New ADHD study leaves some wiggle room

Reply Wed 3 Jun, 2009 08:45 am

As many of you know I have fought a long battle with my son's school over ADHD. They kept saying he had it, I kept saying he didn't and I back up my "didn't" with a comprehensive evaluation showing that he didn't.

The basis of my fight was that by treating him as if he had ADHD they were being counterproductive and having a negative effect on his learning.

But maybe I was wrong. Maybe he does have ADHD and the way it is dealt with in school for all the kids is wrong.

From the new study:

Rapport’s research indicates that children with ADHD need to move more to maintain the required level of alertness while performing tasks that challenge their working memory. Performing math problems mentally and remembering multi-step directions are examples of tasks that require working memory, which involves remembering and manipulating information for a short time.

“We’ve known for years that children with ADHD are more active than their peers,” said Rapport, whose findings are published in the Journal of Abnormal Child Psychology. “What we haven’t known is why.”

“They use movement to keep themselves alert,” Rapport added. “They have a hard time sitting still unless they’re in a highly stimulating environment where they don’t need to use much working memory.”


The findings have immediate implications for treating children with ADHD. Parents and educators can use a variety of available methods and strategies to minimize working memory failures. Providing written instructions, simplifying multi-step directions, and using poster checklists can help children with ADHD learn without overwhelming their working memories.

“When they are doing homework, let them fidget, stand up or chew gum,” he said. “Unless their behavior is destructive, severely limiting their activity could be counterproductive.”

Read all about it: http://news.ucf.edu/UCFnews/index?page=article&id=002400410133cccfb011fd899639b007f63

This new line of research offers hope that the "sit down, be still, miss recess, blahblahblah" methods of school will be a thing of the past.
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Reply Wed 3 Jun, 2009 09:01 am
Hey Boomer -

I agree with this. I teach Sunday School at my church. My kids that can't sit still, I allow to stand up to read or do a certain activity. I keep them moving as much as possible...but even when we are sitting down the ones that fidget a lot seem to do better standing up or even drawing while I read. They still answer questions and seem to be getting it just fine. I am always amazed by this.

It probably helped that because I want them to enjoy Sunday School and not hate it, that I have refrained from being real strict with them. But by giving in and letting them wiggle a bit and be busy while I am doing whatever it is I feel I need to do...they seem to be getting it and it is easier for me and for them. It does not bother the others that like to sit and listen at all. It is a very happy 45 minutes we spend together. I also try to use games and activities to help them learn...then we go to the playground for about 15 minutes...I figure their life is full enough of having to sit and listen...school, church - whatever. It was an accidental finding. If I was a hardnosed "You Gotta Learn The Sunday School Lesson Before You Leave, So Sit Still and Listen" kind of teacher - I don't think they would be learning as much or enjoying it as much.

It makes great sense to me.
Reply Wed 3 Jun, 2009 10:00 am
Good on you, mismi.

It makes sense to me too.

I was talking to my brother about all this not long ago and we decided that in a perfect world classes would be divided between the still kids and the fidgety kids so a teacher could design their day around the need for kids who need to move around, or not move around.

Instead of doing candy math* they'd do basketball math; instead of studying bugs in books they'd go dig up earthworms, that kind of stuff.

It seems that the way they do things now -- dividing the classes between the still kids and the moving kids -- shortchanges everyone.

*candy math = some bizarre trend where snacks seems to be the unit of measurement, pattern, fraction, whatever.
Reply Wed 3 Jun, 2009 10:20 am
You know Boomer - there is a distinct difference between girls and boys as well. I read somewhere...(I will have to think about it and see if I can remember) But because the classroom was initially started and managed by women that it is arranged according to a woman's ability to sit still and focus.

Little boys, because of testosterone, have a tendency to wiggle more and need to move while learning. My boys have always done better at hands on, application kind of study verses sit down and listen.

Although, I am a visual learner, myself...I need to see it and do it to get it. There are so many different types of ways to learn and so many individuals do better at learning by different tactics. The ones that do well in traditional classroom settings are the ones who are auditory learners, it seems. I haven't thought it through enough to know if I am correct or not in this assumption.

I have a friend who is a math tutor and her success has come from figuring out how the child she tutors learns, she tries them all and has tools she has learned to help them understand.

Come to think of it...most of the ones that had trouble sitting still in my class were little boys. I had one little girl and she is a perfect example of having focus issues. Keeping her interested meant keeping her task oriented.

It may be that Mo is just a little boy and just needs to move because of his natural tendencies.
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Reply Wed 3 Jun, 2009 10:23 am
I had a job once to which i walked, many miles. I'd have elaborate conversations in my head, with people with whom i had problems, those i supervised, and those to whom i was subordinate. It was marvellously helpful. I'd arrive with answers ready for my problems, and even if they weren't necessarily what everyone would consider the best answers, i'd have already resolved my feelings and the details of the problems--put them into perspective. The more exercised i was with a problem or a person, the more i exercised my legs--i sometimes found that i arrived 30 or 40 minutes earlier than usual. I don't think that hyperactivity necessarily, automatically means that there is an attention deficit. The attention deficit comes from forcing someone into a mold which they are not suited to occupy.
Reply Wed 3 Jun, 2009 10:27 am
I think that is a wonderful conclusion Set. I think you may very well be right.
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Reply Wed 3 Jun, 2009 11:07 am
I completely agree, Setanta.

I've been doing some reading around on this topic and one thing that keeps turning up is movement resulting in increased dopamine levels, like "runner's high".

Amphetamines also increase dopamine levels.

So we give kids speed to help them think but won't let them just wiggle around to help them think.

They're self medicating.

And self medication through movement and exercise sounds pretty damn good to me.

Maybe the military has it right -- you screw up, extra PT for you, -- "drop and give me 10", not "time out". Maybe that's whey "troubled kids" often get sent off to , and do very well in, military school: make your body make your brain work.
Reply Wed 3 Jun, 2009 11:21 am
We adjust (serotonin) neurotransmitter levels to help with depression....

Come to think of it, exercise is as effective at managing depression as antidepressant medications are, so it would make sense that regular exercise would help with managing "ADHD".

Perhaps the upswing in ADHD is simply a consequence of focusing on academics at the expense of PE.
Reply Wed 3 Jun, 2009 11:22 am
One of the twins has a horrible temper. It has improved greatly with the "drop and give me 10" every time he throws something or kicks something out of anger. He put his foot through my antique wicker chest one day...I had to do something to make him think before he reacts and hurts himself...or someone.

This has definitely helped more than taking away a privilege. I have also suggested that he go use the punching bag downstairs when he gets angry- before he lashes out at someone or some thing. It is a good way for him to learn self-control and use that pent up energy in a more effective manner. I also made him pay me for the damage done. That really bothered him.

I think there are good physical ways to help kids learn. I think the traditional classroom setting lets a lot of kids down in some aspects.
Reply Wed 3 Jun, 2009 11:30 am
Perhaps the upswing in ADHD is simply a consequence of focusing on academics at the expense of PE


I wonder how typical a diagnosis of ADHD is in rural areas where a kid might go home from school and work on the farm for a few hours.
Reply Wed 3 Jun, 2009 11:34 am
That would be interesting. If things today are as they were when i was a boy, farm kids probably have already put in an hour or more of labor before they get on the bus.
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Reply Wed 3 Jun, 2009 11:41 am
(following all this with interest..)
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Reply Wed 3 Jun, 2009 11:47 am
I might start with the "drop and give me 10" or running laps or something. Taking away a privilege doesn't phase Mo at all.

I know the traditional classroom is letting Mo down.

I also understand what they're up against so I've learned to play the part and not blame Mo too much for stuff.

Just yesterday he got in trouble for something minor so he had a "time out" and missed part of his recess.* Later he got sent to the principal's office for somehow flinging himself on and off a wall in the restroom and some kid told on him.

So of course I had to meet with Mo and his teacher after school where I was told that Mo saw the principal....

Teacher: Mo, do you know why that was the wrong thing to do?

Mo: Uhhhhh..... I guess it's kind of hard to explain....

Teacher: You could have broken the wall.

Mo: Actually that wall is pretty sturdy......

Me: (trying hard not to laugh) I guess what you were doing bothered some kids and that's why they told on you. The school doesn't want you hanging off the wall so don't hang off the wall anymore. They don't want anyone to get hurt.

Mo: Everyone hangs off the wall and nobody gets hurt.

Me: Doesn't matter. Go home and hang off the fence. Don't hang on the wall at school.

Mo: Okay.

Me: (To myself: if you'd just let him have his darn recess he wouldn't have been hanging on the dang wall! For the 10,000th time -- time out does not work with this child.)

Welcome to Eugene Ionesco Elementary School......

Reply Wed 3 Jun, 2009 11:52 am
Welcome to Eugene Ionesco Elementary School......

Now that was pretty damned funny . . . are you familiar with La Leçon?
Reply Wed 3 Jun, 2009 12:41 pm
I had to go back and refresh my memory but yes, I have seen that one preformed!

Lucky me: half my life ago I lived near the University of Chicago and the drama department was doing Ionesco. For a couple of bucks I could be bewildered and laughing for a few hours before heading back to the black clad emo art school scene.

I love Ionesco and now I thinking I should go read some of it!
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Reply Wed 3 Jun, 2009 07:05 pm
Unfortunately most teachers still require students to be seated during class. In learning centers, so long as they can keep focused, students with adhd can be standing at their desks and even pacing a bit. The thing is that sometimes that often the H leads to the D (hyper-movement leads to a point of distraction).

For example, one boy I've worked with would be working on filling in the blanks of a science sheet. He wouldn't use his textbook. He remembers verbal teaching best and could recall what was taught orally in class given enough thinking (sometimes quite quickly). But, he'd wander over to the window as he thought, pick up the shade pull and twist it around. After a couple of minutes, I 'd check in with him. Sometimes he'd complain that he was thinking and needed me not to interupt, but sometimes he was completely off on a tangent (making a noose, watching life outside the window).

I'm all for kids being able to stand or even move(kinetic learners) while learning, in principal. But in practice, with more than one in a class, it can get a little messy. Of course, it could be a structured whole-class movement. Reader-theater is a fun way to do this with text. Clapping out syllables and chant-spelling is quite common. Clapping out definitions worked for the student above in his scinece class (which was heavy with definitions).
Reply Wed 3 Jun, 2009 07:09 pm
Ah yeah - "at the expense of PE". This is such a stupid new trend. Kids in elementary school getting 3 gym periods in 2 weeks! Who thought that up? Oh yeah, principals accommodating changes required by law (NCLB).
High Seas
Reply Thu 4 Jun, 2009 10:01 am
Plato's Academy (5th century BC) had ALL instruction made by teachers and students while walking around the grounds - whence "peripatetic", Greek for "walking around". May be the most famous philosophy school of all times, too. Hardly a new concept.

Anyway, if you recall the magicians' tricks article on neurology involved: there are 2 distinct groups of brain cells involved, one group that focuses on the task at hand, the other group blanketing out all other brain activities, since they might interfere with the work of the first group.

Magic tricks do both, and neuroimaging of people with focusing difficulties does seem to suggest (to medics, not a class to which I belong) that flooding the brain with either stimulants (amphetamines etc) OR with depressants (anti-anxiety drugs and the like) is a brute-force approach bound to interfere (by definition) with either one or the other group of brain cells (either the alert-focus ones or those involved in the systems-shutdown part) whereas BOTH groups should be allowed to work in tandem. There were some pharmacology references in that article.
High Seas
Reply Thu 4 Jun, 2009 10:13 am
@High Seas,
PS this isn't a directly relevant article, but very useful in discarding so-called "medical tests" which don't help, or even cause harm - the ADHD testing barrage probably included in the latter category. Have to post it in full as it's copyrighted by Forbes (subscription only).



Eight Tests That Could Save Your Life; Only a precious few disease-screening tests make a difference in healthy adults. Here's what you need to know.
On The Cover/Top Stories
1963 Words
08 June 2009
Volume 183 Issue 12
(c) 2009 Forbes Inc.
Only a precious few disease-screening tests make a difference in healthy adults. Here's what you need to know.

No modern doctor would have been surprised at Franklin Delano Roosevelt's death from a cerebral hemorrhage in 1945. His blood pressure was 260 over 150 millimeters of mercury, double the normal level.

Blood pressure, measured by how far pulses of blood in your arm push up a column of mercury, is one health-related number everyone should worry about. But it's on a very short list. If you're healthy and trying to stay that way, the important tests are few and relatively low tech. Measure your cholesterol. Step on a scale. Check for signs of a small number of cancers and tell your doctor if you feel depressed.

This advice may run contrary to what might be characterized as test madness--the tendency of doctors and patients to want to test in all sorts of ways, using dozens of parameters that purport to measure how well your internal bodily engine is running. More are proposed and touted by entrepreneurs all the time--such as exotic new genetic tests and whole-body scans. They claim they will spot disease before symptoms arise. But most have no data proving that taking the test will improve your health or lengthen your life.

"There are five things that can happen with a screening test, and four of them are bad," says B. Ned Calonge, the Colorado doctor who is chairman of the U.S. Preventive Services Task Force, a government-sponsored expert panel that evaluates preventive tests. Tests can indicate you have a disease you don't. They can tell you don't have a disease you do, leading you to ignore symptoms. They can spot a slow-growing disease you might be better off not knowing about. And they can waste money with unhelpful information.

Conclusion: Before you take an exotic test, talk to your doctor about whether taking it will really improve your health.

The Preventive Services group takes a conservative approach and tries to cherry-pick the few tests that are highly likely to lead to better health. Its list of recommended screening tests for healthy adults provides the basis for ours; we've added an overall calculator for heart risk, and waist circumference, which many cardiologists believe may spot risky amounts of abdominal fat.

Most of our tests screen for the risk of heart disease and stroke. Cardiovascular disease slays 800,000 Americans a year, 60% more than cancer, the runner-up killer. Heart disease put the whole idea of risk screening on the map. The Framingham Heart Study, which has followed 5,000 patients in Framingham, Mass. for half a century, established blood pressure and cholesterol as risk factors way back in 1961.

Routine blood panels done by doctors often include dozens of obscure numbers. Finding out many of these lab numbers might not hurt, but there's not a lot of proof they'll help you in the long run. If you do enough tests, one will be high just by chance-- causing unnecessary anxiety and yet more tests.

Health is not just about the numbers. Too often, "the abnormality on the screening test has become the disease," says Peter Bach, a pulmonologist and epidemiologist at Memorial Sloan-Kettering Cancer Center. Equating the number with the disease can lead to problems. In one big study diabetics who had their blood sugar lowered all the way back to normal died sooner than those who had it lowered somewhat less. So stick to treatments that have been proved in clinical trials.

Blood Pressure

Optimal: 120/80 mm Hg or lower Borderline: 120/80 to 140/90 mm Hg High: above 140/90 mm Hg

Every 20-point increase in blood pressure doubles your risk of dying from a heart attack or stroke. The top number measures the pressure of blood flowing through your arm when your heart beats; the bottom is the pressure between beats. Even people over age 80 cut their risk of death by 20% if they lower their blood pressure by 15 points with drugs, a 2008 New England Journal of Medicine study found. Various categories of blood pressure drugs lower heart risk; many are cheap generics. Lifestyle changes--such as losing weight, cutting salt intake or increasing fruit and vegetable intake--can have an effect similar to taking a single blood pressure medicine.

Bad Cholesterol (Low-density lipoprotein, or LDL)

Optimal: LDL less than 100 milligrams per deciliter of blood Normal: LDL between 100 and 129 mg/dL Borderline: LDL 130 to 59 mg/dL High: LDL 160 to 190 mg/dL Very high: over 190 mg/dL

Ideally, a person's low-density lipoprotein should be under 100, as it was in your average hunter-gatherer. But national guidelines generally don't push drug treatment until levels reach 160. In people with heart disease, it appears, any lowering of LDL is accompanied by a survival benefit. But extrapolating those results into healthy people requires a leap of faith. The Preventive Services Task Force recommends screening starting at age 35 for men (who are at risk for heart disease earlier) and at 45 for women. The National Cholesterol Education Program recommends screening all adults over 20.

Overall Heart Risk

Low: less than 10% chance of developing or dying from heart disease in ten years Medium: 10% to 20% chance High: more than a 20% chance

A careful internist calculates your risk level before prescribing cholesterol-lowering statin drugs. That risk depends not merely on LDL but on factors like your age, gender, blood pressure and whether you smoke. If your doc shortchanged you, do the work yourself. One risk calculator, based on heart disease rates among residents of Framingham, Mass., can be found by Googling Framingham Risk Calculator; the site is run by the National Institutes of Health. A newer calculator is the Reynolds Risk Score (http://www.reynoldsriskscore.org). It adds family history and results from a blood test for high sensitivity C-reactive protein (CRP), a measure of inflammation (high CRP is above 3 milligrams per liter). You can ask for CRP to be included in your next blood test; it might add $50 to the lab's bill. And once you know your risk level, talk to your doctor about whether you need a statin, blood pressure drugs or lifestyle changes.

Body Mass Index

Obese: 30 kilograms or more of weight per meter squared of height Overweight: 25 to 30 kg/m2Normal weight: 18.5 to 25 kg/m2

Obese people have a higher mortality rate, especially from cardiovascular disease. They are more likely to get diabetes, arthritis and certain cancers. Obesity is defined as a body mass index (BMI) above 30. BMI, in turn, is an abstract ratio that compares a person's weight to the square of his height. As a shortcut, multiply your weight in pounds by 703 and divide the result by the square of your height in inches; or go to http://www.nhlbisupport.com/BMI. Being very underweight raises the risk of death, too. Whether being moderately overweight will kill you is murkier, with studies showing conflicting results. One reason: BMI is a crude metric that doesn't directly measure the level of abdominal fat. (It overstates the obesity of muscle-bound athletes and understates that of flabby people.) Abdominal fat is probably a driver of heart risk.

Waist Circumference

Men: risky if at or above 40 inches Women: risky if at or above 35 inches

Another metric that may help distinguish people at high risk of cardiovascular disease is the waist circumference. People with bulky waistlines are significantly more likely to die over the next ten years, even if they aren't obese or overweight, according to a 2008 study of 359,000 European men and women published in the New England Journal of Medicine.


Bone mineral density (T-score)Normal: 0 to --1 Low bone density: --1 to --2.5 Osteoporosis: --2.5 or lower

The Preventive Services panel recommends bone density screening for women starting at age 65, when osteoporosis becomes more common, or at age 60 if other risk factors are present, such as previous fractures. It doesn't yet make a recommendation for men, who have much lower fracture rates. (The American College of Physicians recommends older men get screened if they have risk factors such as previous oral steroid treatment.) The most common test, a T-score, measures how much less dense your bones are compared with those of an ethnicity-matched 30-year-old. The most relevant tests measure the bone density in the hip or spine, where fractures are most serious.

It can make sense to take other risk factors into account. To estimate your hip fracture risk based on World Health Organization data, Google "frax" or go to http://www.shef.ac.uk/frax, click on the phrase "Calculation Tool" in the drop-down menu and select your country and race. You can leave question 12 (on bone mineral density) blank. A 3% ten-year risk of hip fracture made drug treatment cost-effective, a 2008 study found.

Blood Sugar1

Normal: under 100 mg/dL Prediabetes: 100 to 125 mg/dL Diabetes: 126 or higher mg/dL 1There are multiple tests; these numbers are for the fasting plasma glucose test.

Diabetes kills mostly through heart disease. If you don't have symptoms, you can wait to get your blood sugar tested until your blood pressure is high or you are considering treatment for high cholesterol, Preventive Services says. Diabetics need more aggressive blood pressure and cholesterol lowering, in addition to treatments to lower their blood sugar. Preventive Services says there is "insufficient evidence" to recommend blood sugar tests for all older adults, as no trial proves that doing this saves lives. The American Diabetes Association recommends blood sugar tests for all individuals over 45. For those in the high-risk prediabetic category, diet and exercise are more effective than drugs at preventing full-blown diabetes (so found a big 2002 government trial). GOP presidential candidate Mike Huckabee reversed his diabetes by dieting.

Cancer Screening

Numerous cancer screenings have been proposed over the years, but Preventive Services recommends only three: Pap smears for cervical cancer; colonoscopy or other screening tests for colon cancer in men and women starting at age 50; and mammograms in women starting at 40. Pap smears are credited for dramatically reducing cervical cancer deaths, and some trials have shown that mammograms prevent breast cancer deaths.

The group recommends avoiding many other cancer screens, including blood-in-urine tests for bladder cancer (too many false positives); various tests to spot ovarian cancer (many false positives); testicular cancer exams (unlikely to provide benefit); ultrasound to spot pancreatic cancer (no evidence this helps); and prostate-specific antigen tests for men 75 and up (who are likely to die from something else). Recent studies in younger men showed that tests for psa lead to lots of treatment but save few lives, as prostate cancer is such a slow killer. Skepticism may be warranted.

Additional Tests

Preventive Services also recommends: HIV tests for adults at increased risk; chlamydia and gonorrhea tests for sexually active young women; one ultrasound check for aortic aneurysms in male smokers and former smokers between ages 65 and 75; counseling to consider BRCA1 and BRCA2 breast cancer gene tests in women at risk due to family history. Talk with your doctor about your alcohol use and if you are frequently sad. Pregnant women need additional tests.


(c) 2009
Reply Thu 4 Jun, 2009 10:19 am
Ah yeah - "at the expense of PE". This is such a stupid new trend. Kids in elementary school getting 3 gym periods in 2 weeks! Who thought that up? Oh yeah, principals accommodating changes required by law (NCLB).

This has been one of my concerns. I am afraid they are just headed toward more active children and more classroom problems by limiting their PE time - and playtime.

The boys told me that they stopped having recess at the end of the year and started doing math fact drills instead. I wouldn't have a problem with this if theire PE time was more than standing in a circle and popping a ball around on a parachute. Not only that - but they are limiting their physical activities at school and then sending them home with homework so that they have less time to be active and outdoors when they get home.
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