to premature Death. Obviously not all neglected cases develop these complications.

Many of the so called side effects of Ritalin use, seen in adolescents or young adults, quoted by the anti-Ritalin lobby, are in fact the results of premature withdrawal or incorrect use of medication. (The case history of Julia Grey published in the September issue of Teacher, is a case in point.). The cost of incorrect treatment in Rands must run in to thousands annually. The cost to the patient in lost education and productivity can only be imagined.

FINALLY

all statements made in this article are backed up by references to scientific studies. These are available on request."

Dr W.J.Levin



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Attention Deficit Disorder Online Information




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