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ADHD Summer Survival Tips

How to keep ADHD kids happy and healthy all summer long. Plus, is summer the right time for a medication vacation?

By Denise Mann
WebMD Magazine – Feature

Reviewed by Amal Chakraburtty, MD

When her son Anthony was diagnosed with attention deficit hyperactivity disorder (ADHD) at age 6, Mary Robertson quickly became an amateur travel agent during his summer vacations.

She didn’t have much of a choice. “One day Anthony came home hiding a handsaw behind his back because he had sawed down a neighbor’s tree to see how old it was,” recalls the oncology-nurse-turned-ADHD-patient-advocate. “I realized pretty quickly that to stay at home and not have something planned was not gonna work.”

Robertson’s challenge is one all parents face, especially during the summer, and doubly so for those who have kids with ADHD, a behavioral disorder that affects about 2 million children in the United States, according to the National Institute of Mental Health in Bethesda, Md.

ADHD is marked by inattention, impulsivity, and/or hyperactivity, which means that children with the condition may act quickly without thinking; can’t seem to sit still; will walk, run, or climb around while others are seated; and are easily sidetracked by what is going on around them. For these reasons, they may have difficulty at home and school, and in forming and maintaining relationships with their peers.

“During the summer, you have to have a plan. You can’t just wake up in the morning without an itinerary, or [ADHD kids] will figure out things to get into,” says the Lexington, Ky.-based mother of Anthony, now 20, and his sister Samantha, 17, who both have been diagnosed with types of ADHD. “The best thing you can do is to take them somewhere,” she adds. “We have been to every park that there is. My son’s kindergarten teacher even complimented me on the fact that Anthony was so worldly.”

ADHD Summer Tip 1: Stress Structure

“If children with ADHD don’t have a structured day or week, they can get into trouble because they may try to create stimulation for themselves in a way that might result in mischief,” says Karen Fleiss, PsyD, co-director of the New York University Summer Program for Kids and an assistant professor of clinical psychiatry at New York University in New York City. “Kids with ADHD can be sensation-seeking, careless, and more impulsive than children without this behavioral disorder.”

Left on their own, “they may say ‘Let’s bake’ and then get distracted, forget about it, and go outside and play,” Fleiss adds. The result? You guessed it: a four-alarm fire.

Marshall Teitelbaum, MD, a child, adolescent, and adult psychiatrist in private practice in Palm Beach, Fla., agrees. “Kids with ADHD are more likely to get hurt over the summer than during the regular school year. There are a lot more accidents if a child is distracted or impulsive.”

Adds Stephen Grcevich, MD, a child and adolescent psychiatrist at Case Western Reserve School of Medicine in Cleveland: “They misjudge time, procrastinate, and test limits more.”

That’s why a regular routine is so important. “Kids with ADHD are a little less able than kids without ADHD to structure themselves, so they need a little more external support,” says Joel L. Young, MD, a psychiatrist in Rochester Hills, Mich., and the founder and medical director of the Rochester Center for Behavioral Medicine.

ADHD Summer Tip 2: Consider Day Camp

Parents of ADHD kids should try to find “structured activities where children will have the opportunity for interaction with peers, and where they can have a consistent day-to-day routine, such as summer camps, religious camps, or sports-related activities,” says Grcevich.

And camps don’t have to cater exclusively to children with ADHD, he says. “Some kids, especially in the group with predominantly inattentive symptoms [such as being easily sidetracked or daydreaming, rather than being hyperactive or impulsive] of ADHD, will do well in many nonacademic settings or activities.”

Still, kids with ADHD who have marked social difficulties may benefit from a specialty camp. “Many of these camps — especially the summer treatment programs run by the larger academic medical centers — do a nice job teaching kids skills to help them in making and keeping friends.”

Of course not every family has the funds for such diversions. “Camp is great if you can afford it but not all families can,” says Young, author of ADHD Grown Up: A Guide to Adolescent and Adult ADHD. Instead, “try making a play date in the morning with a friend, and generally having something on the agenda -whether it’s visiting a friend’s house or taking a trip to a local zoo. It’s also really good to encourage creativity. Arts and crafts projects can be helpful.”

ADHD Summer Tip 3: Make Lists

What if you are a working parent who is not at home to oversee such daytime excursions? According to the U.S. Census Bureau, 60.2% of married women were in the labor force in 2005, making activity-planning one more item to add to parents’ already-extensive “to-do” list: “I would recommend that parents sit down with their child care providers and explain the special circumstances and specific expectations regarding daytime structure,” Young says.

To do this, “a schedule or a list would be very helpful and effective,” he says. Don’t be too draconian. “You want them to have plenty of fun during the summer and not simulate the school day. Lists, along with a general time frame of what needs to get done during the day, will be helpful.” For example, 7-8 a.m. is breakfast time, followed by a 9-11:30 a.m. visit to a friend’s house, and reading time at 2-2:30 p.m.

Finally, whether your relatives help with child care, or they are simply around for a summertime visit, “it’s important that all family members agree to maintain the routines for children with ADHD to function well,” says Teitelbaum. This includes plans around medication and behavior modification, common treatments for ADHD.

ADHD Summer Tip 4: Set a Bedtime

Having fun-filled summer days often hinges on getting a good night’s sleep. However, many children with ADHD have difficulty sticking to a regular bedtime. They may get preoccupied with TV or computer games or just have difficulty winding down. As a result, they can be tired and unwieldy the next day. And that can drive parents crazy.

Bad bedtime habits are “more typical of kids with ADHD because their bodies are always active, and it’s harder for them to settle down to go to sleep,” Fleiss says. And no matter what time these kids go to sleep, they often get up at the crack of dawn, she adds.

A set bedtime is essential for kids with ADHD — and this should not change simply because the days are longer in summer.

“Set a bedtime Monday through Friday, then be more flexible on weekends,” Fleiss suggests, and encourage downtime for an hour before the desired bedtime. Read with your child, watch something relaxing on TV, or tell him or her a story to create a transition from an active phase to a sleep phase. And “give in once in a while. If you go to Great Adventure for the day, you don’t have to run home to get your kid in bed by 9:30 p.m.”

ADHD Summer Tip 5: Don’t Drop Academics

Making time for tutoring or other learning activities throughout the summer helps to maintain a routine, and provides academic continuity for maximum success in the fall, Teitelbaum says. “It is especially challenging for many kids with ADHD to get back into the flow when school starts, so a summer reading list or some kind of tutoring can make sure he or she [won’t be] miserable getting started again.”

“It’s important to include some kind of academic activity throughout the summer — even if that just means reading with your child for 20 minutes throughout the day,” echoes Fleiss. “Close to 33% of kids with ADHD also have other learning disabilities, and it can be easier to fit tutoring in during the summer than after a full day of school.”

Young adds, “Summer is a good time for your child to read what he or she likes — instead of books dictated by the school’s curriculum. Go to the library or book store for a book that piques his or her interest.”

While learning activities are important during the summer, kicking it up a notch just before school begins can make a huge difference in your child’s academic performance, says Grcevich. “First impressions among teachers have a large bearing on how the school year will progress,” he says. In the two weeks before school starts, “I would definitely recommend reinstituting bedtimes and wake-up times necessary during the school year. Kids will also benefit from engaging in the cognitive tasks required of them during the school year, such as reading and practicing math.”

Following these tips for kids with ADHD — structured activities, day camps, inspired lists, set bedtimes, and ongoing academics — can alter your attitude toward June, July, and August, says Robertson.

“If you organize your days, then by the end of the summer, you will not be jumping up and down for joy when he or she goes back to school,” she says.

ADHD Medication Vacation?

Another hot-button issue for many parents is whether to stop or adjust their child’s ADHD medication during the summer. Parents may crave the respite because these medications can have unwanted side effects, such as poor appetite, and many have an inherent fear of having their children on any medication — especially a stimulant-type drug. Some parents may just want to see how their child fares without medication when there are no academic pressures.

“Parents can consider using the summer to address concerns and questions that they have about their child’s current medication regimen,” Grcevich says. For example, “if parents see that the child gets benefit from medication but is having worrisome side effects, they can consider a trial of different medication in summer.”

The warm-weather months are a safer time to try this because “you don’t have to worry about your child failing tests or doing poorly academically during the summer, so it can be a good time to make these changes,” says Fleiss.

Robertson took her son off medication one summer. “While on medication, Anthony was better able to play patiently with peers, follow directions, and sit still without a major battle,” she recalls. “When we took him off meds for the summer, Anthony’s hyperactivity, impulsivity, and inability to pay attention returned with a vengeance. It became a full-time job to try to entertain him in an effort to keep him from creating his own entertainment.”

Off medication, with full-blown ADHD symptoms, Anthony used to burn ants and once lit the neighbor’s dry leaves on fire — among other things, she says.

But Nancie Steinberg, a New York City-based public relations expert, is still not sure what she will do about her son Austen’s ADHD medication this summer. “I gave him a reprieve during winter break as an experiment, but I think it showed me he needs it to stay focused and not restless,” she says. “I may try again this summer to see what he is like and determine if he truly needs to be medicated.”

If Steinberg or other parents decide to let their children take a medication break, Grcevich says, “We strongly encourage them to resume medication two weeks prior to the new school year so that kids are prepared to perform at their best from day one.”

Of course, ADHD is a condition with different levels of symptoms and severity. Every ADHD child is different and requires an individual assessment. Parents should speak with their child’s doctor about the best approach during the summer — and year-round.


10 Best Jobs for Adults with ADHD

Written by Kimberly Holland | Medically Reviewed on November 26, 2012 by George Krucik, MD, MBA

The challenges of attention deficit hyperactive disorder (ADHD) in a classroom setting are familiar—students with ADHD often struggle with classwork, interrupt the teacher, and have difficulty passing tests. While many kids outgrow the hyperactivity, impulsiveness, and inattentiveness associated with the disorder, about 60 percent of children with ADHD become adults with ADHD, according to the Anxiety and Depression Association of America (ADAA, 2012).

Adult ADHD is characterized by restlessness, disorganization, and the inability to focus—all things that may prevent a person from getting and keeping a job. But many adults with ADHD do have successful professional careers. Here’s a list of traits common in people with ADHD and the jobs that take advantage of these unique strengths.

Captivated by Change: Police Officers and Firefighters

Police officers and firefighters are busy. No two days are the same, which is a good thing for people with ADHD because a routine can become tedious. ADHD adults find pleasure in constant change; they thrive in an environment that is stimulating and in which they have to adapt and analyze.

The training required to become a police officer or firefighter is challenging, however, and may be too difficult for some. Working with a mentor can help people with ADHD maintain their focus during testing and training. Once they’re in a police station or firehouse, ADHD adults will find themselves busy with work they find both fulfilling and rewarding.

Thrive in High-Intensity Environments: Doctors and Nurses

“People with ADHD tend to work well in a fast-paced, high-intensity environment, like that of an emergency room or ambulance,” says Dr. Stephanie Sarkis, a clinical psychotherapist and assistant professor at Florida Atlantic University in Boca Raton. Like police officers, doctors and nurses never have the same workday twice. This requires them to call up all of their training, maintain focus, and work with others to succeed.

Working in a hospital may involve long hours, stacks of paperwork, and having to answer to authority figures—all possible weaknesses for ADHD adults. But having a strong support staff and colleagues willing to help can allow people with ADHD to succeed in the medical field.

Enjoy Talking a Lot: Salespeople

People with ADHD love talking to others. Sales jobs are a great way to focus this natural energy in a positive way. In an environment that requires heads-down, solo work, ADHD adults may get frustrated without human interaction and begin bothering their co-workers. But with a job that depends one-on-one communication, such as sales, someone with ADHD may find great success.

Express Creativity: Artists and Entertainers

The entertainment industry has long been a mecca for dreamers, creators, and visionaries. The energy and drive it takes to succeed in any aspect of the entertainment industry—as a graphic artist, ballet dancer, or stage actor—is exhausting for most people, but not for those with ADHD. Their high-energy drive can propel them into a fruitful creative career.

Enjoy Physical Work: Members of the Military

The military, in which order and discipline are key, may seem like the last place for a person with ADHD. Yet some do very well in the armed forces. That’s because the intense mental focus and physical demands of training keep their minds and bodies engaged. They have clear instructions, an objective, and incentives to reach their goals.

Still, joining the Army, Navy, Air Force, Marines, or Coast Guard isn’t for everyone. A person with ADHD might rebel in a military hierarchy, not thrive.

Be Independent: Entrepreneurs

Entrepreneurs must have determination, boundless energy, and the desire to succeed. They also have to share that drive by interacting with investors, employees, and customers. This requires a great deal of independent work, organization, and planning—areas in which people with ADHD typically struggle. But not when it’s their own business—something they are deeply committed to seeing through. “When they’re in an area of passion, people with ADHD flourish,” says Dr. Kevin Ross Emery, author of Managing the Gift: Alternative Approaches to Attention Deficit Disorder.

Prefer to Work Outside the Office: Commission Salespeople

Salespeople who work on commission are out-and-about, shaking hands, and seeing new faces. It’s the type of job in which a person is almost always “on.” No cubicles or 9-to-5 schedules here. “Work environments that are ‘outside the box’ are perfect for people with ADHD,” Dr. Emery says. “It gives them the space and flexibility they need, with the right amount of structure so they can be really successful.”

Enjoy Variety: Mechanics

Working on cars, boats, and motorcycles is a hands-on, physical job. It’s one that is different each day, often calls on a person’s critical-thinking skills, and requires face-to-face interaction. It’s perfect for a person with ADHD who feels trapped behind a desk and loves solving problems.

Enjoy Hands-On Work: Construction Workers

The construction business keeps people busy and working hard. It’s also a job that changes frequently while still providing clear instructions and objectives. There’s little time for boredom—as soon as one portion of a job is done, there are usually other tasks to complete. A person with ADHD can succeed in the construction industry, so long as he or she deals well with authority figures.

Need Clear Deadlines: Delivery Truck Driver

Delivery truck drivers are people on a mission; they have somewhere to be, and they have to be there by a certain time. It’s the perfect structure for a person with ADHD. “Employees with ADHD thrive in environments where they have clear instructions and directives,” Dr. Sarkis says.

With a truck full of boxes and a day in which to get them delivered, a person with ADHD will work hard to accomplish the task before them. This profession also allows ADHD adults to work outside of a typical office setting, interact with others, and use their boundless energy to complete assignments.

Hiring Employees with ADHD

Adults with ADHD make very industrious employees. They are high-energy, naturally curious, and eager to succeed. Making a few small adjustments can help you establish a productive work environment for them. “People with ADHD flourish when expectations and deadlines are clear and put into writing,” Dr. Sarkis says. “Employers should break down projects into smaller tasks and assign deadlines to those components.”

Also, help your ADHD employee identify a coworker who may be able to help him or her with the more challenging aspects of the job, such as paperwork. It may take extra time to integrate an employee with ADHD, but once you do, it’s likely to be a very successful partnership.


ADHD Study at Boston University Questions Medications

Dr. Kathleen Kantak thinks medicating adolescents with ADHD may lead to cocaine use later in life.

adhd medsIn 2011, more than six million children and adolescents in the U.S. were diagnosed with ADHD (Attention-Deficit/Hyperactivity Disorder), and that number grows every year. According to the CDC, of the roughly six million ADHD patients, six percent were taking ADHD medication in 2011. As the number of ADHD diagnoses grows each year, so does the amount of medication prescribed to adolescents. Dr. Kathleen Kantak thinks this could be the reason why many ADHD kids develop cocaine habits later in life.

Kantak, a professor of psychology at Boston University, has conducted a study based on previous clinical trials that showed that one in five adolescent ADHD patients develop cocaine habits in their adult lives. She wanted to look at why adolescents who are prescribed ADHD medications like Ritalin and Strattera, have a higher chance of becoming addicted to cocaine in adulthood.

Kantak’s study examined three different types of rats: spontaneously hypertensive rats (SHR) which exhibit similar symptoms to adolescents with ADHD, inbred Wistar-Kyoto (WKY) rats, and outbred Wistar rats. Neither of the Wistar rats showed signs of ADHD and served as Kantak’s control groups.

After observing all three groups’ normal behavior, rats from each group were given either Ritalin, Stattera, or no drugs at all. After the rats’ adolescence was over, they were all taken off the medication. Next, each adult rat was implanted with a catheter through which, at the push of a lever, cocaine could be self-administered at will.

The team observed that the SHR rats, regardless of their medication history, developed a cocaine habit faster than either of the other two types of rats. Additionally, the SHR rats who were given Ritalin as adolescents were more inclined toward higher usage of cocaine than the SHR rats who were not medicated with Ritalin.

Kantak’s conclusion? Rats who exhibited signs of ADHD as adolescents and were given Ritalin as treatment, were more inclined to develop an addiction to cocaine as adults.

In an interesting turn of events, Kantak’s team also found that the WKY rats who received Strattera were quicker to pick up a cocaine habit than those that never took the drug.

The conclusions drawn by the team, according to Kantak, are twofold. “If they’re an adolescent getting a stimulant medication, and they’re properly diagnosed, the medication may put them at increased risk [for adult cocaine risk],” she said in a report. “If they’re misdiagnosed, and get Strattera, this may also be putting them at greater risk… of acquiring an addiction to cocaine.”

The study seems to suggest that adolescents who are diagnosed with ADHD should be given Straterra, rather than Ritalin as treatment, because it is a non stimulant, and those who do not have a definitive diagnosis should avoid taking the medication in order to avoid the increased risk developing a cocaine habit later in life.

This also brings into question the high numbers of ADHD diagnoses in the past few years, as it is possible that over-diagnosis of adolescents may result in increased cocaine addicted adults in the future.

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More Than 1 in 10 U.S. Children has ADHD, U.S. Survey Finds

BrainATLANTA — The number of U.S. children with attention deficit hyperactivity disorder continues to rise but may be levelling off a bit, a new survey shows.

More than 1 in 10 children has been diagnosed with it, according to the Centers for Disease Control and Prevention, which surveyed more than 95,000 parents in 2011.

ADHD diagnoses have been rising since at least 1997, according to CDC data. Experts think that’s because more doctors are looking for ADHD, and more parents know about it.

The condition makes it hard for kids to pay attention and control impulsive behaviours. It’s often treated with drugs, behavioural therapy, or both.

The latest survey found about 11 per cent of children ages 4 through 17 had been diagnosed with ADHD. That translates to nearly 6 1/2 million children. Half of children are diagnosed by age 6, the study found.

A 2007 survey put ADHD diagnoses at 9.5 per cent of kids.

The CDC survey asked parents if a health care provider told them their child had ADHD. It’s not known how thorough the assessment was to reach that conclusion.

ADHD diagnoses were increasing at a rate of about 6 per cent a year in the mid-2000s, but slowed to 4 per cent a year from 2007 to 2011. That may reflect that doctors are closer to diagnosing most of the kids with the condition, said the CDC’s Susanna Visser, the study’s lead author.

Mike Stobbe, The Associated Press
November 22, 2013

Ritalin: 10 Facts You Didn’t Know About The So-Called ‘Smart Drug’

The Huffington Post UK  |  By Charlotte Meredith

RitalinRitalin is hitting the headlines yet again, after new figures revealed the number of drugs being dished out to ADHD sufferers has increased by 56% in just six years – sparking fears students may be buying into a new ‘smart-drug’ craze.

    • Ritalin, also known as methylphenidate, is a central nervous system stimulant that affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control
    • If it is snorted, swallowed in high quantities or injected, the drug can have a similar effect to using cocaine or amphetamines – and can be just as addictive.

 The use of methylphenidate drugs, including Ritalin, is on the rise 

    • In the United Kingdom, methylphenidate is a controlled ‘Class B’ substance. Possession without prescription carries with a sentence up to five years and/or an unlimited fine, and supplying it is 14 years and/or an unlimited fine
    • Street names for Ritalin include: Kibbles and bits, Kiddy cocaine, Skippy, Smarties, Vitamin R and Pineapple
    • The side-effects and misuse of methylphenidate have been associated with an increased risk of aggression, hostile behaviour and psychosis
    • The effects of long-term treatment on the developing brains of children with ADHD are ongoing, but there is limited data that suggests there are benefits to long-term use
    • The most common side common side effects are nervousness, drowsiness, bad vision and insomnia
    • More than one in 100 users can suffer from depression, hair loss and problems controlling muscle movement
    • Other users can suffer from anorexia, meaning some use it as an appetite suppressant
    • Some people who take the drug can subseuently suffer from Tourette’s syndrome.

The Upside of ADHD

Attention deficit hyperactivity disorder (ADHD) hasn’t changed, but how experts view the disorder is evolving in a new direction. Instead of only focusing on the difficulties posed by ADHD, today, the upsides are likely to be noted, too: the quick-wittedness, the speedy grasp of the big picture and the great enthusiasm for nearly everything. These traits make ADHDers endearing and simultaneously exasperating.

This change may sound like just a new way of describing the same old thing, but to those with ADHD, the difference is profound. An estimated two percent to four percent of American adults and three percent to seven percent of children have the brain-based disorder. For them, it’s the difference between seeing themselves as broken and thinking of themselves as having advantages, even if they have to cope with being fidgety, distractible or easily bored.

 In Praise of ADHD

 JetBlue Airways CEO and founder David Neeleman is famously frank about his ADHD. He was diagnosed in 2001, seven years after he realized he had it. By then, he’d already founded and then sold Morris Air. He had done so well in his own eccentric way that he felt he was doing fine without medication. Still, Neeleman says he’s not anti-meds: “I have talked to a lot of people who swear by the medication.”

Neeleman credits ADHD with his creativity and “out-of-the-box thinking”—it led him to invent e-tickets while at Morris, for example. “One of the weird things about the type of [ADHD] I have is, if you have something you are really, really passionate about, then you are really, really good about focusing on that thing. It’s kind of bizarre that you can’t pay the bills and do mundane tasks, but you can do your hyper-focus area.” He spends “all my waking hours” obsessing about JetBlue. The rest of his life, Neeleman says, would be a “disaster” if not for his wife, who manages their home and children; his accountant, who pays the bills and tracks his finances; and his personal assistant, who sends him his schedule every day and steers him from appointment to appointment, keeping him on track.

Ken Melotte, 43, of Green Bay, Wis., is quick to credit ADHD for his successes, too. “I have ideas immediately,” says Melotte, who’s on the management team of a national trucking firm. “I instantly start working on solutions, seeing different ways to do things.”

Yet, ADHD has been a struggle for him. Melotte doesn’t care for medication. The disorder vexes him most at work, as a project manager, when he had “a terrible struggle” keeping track of all the details. On the other hand, he believes that ADHD traits like empathy, intuition and the ability to motivate and inspire others made him a successful manager.

A “Context Disorder”

ADHD is considered a “context disorder,” Thom Hartmann says. Hartmann, an expert on the disorder, is one of the few who saw the positive side of ADHD before it was fashionable.

“If a left-handed person has a job cutting origami with right-handed scissors, that doesn’t mean they have a disability; they have a context disorder,” Hartmann explains. “Short people trying to play basketball have a context disorder.”

People with ADHD “may instead be our most creative individuals, our most extraordinary thinkers, our most brilliant inventors and pioneers,” writes Hartmann in his 2003 book The Edison Gene: ADHD and the Gift of the Hunter Child (Park Street Press, 2003). He posits that the people with ADHD may carry genetically coded abilities that once were, and may still be, necessary for human survival and that contribute richness to the culture.

A spate of books has come out that echoes Hartmann’s positive spin, including Delivered From Distraction: Getting the Most Out of Life with Attention Deficit Disorder (Ballantine, 2005), by Drs. Edward Hallowell and John Ratey, and The Gift of ADHD (New Harbinger, 2005) by Lara Honos-Webb.

To Hartmann, “Any kind of difference, even those differences that may make life more difficult or be viewed by some as pathologies, have to have some sort of upside, outside of pure disease processes. Otherwise they wouldn’t survive in the gene pool.”

by Marilyn Lewis for MSN Health and Fitness