Lunchroom Lowdown- Attention Deficit Disorder (Article)

My partners are really smart people with a lot of experience under their collective belts. I pay a lot of attention when they speak, because I always learn from their wise insights. Such was the case the other day in the lunchroom, when the subject of practical ADD management tips came up. One of our doctors has a child with ADD, so she is speaking from more than doctoring experience, which gave the conversation a whole new perspective. Here are the highlights:

Things are not always what they appear: Dr. Kimberly Riley recalled stories of children whose main problem was not attention span but learning disabilities. She has noticed that after their learning problem had been identified and helped, the impulsiveness and inattention faded away. They didn’t have ADD, simply a learning disability that had not been recognized. Dr. Riley also pointed out that if a child has severe learning difficulties, genetic testing may aid in looking for recognized genetic problems that impair learning. Conversely, Dr. Downing has noticed that in her experience, many of the children that present mood problems like anxiety, depression, or oppositional behavior really have ADD as a core feature dominating these children’s personality. Both the mood problem and the ADD issue need to be addressed for the child to get maximum benefit.

Sleep problems usually seem to accompany the ADD personality
: all of the doctors agreed that many children who are diagnosed with ADD have innate sleep difficulties. Certainly, the medications that are used to treat ADD can cause sleep problems on their own, but this is not the root cause. Dr. Plonk has noticed that initiation of sleep can be very difficult for these children, going all the way back to infancy. He believes that this problem has a neurological basis. Drs. Plonk, Riley, Moorman, and Downing all recommend 1-3 mgs. of Melatonin about 30 minutes before bedtime to help children get to sleep; they feel that this OTC hormone is both safe and effective. They also have found that a homeopathic product called Calms Forte can be effective in children with ADD. Both of these products have unfortunately not been tested by the FDA for safety or effectiveness since they are non prescription products. Keep in mind, however, that both parents and doctors are fans of melatonin so I think you can be confident giving it a try.

Beware of the easy fixes
: My colleagues believe that ADD is a neurologically based “chronic” disorder. Chronic means just that, chronic. They have noticed that as children mature, they almost always improve in their ability to concentrate and to avoid distractions but often don’t catch up with their age-matched peers until adolescence or beyond. For those who need help, the combination of behavioral therapy, attention to learning problems and associated mood problems, and possibly medication seems to get the best results. The doctors were pretty unanimous declaring that dietary supplements (except fish oil), strict dietary restriction of sugar, gluten and preservatives along with other assorted therapies seem to have limited effectiveness. As you will hear in the Pedcast featuring Dr. Kilbane, other physicians strongly disagree with that contention.

Let’s not forget there is a kid with feelings behind that diagnosis of ADD: Drs. Plonk, Riley, Downing, and Moorman became very animated and forceful when the subject of a child’s self image and self esteem came up. They all strongly feel there is a need to speak directly and honestly to children who have this diagnosis, reminding them that they are not “bad kids” and that to a large degree, they can’t help this impulsive behavior and lack of attentiveness. Dr Downing even noted that one of her patients declared to his mother just after this conversation, “You owe me, Mom” (an apology I presume). Understanding that the ADD behavior pattern is not anyone’s fault can be a huge relief to many families. As Dr. Downing points out, guilt is a strong emotion, and doctors can be very useful in mitigating some of this emotional baggage.

Conclusions of the doctors: My partners feel that the best approach to helping a child with an ADD diagnosis includes: having their learning problem and mood difficulties addressed, managing sleep problems if they exist, making sure that the school they attend provides appropriate accommodations to help the child with behavior and learning, initiating good behavioral management strategies at school and home, and most of all treating the child and his/her family with the respect and patience they deserve. That is the Lunchroom Lowdown for this week.


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From the Desk of DocSmo- ADD Steps 1,2,3,&4 (Article)

So, the establishment has come to you and said there is something wrong with your child’s behavior. They say that he or she is not meeting the school’s expectations. Maybe he or she doesn’t pay attention well in school. Perhaps they are more active than other children. Or, maybe they are simply more impulsive than their friends. What next? Where do you turn? How should you react? In this post I am going to give you my advice–and hopefully some insight–about how to handle this situation should you find yourself faced with it.

First, I think you need to understand that your child’s teachers have his or her best interests at heart. They want your child to succeed and learn as much as possible. Most likely, your child’s teachers are coming to you with concerns and observations that are important for you to know. Try not to get angry or defensive, because this will not help. I recommend that you listen and evaluate what you are being told, but keep in mind that the teacher’s opinion is just one of many. As you will see from this discussion, input from as many sources as possible is essential. The teachers are simply reporting a pattern of behavior that they are observing in the classroom. Your child’s behavior is complex with many factors that have influence. Many of life’s twists and turns can make a normal child exhibit ADD behavior, including: stress of family problems, an impending big life change such as a move, a medical issue, or a sleep problem, just to mention a few. You know your child best. Give all these factors consideration when trying to evaluate his or her behavior.

Step One:
If the school establishment believes that your child has ADD or ADHD, it is useful to back up and recall the definition of ADD and ADHD. All of the following criteria must be met to justify the diagnosis:

– A child who is healthy and of schoolage (less than 7 years) who is found to have a shorter attention span than normal and to be more impulsive than his/her peers.
-These impairments need to be seen across many settings such as school, church, camps, etc.
-These impairments must be chronic, which is defined as at least 6 months in duration.
-These impairments must be affecting the child’s ability to learn in a classroom setting.

Without ALL these features, an ADD or ADHD diagnosis is not justified. So ask yourself, does my child fit all these criteria? If so, you need to proceed. If not, maybe watching and waiting is in order.

Step 2:
Assuming that you and the school feel that the above criteria are met, it is time to proceed to the level of professional help. After all, this is your child’s academic success we are talking about. At minimum, standardized measures of attention and other factors should be completed by both parents and teachers, the two most common of which are Conner’s and Vanderbilt scales. Even better is a full psychological assessment by a psychologist including an actual classroom observation. At the same time, your child should also visit a healthcare provider who knows them and your family. During this visit, your child’s doctor will be trying to find things that are known to interfere with learning such as chronic sleep problems, difficulty with mood, family stress such as alcohol abuse or violence, genetic problems, vision or hearing problems, or any other factors that could be affecting learning.

Step 3:
If your child made it to this level of inquiry and met the initial criteria, it’s time to make some decisions and recruit as much help as possible. ADD is considered a disability under the 1990 Americans with Disabilities Act. Schools must provide accommodations to help your child if they have an ADD diagnosis. These can be very helpful. More testing time, quiet test areas without distractions, closer supervision by the teacher, and special academic tutoring are a few examples of accommodations that can be made to help your child succeed in school. Take advantage of them. Also make sure that your child’s school sets up a formal behavior program to address troublesome behaviors that get in the way of his or her learning.
My experience and research confirms that the most successful approach to assist a child with ADD is what is called the multimodal approach; that means the combination of school accommodations, behavior management, counseling for the family, and medication for the child. Many families are very leery of the strong medications that are used for children with ADD. It is a big step, but the results can be amazing. Keep an open mind when this subject is discussed. Your child’s doctor needs to do the same and recognize that not all children with ADD either need or can tolerate these medications. If you have access to an integrative pediatrician, I recommend you get their input as well. If your child has a disturbance of mood, is oppositional, or has major learning disabilities, I think a pediatric neurologist or psychiatrist should be in the mix.

Step 4:
Here is an important thought I want you to consider if you have a child with ADD–don’t despair, the news is not all negative. Remember, children with this pattern of behavior have many advantages over their non ADD friends such as high energy, enthusiasm, and sometimes, incredible creativity. Unfortunately, their learning style does not fit well in a traditional classroom. This fact is something that you and your child are going to need to deal with but can overcome. Remember, slow and steady wins the race, always has and always will. School is likely to be more difficult for your child as well as for your family, but success can and will be yours if you persist. I see this everyday. Families where education is valued, learning is made fun, intellectual stimulation is plentiful, hard work is encouraged, and failure is not an option will have success.
I also want you to remember that there is a person inside that child who is struggling to meet the school’s expectations. Despite their academic difficulties, they are most likely very intelligent! They are going to need a lot of encouragement and praise whenever possible. Not fake praise, but the real thing. Make sure you notice and compliment progress, determination, and creativity. Eventually, your child’s impulsiveness and inattentiveness will wane, but we want to be left with a confident and self-assured adult, not someone who feels like a longtime failure. You are your child’s best advocate. Be relentless!

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ADD-An Integrative approach with Dr Sheila Kilbane (Pedcast)

It is my honor to be able to interview Dr. Sheila Kilbane, a pediatrician trained in both traditional Western medicine and the integrative medical approach. In this Pedcast, Dr. Kilbane will explain the “Integrative Approach” and give specific examples of how this approach relates to children with ADD. As you will see, Dr. Kilbane has a gift of making complex subjects easy to understand and is full of  practical suggestions that can help your child, whether they have ADD or not.  Make sure not to miss this informative conversation between Dr. Smolen and Dr. Kilbane.



1. Addressing ADD Naturally, Improving Attention, Focus, and Self-Discipline with Healthy Habits in a Healthy Habitat by Kathi J. Kemper, MD, MPH
2. ADHD Without Drugs A Guide to the Natural Care of Children with ADHD by Sandford Newmark, MD
3. The Kid Friendly ADHD and Autism Cookbook, the ultimate guide to the gluten-free casein free diet by Camela Compart MD and Dana Laake, RDH, MD, LDN


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Attention Parents; Let’s focus on ADD (Pedcast)

ADD and ADHD can be a bewildering diagnosis for parents.  In today’s pedcast, Dr. Smolen tries to shed some light on the diagnosis and it’s biologic basis.  See if he can convince you that ADD is a real thing.




Your listening to a “Pedcast”, a practical, educational podcasts for parents.

From babyhood to bonafied adult, you will find useful information here.

Let me remind my listeners that by listening to this podcast you are agreeing to my terms and conditions as stated on my website,

Today we are going to discuss a common and controversial diagnosis, ADD.

I am going to give you the DocSmo view. That’s all I have.

I have not done research, I am not a psychologist and have very little psych training, however I feel I have a valuable point of view.

After all, 30 years of general pediatric practice must be useful for something.

Let’s get into, shall we?


First, my worldview when it comes to behavior.

I believe that much of our personalities are genetic.  Not an individual behavior but our temperament and general reactions to the world are to a large degree predetermined by our genes.

Experiences play an important role but I feel that temperament often trumps experience.
So for me, it is not a leap to believe that some children, about 5% of especially males, are born with a tendency to be very impulsive, inattentive, and distractible.

All human traits fall on a continuum and attention and impulsiveness is no different.

The 5% figure comes from the fact that this group is inattentive enough that, when they reach school, have great difficulty being successful in the classroom.

It’s that simple.


Here are some other observations to ponder.

The 5% figure is pretty constant cross culturally…to me that means biologic.

Many if not most children with this pattern of behavior have a close relative with the same difficulty… to me again, that means biologic.

Adults who have neurological illness or injury often develop typical ADD symptoms very similar to children with ADD even though they did not demonstrate this behavior in childhood… to me again that means biologic basis.


Have I convinced you that ADD is a physical problem or do you believe that is stems from a weak character or lack of discipline?

My view is the former.


So now you know where I am coming from.  I believe that the ADD behavior pattern is a biologic trait, very much like blue eyes or dark skin are. I admit, this is simply my belief.  Remember, there are no biologic tests that confirm the diagnosis. I have no more evidence than that mentioned before.

Lets define what ADD is; a behavioral disorder that presents with a child usually of school age who has enough difficulty sustaining attention, chronically, in multiple settings, as to interfere with learning.

Notice the definition includes impairment of attention, chronically, in multiple settings, with interference in learning.  Got to have all this to qualify.

Lots of look alikes… children with anxiety and other mood difficulties, children who are bored, children with seizures or mental retardation, children with hearing or visual impairments,  children with learning disabilities, and even children with serious psychiatric problems like schizophrenia and bipolar disease.


Here is another opinion;  Teachers are in the best spot to recognize a child with ADD.  After all, they have 20-30 other children to compare this child with and a lot of hours to watch.

This is almost always a disorder of school age children.

And…I don’t believe that teachers have any reason to want to over diagnose their students with this diagnosis.

I think almost all their referrals are legit.  I listen when they speak and I think parents should as well, especially if you hear this from more than one teacher.


Question: So is involved in the process of diagnosing a child with ADD?


We are talking about a complex thing here, human behavior.

Lots of determinants.  A good evaluation by a psychologist is really important to get the diagnosis right.  Insist on it.

If your child is struggling, insist that this evaluation be done.  Remember, the squeaky wheel gets the grease! You and your child’s doctor are your child’s best advocate.

If the psychologist and the teacher feel that your has significant problems, next you need to speak with your child’s pediatrician or family doctor.

He or she can really get the ball rolling, nudging the school to get a special educational and behavior plan for your child as well as discussing the pros and cons of medication for your child.

If your child has physical problems like sleep difficulties, seizures, vision problems your doctor can help there as well.

Your child’s pediatrician can also provide a lot of experience and wisdom and let you and your child know you are not alone in this process. It is a frightening experience for many families and you doctor can be of great help.


School is tough and expectations are high.

Many children will struggle at some point with academics given the immense pressures today.  They don’t all have ADD!

Not all children are on the same developmental plane at the same age and some of what is called ADD is simply a child who is behind their peers.

Navigating all this can be tough but don’t despair, almost all  children do well in the end.

I will say this, overall, I think that the extra attention children with academic and behavior difficulties receive can be extremely beneficial.


Thanks for joining me today.  This is your host, Dr Paul Smolen.

Hoping this short talk improved your understanding of a complex and controversial disorder.

As always, comments welcome.

New content weekly so subscribe on iTunes, or follow me on Face book or Twitter.

A free pediatric education is yours to take.

This is Dr Paul Smolen, DocSmo, broadcasting from studio 1E in Charlotte, NC… hoping your child’s teacher never has a mention, about your child’s attention.


Until next time

Attention Parents: ADD Week coming July 11-17 (Article)

We are continuing our presentation of “theme weeks” at Hopefully you survived “Bathroom Bootcamp” and attended “Camp Essentials” in recent weeks. Starting July 11, 2011 we are going to explore the subject of ADD in true DocSmo style: full of opinions, learning, and interviews in a practical and portable format. During this week, I am excited to be able to bring you the perspective Dr. Sheila Kilbane MD, an integrative pediatrician, who will give you her unique and fascinating perspective on the important subject of ADD and school problems. Don’t forget to stay alert for “ADD Week,” coming next week!

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