Written by Dr. Carosso
Traditional approaches, for better or worse
You all know the traditional approaches to helping kids with ADHD. Children are often prescribed medication, and a number of behavioral approaches are used in the classroom including sitting away from distractions, near the teacher, calling on these children more often, and using sticker charts for success in completing assignments. These approaches have varying success rates; sometimes the distractions are too tempting, and some kiddos can’t tolerate medication.
A ‘stationary disorder’
For lack of a better description, ADHD can be considered a stationary disorder; the child has a very hard time remaining stationary. They have an overwhelming compulsion to move, fidget, look around the room, and get out of their seat.
If you can’t beat’em, join’em
We spend so much time trying to keep our ADHD kids stationary that we end up, as someone very important once said, ‘kicking against the goads’ (your quiz for the week is figuring out who said that). Anyway, why fight it; if your child wants to move then, by all means, let’em move.
A recent study
At Michigan State (study published in Journal of Pediatrics), they found kids functioned significantly better on an lengthy academic task after 20 minutes of running around like a, well, running around a lot; compared to those who did not. They focused better and, if they made a mistake, were better-able to slow themselves to avoid making another error. By the way, there has been prior research suggesting that brisk activity in green space was even more calming.
Why not at home too?
Why not use this approach in brief stints throughout the day to help your child persevere through school, homework, before a trip to the store or church, and in any endeavor that requires sustained attention, self-control, and being stationary. Otherwise, you can keep kicking against the goads, which will make both you and your kiddo quite frustrated. This approach should be incorporated into the school day (and for goodness sake, never have an ADHD child lose recess as punishment) and ensure the child is actually running vigorously rather than standing around playing video games or talking. You may want to get on your running shoes as well. We need more research to specify the necessary length of the activity; the research subjects were active for 20 minutes, but I’ve seen success at 8-10 minutes.
Give it a try
Let me know about your positive outcomes and how you’ve adapted this technique to make it more practical. I can be reached at jcarosso@cpcwecare.com. Okay, let the running begin.
The Sting
Not too long ago I was stung by a hornet. Not a pleasant experience by any means, but it’s not like I haven’t been stung before so didn’t think it would be much more than an annoyance.
All stings not created equal
Well, as it turns out, the first sting, possibly years earlier, may only result in a minor reaction but it can sensitize a person for major reaction the next time. Also, of course, there a bunch of different types of bees (upwards of 4 different types of hornets in this area, wasps, and regular old honey bees). Turns out I’m not allergic to honeybees, but big-time to all the rest of them. Who knew?
What happened??
Only seconds after the sting, I was bright red, burning-up, and super itchy. About two minutes later, I went into anaphylactic shock and fell unconscious. Actually, I apparently came-to (don’t remember a thing) but again passed-out, fell down once more, causing further injury and whatnot.
How did it end-up?
By the grace of God, Frances, my wife, was present and she understood what was happening, alerted our quick-acting neighbor, Mr. John Sarneso, who just happened to be available with an epi-pen. Otherwise, I probably would not be writing this now. Within seconds after the shot, I started to come to my senses and become coherent. It took a few more hours in the hospital to finally feel somewhat okay; but I didn’t get back to work till 48 hours later.
An ounce of prevention…
These days, I don’t go too far without an epi-pen, which is available from your local allergist, PCP, or pediatrician. I got mine from my dear friend and allergist, Dr. Pierre Dauby, M.D.,FAAAAI who is an excellent doctor and also works great with kiddos. Dr. Dauby is with UMPC Greensburg Allergy Associates (724-837-4070). He also provided more specific allergy testing and will soon begin my desensitization regimen so that, in a few months, I’ll have a minimal reaction to a bee sting.
What about you and your kids?
I am now on an epi-pen crusade. No home should be without one. You never know whether a direct family member, neighbor, relative, visitor, or whomever is suddenly going to have a horrible reaction to a sting (or peanuts, tree nuts, diary, various medications…) and you’ll be helpless without an epi-pen. They come in two different doses based on weight: below and above 60 pounds.
Another tip
I’m no paramedic, but apparently it’s best to NOT sit-up the person; rather, keep them down and elevate their feet. This way, the blood is more likely to remain available for the heart and brain. Otherwise, well, the opposite is true, which is not a good thing.
This isn’t a typical post?
True, this post is not about autism or childhood behavioral health, which is uncommon for me. However, there are few issues that are so potentially fatal while, at the same time, so easily preventable. Keeping you, your family, and your child safe is of primary importance, which is why I wrote this post. Moreover, most people are completely ignorant (as was I) about the utility of epi-pens.
Some shout-outs!!
Want to take this opportunity to again thank John for his quick-acting and unflinching jab with that epi-pen, in spite of my incoherent attempts at pushing him away. Thanks again to Dr. Dauby who hopefully will make me immune to those little stinging gremlins, and also a big thanks to my neighbor, Dr. Emmanuel Frempong-Manso, M.D. who made a special trip to the hospital after a long day, got everything in-line, and got me out of there in a timely manner. Thanks again to all and, of course, thanks to God for deciding to keep me around for at least a little while longer.
Comments and share your story
Okay, that’s my drama and hopefully never to have another. I’d love to hear your stories, comments, and feedback about this issue. Feel free to email me at jcarosso@cpcwecare.com
God bless and stay safe.
Dr. John Carosso
Marvelous Melatonin | September 11, 2012
It seems that melatonin is becoming increasingly popular as a sleep aide. This trend stands to reason, given the anecdotal and research-based evidence that it’s effective and safe.
Drawbacks?
It would seem intuitive that it’s always best to first try behavioral approaches and more “natural approaches”. Not that melatonin isn’t “natural” (it’s a hormone that naturally exists in our bodies), but artificially increasing the levels of melatonin in our body may be something not considered the best ‘first-option.’
When melatonin is something to be considered
Consider melatonin only when all other options have been attempted, under the guidance of a sleep specialist, pediatrician, psychiatrist, or dietitian. Melatonin is more regularly used with children who have developmental issues, as opposed to typical children. In that regard, the former kiddo’s tend to have more problems producing optimal levels of melatonin on their own.
Other options?
I’ve written in earlier posts about any number of strategies to help induce sleep in children, and naturally raise melatonin levels. These include lots of activity during the day; ample exposure to natural sunlight, turning-down the lights, noise, and stimuli as the evening approaches and throughout the night; turning-off the computer and TV two hours before bedtime, no light in the bedroom (I know, some kids rely on a nightlight, but there is an alternative – see below), and a consistent bedtime routine.
One more thing: Blue-Blocking Glasses and Bulbs
There is increasing evidence regarding the benefits of Blue-Blocking Glasses to improve sleep. These glasses block blue rays, which apparently helps to increase melatonin levels (blue rays inhibit production of melatonin). They are worn two hours before bedtime. There is also some evidence suggesting that blocking blue-rays also helps with ADHD, avoiding post-partum depression, and seasonal affective disorder. An alternative to the glasses is night-lights and bulbs that have a coating that block blue light. Oh, by the way, in terms of the glasses or bulbs improving ADHD symptoms, it has been found that improving the sleep-wake cycle benefits attention to task and impulse control, which sort of makes sense.
Okay, hope this helps; pleasant dreams. I’d love to hear your feedback regarding sleep issues and what has helped: jcarosso@cpcwecare.com
Written by Dr. Carosso
Yes, it’s that time
It’s that ‘back to school’ time. Yes, it’s sad to see the summer coming to a close but definitely time to get back to the school routine.
Summer vs School Routine
Need I mention the difference between summer and school-year routines? If you start about 2-3 weeks out, it’s much easier to ship your kids into shape. Otherwise, it’s a culture-shock for your child, and not too pleasant for you either.
What to do (tips for parents of children with autism, and typical kiddos) :
1. Begin slowly adjusting routines for earlier bedtime.
2. Incorporate lengthier study and quiet-reading sessions throughout the day and week. This could include anything even remotely academic.
3. Visit the school playground more frequently to promote your child becoming more comfortable with being at school, and on the school grounds.
4. Arrange play-dates with school friends/acquaintances not seen for most of the summer, especially those kids who will be in your child’s class or grade.
5. If you can arrange a visit to the classroom, and meet the teacher, so much the better.
6. It can be helpful to color-code school supplies (notebooks, file-folders…). Integrate material-color with picture schedule.
7. Purchase school clothes early, wash them a few times, cut-off tags, and make sure your child is comfortable with them well in advance.
8. Pick-out a “cool” outfit for the first day and get a fresh haircut (first impressions are important).
9. Use picture schedules and social stories to prepare for the first day.
10. Prepare school with emergency contacts and any dietary issues.
11. Prepare the teacher, aide, Guidance Counselor, ‘specials’ teachers, cafeteria workers, and anybody else who will listen for what to expect, and how to effectively intervene if necessary.
12. Don’t forget to say a prayer with your kids before they venture off to school; they find that comforting and reassuring.
13. Autism-Speaks also has some nice back-to-school bulletins (I especially like the ‘about me’ activity):
http://www.autismspeaks.org/family-services/community-connections/back-school-its-transition-time
If you have any other tips, please comment; it’ll be appreciated. Comment at jcarosso@cpcwecare.com.
God bless and enjoy the rest of the summer!
Is Your favorite Show Harmful?
Do you watch re-runs of your favorite show, or do your kids enjoy the Disney Channel. Seems pretty harmless, right? Well, maybe not so much.
The TV Blues
Does watching TV cause depression? Well, the poor quality of television programming may, in fact, be quite depressing, but a team of neuropsychologists at Ohio State University Medical Center studied the effects of falling asleep while watching television. More specifically, the effect of sleeping in dim light as opposed to total darkness. The results weren’t good.
When It’s Best To Stay ‘In The Dark’
The researchers, studying mice, found that the little critters were far less happy when exposed to dim light while sleeping. How does one measure mice sadness (or happiness for that matter)? Well, apparently unhappy mice are less active and show little interest in activities they had found to be fun (bothering humans and enticing cats?). Anyway, the little mice got back their mojo when the dim light was removed, suggesting that this condition is reversible.
Anything Else?
Yes, there’s more. Check-out my prior post about sleep disorders. Over a year ago I wrote about how ‘garbage-light’ (from light-bulbs as opposed to the sun) in our civilized world has messed-up our sleep and our mood. Rather than sleep being a slow process, as the sun slowly sets in the sky; sleep is now a sudden event. We turn off the TV (computer or whatever), and expect to immediately ‘turn off’ ourselves and go to sleep. For many, that ain’t so easy.
What’s More…
Even worse, we often don’t turn off the TV or computer. We’ve grown accustomed to sleeping with the TV on, as have our kids. We’ve known for years that even super-dim light (eg. light from a digital alarm clock) can interfere with REM sleep; now we have reason to believe it can also impact our mood (no real surprise).
What To Do?
Fortunately, this is an easy fix. Don’t have to go to be a rocket scientist to know to off the TV, and any light source, when going to bed. Even better, turn down lights as the evening and bedtime approach, making a calm and soothing transition to lullaby-land. This will improve you and your kid’s sleep and how you feel the next day. If you’re prone to depression, or your kids are prone to irritability, this is especially important. Try it now; it only took two weeks, sleeping in darkness, for the little mice to smile again. Don’t you want to see more smiles in your home?
Sleep tight.
Let me know what you think: jcarosso@cpcwecare.com
I’ll keep this one short and simple; yes, they work. However, as usual, there’s a bit more to it than that.
Short and long-term
A social group program out of UCLA found that a social group for teenagers with autism proved to be successful not only for the short-term, but the gains were ongoing and generalized.
The power of peers
The social group was, however, was a bit different in that the leaders tended to role play and rehearse responses to social encounters that were socially acceptable from a teenager’s point of view. For example, if faced with teasing, most adults might suggest the teen ignore and walk away. However, fellow teens would likely be more inclined to give a short come-back such as “whatever” or something along those lines. It seems that the autistic teens were far more receptive to teen-oriented strategies, and more likely to use them into the future, and in other settings.
Conclusions?
What do we take from this? Well, we know that rehearsal and role-play work well, and it works even better when in the company of peers, and when using appropriate and non-confrontational approaches approved by peers. Good to know. Now go and do those role-plays.
Feel free to comment or inquire at jcarosso@cpcwecare.com
To lie or not to lie
Okay, I’ll set the stage. Harvard researchers used an MRI to assess people’s brain wave functioning comparing those who lied vs. those who did not lie when asked a particular question.
What’d they find?
Those who lied tended to have significantly elevated brain wave activity in the prefrontal cortex (PFC) of the brain, which suggests that the “liars” were involved in quite a bit of mental wrangling before making the decision to lie. However, a portion of the ‘truth-tellers’ had minimal PFC brain wave activity.
So what?
It would appear that those who lied put ample thought into how to handle the situation, and ultimately chose to lie. In contrast, those who told the truth often did not think much about it; they simply told the truth. It was not hard for them to make the decision; they apparently acted on moral principle. For them, there wasn't much to think about.
How do we get our kid’s brain to turn off?
Wouldn't it be nice if our kiddos don't think much about doing right or wrong but, instead, they simply, easily, quickly, and handily choose to do what’s right even if it’s not entirely convenient at the time? How do we instill this sense of moral strength and conviction in our children? Here are some ideas:
1. Model honesty daily for your children. If they frequently see you telling ‘little white lies’ then you can bet those PFC neurons will be firing big-time when they’re tempted to lie. Remember the old saying, ‘what you do speaks so loudly, I can’t hear what you say’.
2. Speak to your child about the complications of lying. More importantly, make sure they do not get away with lying and face natural consequences.
3. Get your child church or synagogue-involved, or wherever you may attend. Children have a natural faith in God; fostering their faith will strengthen convictions, inner strength, and a desire to ‘what’s right.’ Suppose that’s true for us adults as well.
The coma-club
During times of temptation, I want my PFC to be coma-like. In fact, I want that too for my kids (my wife is perfect already); which translates into having the moral conviction to simply, easily, quickly, and handily choose to do what’s right, even if it’s not entirely convenient at the time. How about you? Let’s start today.
Feel free to question or comment at jecarosso@cpcwecare.com. God bless.
The SportZone fundraiser for the Autism Center of Pittsburgh (ACP) has been changed to Friday, June 15, from 6-9:00 PM.
There will still be tons of activities for your kids including Deck Hockey, crafts, cookout, obstacle course, volley ball, water balloon contest, and much more.
Only $10.00 per child (all ages and exceptionalities, or nonexceptionalities, are welcome), with all proceeds going to a great cause.
Please RSVP Brittanie at
brittanie.steiner@autismcenterofpittsburgh.com
and please spread the word.
You can find out more at the ACP website at:
autismcenterofpittsburgh.com
See you there!
Check-out Dr. C's Morning Minute at AutismCenterofPittsburgh.com where you'll find information-packed minute-long video-posts covering topics such as:
-Autism and ADHD
-Autism and OCD
-Autism and Antidepressants
-Deciphering Research Findings
-Autism and Applied Behavioral Analysis
-Autism and Discrete Trial Therapy
and more to follow.
Feel free to request a topic of your choice at DoctorC@AutismCenterofPittsburgh.com or at jcarosso@cpcwecare.com. See you there.
Dr. John Carosso
Written by Dr. John Carosso
It’s only been a week:
It’s been barely a week since my last post about the difficulty deciphering research findings given the bias in the reporting. In that respect, you may already have heard the findings of a recent meta-analysis, regarding the effect of anti-depressants on self-stimulatory behavior, suggesting that studies reporting positive results were more likely to be published than those with negative or neutral results.
The Bane of Bias:
This type of misrepresentation is destructive for many reasons; including that it may dissuade parents from considering such medication even when their child is struggling significantly with self-stimulatory behaviors (hand-flapping, rocking, obsessing…). These findings only result in more confusion and cynicism, which is especially troubling given the evidence that these medications can have a positive impact on certain types of “stims.” I work as a Licensed Child Psychologist, not a psychiatrist, but I have seen countless kiddos benefiting greatly from an antidepressant. However, I have found such benefit more-so for obsessive tendencies, compulsive behaviors, and rumination rather than stims such as hand-flapping or rocking. In any case, it’s vital to consult with your child’s psychiatrist or pediatrician to thoroughly discuss the pro’s and con’s.
Behavioral interventions for “stims”:
Check out my prior post, “De-Stimulating those Stims” for a full description of how to use a litany of behavioral interventions to target those troublesome behaviors.
Speaking of depression:
Talk with your child’s psychiatrist, pediatrician, or DAN doctor about the natural supplement, SAMe (S-Adenosyl Methionine) for the treatment of depression. The recent studies, which appear to be well-done with valid results, have been exceedingly positive with a quick reaction time and few side effects.
Diet and ADHD:
Researchers from the University of Copenhagen just completed an extensive report reviewing the potential benefits of dietary modifications in the treatment of ADHD. The report suggests that any number of dietary changes have produced positive results, such as increasing fatty acids, as well as elimination diets (removing red dye). Okay, like we did didn’t already know this? In any case, the reports also highlights that more research is needed due to some contradictory findings (kinda already knew that too). Nevertheless, given that such dietary approaches are benign if not beneficial, experimentation would appear worthwhile. Professionally, I’ve seen a hundreds of children benefit; talk to a dietitian or DAN doctor in that regard.
More about Depression
There is evidence to suggest that a new computer game is beneficial for treating adolescent depression. The program, called “SPARX”, is interactive, 3-D, and involves the teen taking on various challenges that ultimately attack the child's “Gloomy Negative Automatic Thoughts.” I don’t know if the program works, but clearly the underlying strategy is vitally important; I tell parents all the time about how to help their kids to view the world in a more positive way. The classic book “Feeling Good”, by Dr. David Burns, is a good read in that regard.
Sum it up
1. Don’t be afraid to talk to your child’s doctor about any troublesome self-stimulatory behavior, especially if obsessive in nature.
2. Do some research on SAMe
3. Go to cpcwecare.com, to our Parent Resource section, and find the dietary guide, which can be very helpful regarding ADHD.
4. Attack negative self-talk that contributes to depression.
I think that sums it up. Please comment about your experiences. God bless you.
