Potomac Pathways

Potomac Pathways drug tests now include "spice" (synthetic cannabinoids).

2011-05-16T13:21:00.000-07:00

For more info about spice, synthetic cannabinoids, click here.

Info from our lab, NMS Labs:

Synthetic Cannabinoid Metabolites (Qualitative), Urine Test (4280U)

Analysis Code	4280U
Test Name	Synthetic Cannabinoid Metabolites (Qualitative), Urine
Test Includes	JWH-018 Hydroxy-metabolites [LC-MS/MS], JWH-073 Hydroxy-metabolites [LC-MS/MS]
Compound Synonym(s)	K2 Space Spice Spike Synthetic Cannabinoids Yucatan Fire
Purpose	Exposure Monitoring/Abuse Monitoring
Category	Synthetic Cannabinoid
Method(s)	High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS)

13 Myths about Substance Abuse Treatment

2011-03-02T09:14:00.000-08:00

Myth #1: Drug addiction is voluntary behavior.
A person starts out as an occasional drug user, and that is a voluntary decision. But as times passes, something happens, and that person goes from being a voluntary drug user to being a compulsive drug user. Why? Because over time, continued use of addictive drugs changes your brain -- at times in dramatic, toxic ways, at others in more subtle ways, but virtually always in ways that result in compulsive and even uncontrollable drug use.

Myth #2: More than anything else, drug addiction is a character flaw.
Drug addiction is a brain disease. Every type of drug of abuse has its own individual mechanism for changing how the brain functions. But regardless of which drug a person is addicted to, many of the effects it has on the brain are similar: they range from changes in the molecules and cells that make up the brain, to mood changes, to changes in memory processes and in such motor skills as walking and talking. And these changes have a huge influence on all aspects of a person's behavior. The drug becomes the single most powerful motivator in a drug abuser's existence. He or she will do almost anything for the drug. This comes about because drug use has changed the individual's brain and its functioning in critical ways.

Myth #3: You have to want drug treatment for it to be effective.
Virtually no one wants drug treatment. Two of the primary reasons people seek drug treatment are because the court ordered them to do so, or because loved ones urged them to seek treatment. Many scientific studies have shown convincingly that those who enter drug treatment programs in which they face "high pressure" to confront and attempt to surmount their addiction do comparatively better in treatment, regardless of the reason they sought treatment in the first place.

Myth #4: Treatment for drug addiction should be a one-shot deal.
Like many other illnesses, drug addiction typically is a chronic disorder. To be sure, some people can quit drug use "cold turkey," or they can quit after receiving treatment just one time at a rehabilitation facility. But most of those who abuse drugs require longer-term treatment and, in many instances, repeated treatments.

Myth #5: We should strive to find a "magic bullet" to treat all forms of drug abuse.
There is no "one size fits all" form of drug treatment, much less a magic bullet that suddenly will cure addiction. Different people have different drug abuse-related problems. And they respond very differently to similar forms of treatment, even when they're abusing the same drug. As a result, drug addicts need an array of treatments and services tailored to address their unique needs.

Myth #6: People don't need treatment. They can stop using drugs if they really want to.
FACT: It is extremely difficult for people addicted to drugs to achieve and maintain long-term abstinence. Research shows long-term drug use actually changes a person's brain function, causing them to crave the drug even more, making it increasingly difficult for the person to quit. Especially for adolescents, intervening and stopping substance abuse early is important, as children become addicted to drugs much faster than adults and risk greater physical, mental and psychological harm from illicit drug use.

MYTH #7: Treatment just doesn't work.
FACT: Treatment can help people. Studies show drug treatment reduces drug use by 40 to 60 percent and can significantly decrease criminal activity during and after treatment. There is also evidence that drug addiction treatment reduces the risk of HIV infection (intravenous -drug users who enter and stay in treatment are up to six times less likely to become infected with HIV than other users) and improves the prospects for employment, with gains of up to 40 percent after treatment.

MYTH #8: Nobody will voluntarily seek treatment until they hit ‘rock bottom.’
FACT: There are many things that can motivate a person to enter and complete substance abuse treatment before they hit "rock bottom." Pressure from family members and employers, as well as personal recognition that they have a problem, can be powerful motivating factors for individuals to seek treatment. For teens, parents and school administrators are often driving forces in getting them into treatment once problems at home or in school develop but before situations become dire. Seventeen percent of adolescents entering treatment in 1999 were self- or individual referrals, while 11 percent were referred through schools.

MYTH #9: You can't force someone into treatment.
FACT: Treatment does not have to be voluntary. People coerced into treatment by the legal system can be just as successful as those who enter treatment voluntarily. Sometimes they do better, as they are more likely to remain in treatment longer and to complete the program. In 1999, over half of adolescents admitted into treatment were directed to do so by the criminal justice system.

MYTH #10: There should be a standard treatment program for everyone.
FACT: One treatment method is not necessarily appropriate for everyone. The best programs develop an individual treatment plan based on a thorough assessment of the individual's problems. These plans may combine a variety of methods tailored to address each person's specific needs and may include behavioral therapy (such as counseling, cognitive therapy or psychotherapy), medications, or a combination. Referrals to other medical, psychological and social services may also be crucial components of treatment for many people. Furthermore, treatment for teens varies depending on the child's age, maturity and family/peer environment, and relies more heavily than adult treatment on family involvement during the recovery process. "[They] must be approached differently than adults because of their unique developmental issues, differences in their values and belief systems, and environmental considerations (e.g., strong peer influences)."

MYTH #11: If you've tried one doctor or treatment program, you've tried them all.
FACT: Not every doctor or program may be the right fit for someone seeking treatment. For many, finding an approach that is personally effective for treating their addiction can mean trying out several different doctors and/or treatment centers before a perfect "match" is found between patient and program.

MYTH #12: People can successfully finish drug abuse treatment in a couple of weeks if they're truly motivated.
FACT: Research indicates a minimum of 90 days of treatment for residential and outpatient drug-free programs, and 21 days for short-term inpatient programs to have an effect. To maintain the treatment effect, follow up supervision and support are essential. In all recovery programs the best predictor of success is the length of treatment. Patients who remain at least a year are more than twice as likely to remain drug free, and a recent study showed adolescents who met or exceeded the minimum treatment time were over one and a half times more likely to abstain from drug and alcohol use. However, completing a treatment program is merely the first step in the struggle for recovery that can extend throughout a person's entire lifetime.

MYTH #13: People who continue to abuse drugs after treatment are hopeless.
FACT: Drug addiction is a chronic disorder; occasional relapse does not mean failure. Psychological stress from work or family problems, social cues (i.e. meeting individuals from one's drug-using past), or their environment (i.e. encountering streets, objects, or even smells associated with drug use) can easily trigger a relapse. Addicts are most vulnerable to drug use during the few months immediately following their release from treatment. Children are especially at risk for relapse when forced to return to family and environmental situations that initially led them to abuse substances. Recovery is a long process and frequently requires multiple treatment attempts before complete and consistent sobriety can be achieved.

Study: Marijuana use potential trigger for psychosis

2011-02-11T09:26:00.000-08:00

2/9/11

The Archives of General Psychiatry has published a study (full text available here) that provides additional evidence for a relationship between cannabis use and earlier onset of psychotic illness.

Conducted by Matthew Large, BSc (Med), MBBS, FRANZCP, Swapnil Sharma, MBBS, FRANZCP, Michael T. Compton, MD, MPH, Tim Slade, PhD, and Olav Nielssen, MBBS, MCrim, FRANZCP, the study supports the hypothesis that cannabis use plays a causal role in the development of psychosis in some patients and suggests the need for renewed warnings about the potentially harmful effects of cannabis.

The results found that the age at onset of psychosis for cannabis users was almost three years younger than for non-users. For those with broadly defined substance use, the age at onset of psychosis was two years younger than for non-users.

Differences in the proportion of cannabis users in the substance-using group made a significant contribution to the heterogeneity in the effect sizes between studies, which researchers believe confirms an association between cannabis use and earlier mean age at onset of psychotic illness.

Alcohol use was not associated with a significantly earlier age at onset of psychosis.

Spice-- the marijuana alternative

2010-08-31T16:25:00.000-07:00

The growing buzz on 'spice' -- the marijuana alternative

By Michael W. Savage
Washington Post Staff Writer
Saturday, July 10, 2010; A01

In the small backroom of Capitol Hemp, a head shop in Adams Morgan, a worker dutifully arranges an array of ceramic pipes displayed in a well-lit glass case. Another clerk helps a couple of customers as they peruse a selection of bongs and vaporizers.

Stored behind the counter is another amply stocked product whose popularity is booming: "spice," the generic name for a legal "synthetic marijuana." Capitol Hemp owner Adam Eidinger said that in the 18 months since he began stocking spice, demand has doubled each month, and its sales now represent a third of his revenue. On some Fridays, he said, his two District stores can bring in $10,000 from the sale of spice alone.

In the District and most states across the country, it is legal to buy and sell spice, whose crushed green leaves are sprayed with various man-made chemicals. When smoked, the treated leaves can produce a marijuana-like high.

But alarmed by its growing use and questions about its safety, lawmakers in a number of states have begun taking action.

Last week, Missouri Gov. Jay Nixon (D) became the latest to sign a state ban. In March, Kansas was the first state to outlaw the product, followed by Kentucky, Alabama, Tennessee and Georgia. Lawmakers in other states, including Iowa, Michigan, Illinois and Louisiana, are working on bans. Similar legislation has not come up in Virginia, Maryland or the District.

Gil Kerlikowske, President Obama's drug czar, said in an interview that the substance is "on our radar" but added that he thought state legislatures are dealing well with the issue.

But others decry what they see as a knee-jerk reaction from lawmakers, making the synthetic marijuana product the latest substance at the center of an ongoing debate about the merits of prohibition.

"We have never had any complaints or concerns from customers," Eidinger said. He added that he began stocking spice products after several requests from customers. "We always ask the manufacturers if there is anything illegal in the products. We only use the products we trust, and if it is made illegal in D.C., we will stop selling it."

At his shop, customers show ID to prove that they are 18 or older, then enter a room where they can study a sheet of paper listing the available brands of spice. For $55, they can buy three grams of K2 Summit, packaged in shiny foil. Those wanting a fruity option can go for Pep Pourri at $22.50 a gram.

Scott Rupp, a Missouri state senator, said he backed the ban for good reason. "We were getting reports from local law enforcement that this was exploding among the youth population," the Republican said. "We were getting reports of kids hurting themselves and showing up in the emergency room as they were sick from it."

The fact that spice cannot be detected by drug screening has also made it popular with other groups, including parolees, according to drug experts. Eidinger said many of his customers are in the armed forces. "They sometimes buy a $400 batch before going on tour," he said.

A lack of data and controlled testing make it difficult to determine the drug's safety. And there are no official estimates of its growing use. But there has been a significant bump in calls to poison centers concerning spice. Nationwide, the American Association of Poison Control Centers logged 567 cases across 41 states in which people had suffered a bad reaction to spice during the first half of 2010. Just 13 cases were reported in 2009.

In the Washington area, where several stores stock spice, the National Capital Poison Center has received six to eight reports from people who had taken the legal drug since the beginning of the year, said Cathleen Clancy, a doctor at the center.

Manufacturing questions

Drug Enforcement Administration officials say spice products are manufactured both in the United States and in foreign countries, but little is known about how the products are made or who makes them. Wholesaler Web sites are secretive about where they obtain the product, and wholesalers themselves did not return calls seeking comment.

The packages containing spice state that it is to be used as incense and not meant for human consumption or to be smoked, a point reiterated by many who sell it. "Smoke inhalation may cause light-headedness and be harmful to your health," reads one package of K2.

On Internet forums, users have reported a range of experiences after smoking spice -- from feeling little to feeling the same kind of euphoria, increased heart rate or paranoia that marijuana can trigger. Some have reported more extreme reactions, such as hallucinations.

According to police reports cited in news accounts, one person in Texas suffered seizures after smoking two types of spice together. In Iowa, an 18-year-old suffered a panic attack and committed suicide after smoking spice with friends last month, police said.

"We're getting extreme anxiety in many patients, agitation, heightened heart rate and blood pressure," said Anthony Scalzo, medical director of the Missouri Poison Center. "I've done emergency medicine for 28 years and toxicology for 22, and I don't see that kind of effect generally from a patient who comes in having taken marijuana."

The DEA has begun to test the products, but it is difficult because several substances are being used to create spice.

Marilyn Huestis, chief of chemistry and drug metabolism at the National Institute on Drug Abuse, said the chemicals had been developed by several university medical researchers to study the part of the brain responsible for hunger, memory and temperature control. The compounds, known as synthetic cannabinoids, mimic the effects of tetrahydrocannabinol (THC), the ingredient in cannabis that gives users a high. They were not, however, designed for human consumption.

"These different, synthetic compounds are up to 100 times more potent than THC and have not been tested on humans," she said. "When people take it, they don't know how much they're taking or what it is they're taking."

Internet-fueled sales

DEA Special Agent Gary Boggs said the chemicals can be purchased in pure form on the Internet, which has helped them spread across the country. "We think there is potential for long-term, adverse effects on the brain, the lungs and the heart," he said.

Others are skeptical of the dangers. Peter Rugg, a writer for the Pitch, a Kansas City weekly newspaper, gathered with a group of volunteers last year to test the drug. One regular pot smoker said it was similar to weak marijuana, according to Rugg. An occasional cannabis user became nauseated. When Rugg smoked it, he said, it reproduced the effects of marijuana for a short time.

"I do think the reaction from some states has been a bit hysterical, but it seems to be the sort of thing we should really study for a little bit before we decide it is dangerous," Rugg said in an interview. "I smoked it a couple of times from different batches, and there was never a moment where I thought I was going to hallucinate or go and do anything crazy."

Lawmakers ought to take up more pressing concerns, he said. "Kansas and Missouri both have huge budget shortfalls but, despite everything on their plates, this became the number-one priority," he said. "To me, it was such a silly thing to get so riled up about."

Eidinger, who is also known locally as an advocate for D.C. statehood, said banning spice would simply push it underground. He also said that laws criminalizing cannabis have driven people to use the murky alternative.

Scalzo, whose Missouri poison center has received 60 calls this year from people who have used spice, urged caution.

"I'm concerned we don't know what's in there, or the quantities that are in there," he said. "Some people may argue you shouldn't ban something when you don't know what's in it. But when the public health is of concern, I think it's right to act."

Staff writer Aaron C. Davis contributed to this report.

Clinical information for parents and professionals: evidence-based rationale for Potomac Pathways programs

2009-08-20T17:12:00.000-07:00

Brooke Brody, LCSW-C, LCADC

There are a variety of factors related to adolescent treatment that suggest the need for the Potomac Pathways approach to adolescent treatment:

• Friends: Many teens relapse because they lack a group of friends who are clean and sober (Winters, K. C. et al, 2009).Potomac Pathways provides a place to go to meet with peers-in-recovery and take part in a range of clean and sober, supportive activities in a welcoming environment, with both structured and unstructured (but supervised) settings.

• Peer mentors: Potomac Pathways’ peer mentors are young adults or teens who have successfully completed a year or more of recovery. The peer mentors attend all the groups and activities and counteract the effect of the “deviant peer contagion effect” (Dembo, R. & Muck, R. D., 2009) that often occurs in conventional treatment groups, whereby more dominant anti-social youths have a negative influence on their peers. The peer mentors are positive kids that model for their peers the idea that “recovery is more ‘cool’ than drug-using and anti-social behavior.”

• “Cool”: Conventional drug treatment is not “cool.” Potomac Pathways has a distinct “cool factor” which is attractive to adolescent clients. For example, the program eliminates concrete block walls and fluorescent lights in favor of natural environmental elements and comfortable furniture. The program incorporates experiential elements like drumming, yoga, meditation, outdoor adventure activities, music, technology and more. Plus, the therapy uses and teaches a strengths-based, solution-focused approach which the clients experience as warm, supportive, and empowering, rather than primarily a lecture format. Potomac Pathways has identified many of these elements as important for increasing client retention and improving positive outcomes for the “subpopulations of youth” which we serve (Dembo, R. and Muck, R. D., 2009).

• Homework: Most outpatient programs focus exclusively on substance use and ignore some of the other irritating factors in the teen’s life that contribute to the problem situation. Sobriety is only one part of an overall recovery program, which includes addressing problems in school, in the family, and for the individual (Brannigan et al, 2004). Many of our clients struggle with learning differences or ADHD, poor grades, poor school attendance, and need support for homework completion. Potomac Pathways currently provides an ADHD support group for teens and is expanding to be able to do more to give support to teens after school. In this supportive environment, students are able to learn positive skills that can contribute to their success in school.

• Outdoors: Outdoor programming has been shown to increase teens’ motivation in treatment (Russell, K., 2005). Potomac Pathways provides a host of outdoor adventure activities for clients in recovery, including: high- and low- ropes course activities, caving, canoeing, kayaking, Native American ceremony on Adventure Island, climbing wall, hiking, skiing/snowboarding, horseback riding. The events include therapeutic work around processing the recovery metaphors that the clients get out of the activities. The events help teens discover the fun in sobriety. And it occasionally happens that a client decides to develop a career in outdoor adventure programming because of these events!

Enhanced effectivness of Potomac Pathways programs

Potomac Pathways programs exemplify these “key elements in effective adolescent substance abuse treatment” (Branningan, R. et al., 2004):

• Assessment and Treatment Matching: Program conducts comprehensive assessments that cover psychiatric, psychological, and medical problems, learning differences, family functioning, and other aspects of the adolescent’s life.

• Comprehensive, Integrated Treatment Approach: Program services address major aspects of the adolescent’s life including substance abuse, learning differences, family relationships, co-occurring depression, anxiety and other mental health issues.

• Family Involvement in Treatment: Research shows that involving parents in the adolescent’s drug treatment produces better outcomes. Programs includes a high level of family involvement.

• Developmentally Appropriate Programs: Activities and materials reflect the developmental differences between adults and adolescents.

• Engaging and Retaining Teens in Treatment: A strong therapeutic alliance is required for engaging and retaining teens (Winters et al., 2009; Diamond et al., 2006). Treatment program builds a climate of trust between the adolescent and the therapist, and between peers.

• Qualified Staff: Staff members are trained in adolescent development, co-occurring mental disorders, substance abuse, and addiction.

• Gender and Cultural Competence: Program addresses the distinct needs of adolescent boys and girls as well as cultural differences among minorities.

• Continuing Care: Program includes relapse prevention program, aftercare planning, referrals to community resources, and follow-up.

Clinical Treatment Model

Most adolescent substance abuse treatment models, including those primarily based on 12-step treatment, are essentially integrated models that utilize elements of several therapeutic program elements (Winters, K. et al., 2009; Hall, J. et al., 2008). Potomac Pathways programs contains elements of the following therapeutic models or approaches to treatment:

• Motivational Enhancement Therapy
Counselors are trained in a motivational enhancement approach in order to meet the clients where they are at, help to bring them to the next level of motivation, and help to reduce the sense of being forced into treatment (Miller, W. & Rollnik, S., 1991).

• Solution-focused approach
The program uses the strengths-based approach of “solution-focused therapy” in order to boost self-esteem, encourage positive interactions between peers in the treatment groups (deShazer, S.,1988).

• Experiential Education
The program uses elements throughout the groups that can appeal to teens with a kinesthetic learning style. Drumming, meditation, yoga, and a variety of props—help break up the monotony of therapy groups and keep clients more engaged.

• Strengths-Oriented Family Therapy
The program offers a series of multifamily and conjoint family sessions that are based on the “manualized” strengths-oriented family therapy (SOFT) treatment model. “SOFT” family therapy includes “a heavy emphasis on solution-focused language, a formal strengths assessment, a pre-treatment motivational session,” as well as a skills-training curriculum (Hall, J. et al., 2008)

• Relapse Prevention Therapy
The program utilizes certain curriculum materials from Terence Gorski, MA based on a cognitive therapy approach to treatment and relapse prevention.

• Spiritual Counseling (Richards, P. & Bergin, A. (eds.), 2004).
Potomac Pathways does not shy away from promoting values such as honesty, integrity, compassion, and love. Many teens have adopted unsavory values, and benefit from hearing about the positive values of their peers who are further along the recovery path. Positive values, such as those enumerated in “The Four Agreements” or in Native American cultures, form the foundation of the Potomac Pathways treatment environment.

References

Barkley, R. (2008). Advances in ADHD: theory, diagnosis, and management (recorded seminar). Lancaster, PA: J & K Seminars.

Brannigan, R., Schackman, B., Falco, M., Millman, R. (2004). The quality of highly regarded adolescent substance abuse treatment programs: results of an in-depth national survey. Archives of Pediatric and Adolescent Medicine, 158, 904-909.

Dembo, R. & Muck, R. D. (2009). Adolescent outpatient treatment. In Leukefeld et al. (Eds.), Adolescent substance abuse: evidence-based approaches to prevention and treatment, New York, NY: Springer.
deShazer, S. (1988). Clues: investigating solutions in brief therapy. New York: Norton.

Diamond, G. S., Godley, S., Liddle, H., Sampl, S., Webb, C., Tims, F. at al. (2002). Five outpatient treatment models for adolescent marijuana use: a description of the Cannabis Youth Treatment Interventions. Addiction, 97, S70-S83.

Hall, J., Smith, D., & Williams, J. (2008). Strengths-oriented family therapy (SOFT): A manual guided treatment for substance-involved teens and families. In LeCroy, C (ed.), Handbook of Evidence-based treatment manuals for children and adolescents, New York, NY: Oxford University Press.

Miller, W. & Rollnik, S. (1991). Motivational interviewing: preparing people to change addictive behavior. New York: Guilford.

Richards, P. & Bergin, A. (2004). A spiritual strategy in counseling and psychotherapy, Washington, DC: American Psychological Association.

Russell, K., 2005. Preliminary results of a study examining the effects of outdoor behavioral healthcare treatment on levels of depression and substance use frequency. Journal of Experiential Education, 27 (3), 305-307.

Stevens, S. & Morral, A., (eds.) (2003). Adolescent substance abuse treatment in the United States: exemplary models from a national evaluation study. New York, NY: Haworth.

Winters, K., Botzet, A., Fahnhorst, T., Stinchfield, R., & Koskey, R (2009). Adolescent substance abuse treatment: a review of evidence-based research. In Leukefeld et al. (Eds.), Adolescent substance abuse: evidence-based approaches to prevention and treatment, New York, NY: Springer.

Father-Son Bonding: Learning to Love Your Child's ADHD

2009-01-23T19:24:00.000-08:00

by Wendi Nelson

My son came into the world without a sound. He seemed perfect from the start, with bright, curious eyes that scanned the room, absorbing every detail. My wife and I named him Drew - meaning "intelligent," according to our baby name book - because we sensed he was a smart one. As I held him for the first time, I felt lucky to be the father of this perfect little boy.

Years passed, and I watched with dismay as Drew changed from that perfect child in the delivery room into a boy with significant developmental delays.

He would hit his friends to let them know he was happy, no matter how many times we told him not to. When he entered school, we noticed that he was slower than his peers at understanding abstract ideas.

I vividly recall the evening my wife, Wendi, patiently explained the concept of death to Drew. When she finished, she asked if he had any questions. "Yes," he replied. "Did you ever die?"

Still, Wendi and I wouldn't admit to ourselves the severity of his delays until we finally heard a doctor say, "He's years behind where he should be." I went from wondering how I was going to pay for a Harvard education to watching Drew climb aboard the special-ed bus each morning. There was no denying that Drew was different from other kids, but I was convinced that if I tried hard enough, I could make him "normal."

At age six, Drew joined a T-ball league. But he seemed to spend most of his time picking dandelions in the outfield. He couldn't understand why his teammates were running all over the place to catch a ball when there were so many beautiful flowers to gather.

Drew moved on to soccer, but he proved less interested in chasing the ball than in playing with the drinking fountain at the edge of the field. In karate class, he spent most of his time putting the other kids in headlocks - something his instructor frowned upon. Nothing really engaged him except building Lego masterpieces.

At age seven, Drew was diagnosed with attention deficit disorder (ADD ADHD). His odd behavior continued. Still, I was determined to find something he could do like any other little boy. So I signed him up for Boy Scouts, volunteering to be the troop leader.

This article comes from the October/November 2005 issue of ADDitude.

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We started off with a series of weekend hikes. Halfway through each outing, I found myself carrying Drew's backpack, along with my own, as he kept stopping to examine anthills or use a stick to trace pictures in the dirt.

By the time we made it to the campsite, the other kids had long since pitched their tents and were gathered around the campfire. My co-leader would optimistically remark on how great Drew was doing. I felt like screaming but comforted myself with the belief that scouting was helping Drew have a happy childhood.

Still, I was really looking forward to our next outing: a 30-mile canoe trip down the Colorado River. The first day was magnificent, perfect weather for a float trip. But Drew wasn't much of a paddler. He didn't so much stroke as he simply stirred the water. Despite my best efforts at teaching Drew how to paddle correctly, we fell far behind the other canoes. It was a long first day.

When we finally reached our campsite, I lost my footing getting out of the canoe and toppled into the water. Drew ran off without a word - he hadn't even noticed. Exhausted and cold, I quickly inhaled some food and said goodnight to Drew, who seemed captivated by the moths circling our lantern.

The next morning, I felt re-energized. If I paddled harder, I reasoned, Drew and I would be able to keep up with the other canoes. But, once again, we fell behind, losing contact with the nearest canoe barely two hours into the trip. Drew and I were alone on the river.

As I sat there in the blazing sun, I felt more frustrated than ever. Drew, oblivious to my disappointment, was peering into the water, looking for fish. Why me, I wondered. Why couldn't Drew be like any other boy who could paddle a canoe, kick a goal, or hit a home run?

Then I began to wonder: What in the world was I doing? Why was I obsessed with having a son like everyone else's? Drew pointed at a butterfly that had perched atop his shoe and gave me a big smile. And there it was, right in front of me: It didn't matter that Drew had no interest in hitting a home run or being the fastest down the river. He was too busy discovering the world around him. No, this wasn't the little boy I'd had such hopes for in the hospital so long ago. But he was happy.

In camp that evening, Drew watched as a pair of dragonflies danced above his head. He turned to me and said, "This is the best trip ever." In that moment, for the first time in a very long while, I felt lucky to be Drew's dad.

ADHD Parenting Advice from Michael Phelps' Mom

2008-11-29T17:49:00.000-08:00

by Judy Dutton

“We worked as a team to overcome ADD”

Debbie Phelps, middle-school principal in Towson, Maryland, and mother of Olympic swimmer Michael Phelps

No doubt about it, Michael Phelps has made waves in his chosen sport. In 2004, at the age of 18, he swam his way to eight medals (six of them gold) at the summer Olympics in Athens. Now 21, he holds 13 world records, including the 200-meter butterfly and the 4 x 100-meter freestyle relay.

Yet Michael might not have loved swimming at all, were it not for the ingenuity of his mother, Debbie Phelps. “At age seven, he hated getting his face wet,” says Debbie. “We flipped him over and taught him the backstroke.”

Michael showed swimming prowess on his back, then on his front, side, and every way in between. But in the classroom, he floundered. An inability to concentrate was his biggest problem.

“I was told by one of his teachers that he couldn’t focus on anything,” says Debbie. She consulted a doctor, and nine-year-old Michael was diagnosed with ADHD.

“That just hit my heart,” says Debbie. “It made me want to prove everyone wrong. I knew that, if I collaborated with Michael, he could achieve anything he set his mind to.”

Debbie, who had taught middle school for more than two decades, began working closely with Michael’s school to get him the extra attention he needed. “Whenever a teacher would say, ‘Michael can’t do this,’ I’d counter with, ‘Well, what are you doing to help him?’” she recalls.

After Michael kept grabbing a classmate’s paper, Debbie suggested that he be seated at his own table. When he moaned about how much he hated reading, she started handing him the sports section of the paper or books about sports. Noticing that Michael’s attention strayed during math, she hired a tutor and encouraged him to use word problems tailored to Michael’s interests: “How long would it take to swim 500 meters if you swim three meters per second?”

At swim meets, Debbie helped Michael stay focused by reminding him to consider the consequences of his behavior. She recalls the time when 10-year-old Michael came in second and got so upset that he ripped off his goggles and threw them angrily onto the pool deck.

During their drive home, she told him that sportsmanship counted as much as winning. “We came up with a signal I could give him from the stands,” she says. “I’d form a ‘C’ with my hand, which stood for ‘compose yourself.’ Every time I saw him getting frustrated, I’d give him the sign. Once, he gave me the ‘C’ when I got stressed while making dinner. You never know what’s sinking in until the tables are turned!”

Debbie used various strategies to keep Michael in line. Over time, as his love of swimming grew, she was delighted to see that he was developing self-discipline. “For the past 10 years, at least, he’s never missed a practice,” she says. “Even on Christmas, the pool is the first place we go, and he’s happy to be there.”

Debbie also made sure to listen to her son. In the sixth grade, he told her he wanted to stop taking his stimulant medication. Despite serious misgivings, she agreed to let him stop — and he did fine. Michael’s busy schedule of practices and meets imposed so much structure on his life that he was able to stay focused without medication.

Debbie and Michael didn’t see eye to eye on every challenge that came his way, but he always understood the role she played in his swimming success. Immediately after being awarded his first gold medal at Athens, he stepped off the winner’s platform and walked to the stands, to hand Debbie a bouquet and the garland that crowned his head. That moment is vivid in Debbie’s memory. “I was so happy, I was in tears,” she recalls.

Michael now attends the University of Michigan, where he’s majoring in sports marketing, while training for the 2008 Olympics. Debbie has become the principal of Windsor Mill middle school in Baltimore, Maryland. She applies what she learned raising Michael to all of her students, whether or not they have ADHD. “All kids can fail us at times,” she says. “But if you work with them, nine times out of 10, they’ll make you proud.”

This article comes from the April/May 2007 issue of ADDitude.

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What does it take to succeed despite attention deficit disorder (ADD ADHD)?

It takes hard work, for starters — a willingness to meet challenges head-on. It takes support from family members, teachers, therapists, and coaches. And, of course, it’s hard to overstate the benefits of ADHD medication.

But, of all the ingredients needed to make a happy, successful life, nothing is more important than good parenting. Behind almost every ADHD success story is a devoted parent (or two). In honor of mothers, let’s give credit where credit is due — and heed their ADHD parenting advice.

The three mothers profiled here helped their sons and daughters achieve great things — more than they could have imagined. Steadfast and resourceful, they saw strength where others saw weakness, and kept looking for ways to help their children after others were ready to give up. Let their stories inspire you!

Study First to Link TV Sex To Real Teen Pregnancies

2008-11-03T07:55:00.000-08:00

By Rob Stein
Washington Post Staff Writer
Monday, November 3, 2008; A01

Teenagers who watch a lot of television featuring flirting, necking, discussion of sex and sex scenes are much more likely than their peers to get pregnant or get a partner pregnant, according to the first study to directly link steamy programming to teen pregnancy.

The study, which tracked more than 700 12-to-17-year-olds for three years, found that those who viewed the most sexual content on TV were about twice as likely to be involved in a pregnancy as those who saw the least.

"Watching this kind of sexual content on television is a powerful factor in increasing the likelihood of a teen pregnancy," said lead researcher Anita Chandra. "We found a strong association." The study is being published today in Pediatrics, the journal of the American Academy of Pediatrics.

There is rising concern about teen pregnancy rates, which after decades of decline may have started inching up again, fueling an intense debate about what factors are to blame. Although TV viewing is unlikely to entirely explain the possible uptick in teen pregnancies, Chandra and others said, the study provides the first direct evidence that it could be playing a significant role.

"Sexual content on television has doubled in the last few years, especially during the period of our research," said Chandra, a researcher at the nonpartisan Rand Corp.

Studies have found a link between watching television shows with sexual content and becoming sexually active earlier, and between sexually explicit music videos and an increased risk of sexually transmitted diseases. And many studies have shown that TV violence seems to make children more aggressive. But the new research is the first to show an association between TV watching and pregnancy among teens.

The study did not examine how different approaches to sex education factor into the effects of TV viewing on sexual behavior and pregnancy rates. Proponents of comprehensive sex education as well as programs that focus on abstinence said the findings illustrate the need to educate children better about the risks of sex and about how to protect themselves, although they disagree about which approach works best.

"We have a highly sexualized culture that glamorizes sex," said Valerie Huber of the National Abstinence Education Association. "We really need to encourage schools to make abstinence-centered programs a priority."

But others said there is no evidence that abstinence-centered programs work.

"This finding underscores the importance of evidence-based sex education that helps young people delay sex and use prevention when they become sexually active," said James Wagoner of Advocates for Youth. "The absolutely last thing we should do in response is bury our heads in the sand and promote failed abstinence-only programs."

Chandra and her colleagues surveyed more than 2,000 adolescents ages 12 to 17 three times by telephone from 2001 to 2004 to gather information about a variety of behavioral and demographic factors, including television viewing habits. Based on a detailed analysis of the sexual content of 23 shows in the 2000-2001 TV season, the researchers calculated how often the teens saw characters kissing, touching, having sex, and discussing past or future sexual activity.

Among the 718 youths who reported being sexually active during the study, the likelihood of getting pregnant or getting someone else pregnant increased steadily with the amount of sexual content they watched on TV, the researchers found. About 25 percent of those who watched the most were involved in a pregnancy, compared with about 12 percent of those who watched the least. The researchers took into account other factors such as having only one parent, wanting to have a baby and engaging in other risky behaviors.

Fifty-eight girls reported getting pregnant and 33 boys reported being responsible for getting a girl pregnant during the study period. The increased risk emerged regardless of whether teens watched only one or two shows that were explicit or surfed many shows that had occasional sexual content, Chandra said.

"It could be a child wasn't watching that much TV per week but was watching shows that got a pretty high rating on sexual content, or it could be a kid who was watching a lot of hours but on average was getting just moderate amounts of sexual content from each show," Chandra said.

Among the shows the teens watched were "Sex and the City," "Friends" and "That '70s Show." Chandra would not identify the others but stressed that they included dramas, comedies, reality shows and even animated programs on broadcast and cable networks.

"We don't want to single out any individual programs," Chandra said.

The researchers recommended that parents spend more time monitoring what their children watch and discussing what they see, including pointing out the possible negative consequences of early sexual activity. Programmers should also include more-realistic portrayals of the risks of sex, such as sexually transmitted diseases and pregnancy, the researchers said.

"Unfortunately, that continues to be relatively rare compared to the portrayals of the positive aspects," Chandra said.

Critics of television programming and experts on teen pregnancy said the research provided powerful new evidence about the role of TV in youth behavior.

"This is very significant," said Melissa Henson of the Parents Television Council, a watchdog group. "It gives us plenty of reason for concern."

Kelleen Kaye of the National Campaign to Prevent Teen and Unplanned Pregnancy praised the study but stressed that the causes of teen pregnancy are complex.

"We need to be cautious about overreaching in our expectations about the role the media can play in our effort to prevent teen pregnancy," she said. "We don't want to assume this is the whole story."

Several experts questioned whether the study had established a causal relationship.

"It may be the kids who have an interest in sex watch shows with sexual content," said Laura Lindberg of the Guttmacher Institute. "I'm concerned this makes it seem like if we just shut off the TV we'd dramatically reduce the teen pregnancy rate."

Chandra acknowledged that other factors might play a role but said the findings are compelling because the researchers were able to track the teens over time and found such a striking relationship.

"The magnitude of the association we did see was very strong," she said.

Study Links Violent Video Games, Hostility

2008-11-03T07:54:00.000-08:00

Research in U.S., Japan Shows Aggression Increased for Months After Play

By Donna St. George
Washington Post Staff Writer
Monday, November 3, 2008; A18

Children and teenagers who play violent video games show increased physical aggression months afterward, according to new research that adds another layer of evidence to the continuing debate over the video-game habits of the youngest generation.

The research, published today in the journal Pediatrics, brings together three longitudinal studies, one from the United States and two from Japan, examining the content of games, how often they are played and aggressive behaviors later in a school year.

The U.S. research was the first in the nation to look at the effects of violent video games over time, said lead author Craig A. Anderson, a psychology professor at Iowa State University and director of its Center for the Study of Violence.

Anderson said the collaboration with Japanese researchers was particularly telling because video games are popular there and crime and aggression are less prevalent. Some gamers have cited Japan's example as evidence that violent games are not harmful.

Yet the studies produced similar findings in both countries, Anderson said. "When you find consistent effects across two very different cultures, you're looking at a pretty powerful phenomenon," he said. "One can no longer claim this is somehow a uniquely American phenomenon. This is a general phenomenon that occurs across cultures."

The study in the United States showed an increased likelihood of getting into a fight at school or being identified by a teacher or peer as being physically aggressive five to six months later in the same school year. It focused on 364 children ages 9 to 12 in Minnesota and was first included in a 2007 book, "Violent Video Game Effects on Children and Adolescents."

Japanese researchers studied more than 1,200 Japanese youths ages 12 to 18. In all three studies, researchers accounted for gender and previous aggressiveness.

"We now have conclusive evidence that playing violent video games has harmful effects on children and adolescents," Anderson said.

The American Academy of Pediatrics, which publishes the journal in which the study appears this month, is in the process of revising its recommendations on media violence, and expects to issue a new statement in four to six months, a spokeswoman said. The academy now recognizes violence in media as a significant health risk to children and adolescents and recommends limiting screen time including television, computers and video games to one to two hours a day.

For many parents, the latest research was unsettling, though not surprising.

Patricia Daumas, 50, a single mother of two in Reston, said she sometimes wonders about her decision to allow her sons, ages 8 and 11, to play war games. But like many parents, she sees the issue as complex. She does not allow her sons to play games rated "mature."

"I don't think the games are good for them," she said, "but what I'm seeing in my own children is that they're still very gentle, that they're very caring, and they have absolutely no behavior problems at school."

Daumas noted that many of her sons' friends play the games. "It's a tough balancing act," she said.

Tracey Goldman, 42, a mother of two in Takoma Park, said she enforces time limits on video-game playing and does not allow violent content. Her fourth-grader plays Lego Star Wars, she said, but otherwise, "I just feel very uneasy about letting him play those kinds of games."

Still, she said, monitoring game-time can require vigilance because children can find games on Internet sites. She recalled looking over her son's shoulder as he played at a computer, asking: "Wait a minute. Is that shooting people?"

Parents have debated the potentially harmful effects of video-game violence for most of the last two decades, as the games have become more popular and more graphic. In the new research, games were deemed violent when one character harmed or killed another.

Still, not all video games are violent or associated with such negative effects, said Joseph Kahne of Mills College in Oakland, Calif., coauthor of a recent video-gaming study by the Pew Internet & American Life Project.

The Pew study, based on a poll of 1,102 youths ages 12 to 17, found that most teenagers play many different kinds of games and that some types of play -- such as making decisions about how to run a city -- are correlated with more political or civic involvement.

Overall, Kahne said, "it's important to pay attention to the nature of the games and the sense that kids make of the experience."

Although the longitudinal studies reported in Anderson's study showed that frequent playing of violent video games leads to greater aggression, Anderson also said this message should be understood in the larger context of a child's life.

"A healthy, normal, nonviolent child or adolescent who has no other risk factors for high aggression or violence is not going to become a school shooter simply because they play five hours or 10 hours a week of these violent video games," he said.

Extreme forms of violence, Anderson said, "almost always occur when there is a convergence of multiple risk factors."

A U.S. surgeon general report in 2001 identified an array of those risk factors, including gang involvement, antisocial parents and peers, substance abuse, poverty and media violence. Males are more at risk.

The new study noted that video games are played in 90 percent of American homes with children ages 8 to 16 and that the U.S. average playing time of four hours a week in the late 1980s is now up to 13 hours a week, with boys averaging 16 to 18 hours a week.

Help Your ADHD Teenager Find His Passion

2008-10-12T11:32:00.000-07:00

Parenting ADHD children: How to help your teenager find his unique talents and skills.

by Patricia Berry

Teens hear it constantly — find your passion. It’s as if one or two talents or skills are the magic pills for success, in school and in life. High-school guidance counselors suggest that a worthwhile hobby is just the ticket for getting into a good college.

The truth is, it can be. A special interest is fulfilling, it may impress admissions officers, and it could lead to success in college and beyond. But for teens with ADHD, finding that one special thing can be a challenge. Where do they begin? How can they pick just one activity when they enjoy so many?

“The busy ADD mind has a great capacity for dabbling in a variety of activities, and not going deep in any one area,” says Theresa L. Maitland, Ph.D., coordinator of the Academic Success Program for Students with LD and ADHD at the University of North Carolina. ADD kids have trouble selecting one or two standout pursuits. The quiet reflection needed to shorten the list of possibilities — what Maitland calls “being still with oneself” — does not come easy for them.

Filling a teen’s days with tutors and life coaches certainly doesn’t help. “We focus too much on our teens’ weaknesses, and not enough on uncovering talent or passion,” says Maitland. “We are all naturally good at something.”

Giving teens time and space to think about what makes them feel good about themselves is one way parents can nurture the process. Another is helping them discover clues about what their passions may be. Your teen has to do the hard work of finding and cultivating her talents, but your support — and the good sense to back off at times — will keep your teen on task.

Rate His Interests

“Each person has unique talents and gifts — it’s just a matter of teasing them out,” says Maitland, who specializes in helping high school and college students stay on track with their academic and extracurricular pursuits. She often refers students to Richard Chang’s book, The Passion Plan: A Step-by-Step Guide to Discovering, Developing, and Living Your Passion (Jossey-Bass), to help them mine their talents.

Tips for Teens

Chang suggests asking your teen to make a list of “passion candidates.” Have him think about the things he likes to do. Hobbies or objects he’s chosen for his room may spark ideas. Is there a guitar leaning in the corner, reminding him of a love for music, for instance? Or a museum poster that reflects a liking for painting or art? If so, encourage him to imagine participating in these pursuits. What do his heart and body tell him when he thinks about each activity? When is he alive, exhilarated, enthusiastic, energetic? When is he bored?

Have your teen rate each interest—say, from 1 to 10—and then rank those on his list. Some interests or passions likely will reflect current pursuits. Others may suggest careers—a useful list for the student contemplating college or vocational school. Maitland suggests that a teen talk to people other than Mom and Dad, who know her too well. Getting the reaction of a grandparent, a family friend, or a beloved teacher to your teen’s passion list will inform the exercise. For example, an aunt may recall the puppets your daughter made for her cousins one year, and the hours she put in assembling each one. Such memories may deepen your teenager’s thinking about a particular pursuit.

Key into His Personality

The things teens get in trouble for can be clues to their passion. The teen who talks too much in class, or who bosses his teacher and classmates around, may be a born organizer, well suited to starting a high school club or leading a management team. The teen who neglects her schoolwork to play outdoors may prefer nature to being at a desk. Such feelings are not talents, but they could be the foundation of a passion.

“Look at the things kids gravitate to and ask, ‘Could those be the seeds of life passions?’” says Maitland. If you saved your teen’s elementary-school report cards, dig them up for clues. Comments from teachers can point out patterns. For instance, a student’s doodling throughout the day back in second grade may be the beginnings of his cartooning for the school paper. Perhaps he’d enjoy drawing classes, to hone his skill.

Think Beyond Oneself

Knowing what you love isn’t the full answer. An athlete, for instance, may love track, and discover it’s not the running he enjoys, but being part of a team and having the structure of practices. “Passion frequently lies in being a part of something bigger than oneself,” says Maitland.

Maitland counsels a college student who “discovered that she felt most alive when she was traveling to foreign countries and meeting people of different backgrounds.” She has decided to take her love for other cultures into the business world, to help company managers cultivate diversity among personnel.

Search for Talent

Passion and talent don’t always go hand in hand, but they evolve together. Nineteen-year-old Morgan Miller, who has ADD, grew up without a specific talent, not unlike many kids with her condition. “I was mediocre at most things,” says the Montclair, New Jersey, native. “I wasn’t a really good dancer. I wasn’t the best softball player.

“I needed to find something I could feel confident about,” she says. Eventually, it came to her: “I realized I love working with kids,” Miller says. “And it was something I knew I was good at. It was my passion. You work at your passion, and it becomes your talent.” Now the Goucher College sophomore is intent on pursuing a career in children’s television. So momentous was this self-discovery that Miller chose passion as the topic of her college application essay.

Keep an Eye on the Prize

When passions begin shaping students’ goals, other pursuits will start to seem like burdens. Maitland works with a student who wants to work for Doctors Without Borders. While he enjoys the science classes that he needs to get into medical school, he hates history, which seems irrelevant to his goal.

Maitland encourages the student to keep his internal dialogue—what she calls “self-talk”—focused on the positive. “He uses self-talk to stay on track with the required courses he doesn’t care for,” she says. This ongoing conversation helps the student get past the frustration of history class —what he sees as a waste of his time—and use it as a stepping stone to accomplishing his goal. He plasters images from Doctors Without Borders brochures on his history notebook, as a reminder of his objective.

Maitland says her teen clients teach her a lot about living their life. “Some people with ADD are incredible at doing only what they love. They could be my tutors,” she says. She understands why students don’t want to take required courses that have nothing to do with their major or their life goals.

“They tell me, ‘I don’t have much time on earth. I only want to do what I’m passionate about.’” Who can blame them?

This article comes from the Spring 2008 issue of ADDitude.

Listening to clients...no, really listening! Studies show a 65% improvement in outcome

2008-10-09T15:21:00.000-07:00

from Scott Miller, PhD (www.talkingcure.com)

Evidence-based practice is, as you know, "all the rage." Like bell-bottoms and skinny ties, listening to clients in therapy is out of fashion. Treatment manuals and fidelity measures are "in." Most of the push for field-wide adoption of specific treatments for specific disorders comes from the top. Government funders, policy think tanks and professional organizations are promoting evidence-based practice as the cure-all for what ails the field--namely, a continuing lack of respect and lingering perception of mental health as the "soft" of science. Here we consider a different idea for addressing the call for accountability in mental health: "practice-based evidence"--that is, using data generated during treatment to inform the process and outcome of treatment. A number of researchers have, over the last decade, been using the client's rating of the therapeutic alliance and progress in treatment as a way of improving retention and outcome in treatment. Interestingly, such research shows that providing therapists with real-time feedback regarding the client's experience of the therapeutic alliance and outcome cuts attrition rates in half and improves outcome by as much as 65%. By the way, such results were achieved without training therapists in any new treatment procedures or limiting the sample diagnostically. As you know, most randomized clinical trials exclude subjects that do not meet narrow inclusion criteria thereby making the applicability of any study findings to real-world clinical settings exceptionally questionable. Bottom line: therapists were encouraged to listen--especially when what they were doing wasn't working or did not fit for the individual client--and the hoped for improvements in retention and outcome followed.

Teen drivers with ADD a problem on the road

2008-10-09T15:03:00.000-07:00

By Judy Fortin
CNN Medical Correspondent

It was hard to miss the bright yellow Student Driver bumper sticker on the back of the car driven by Tosha Mulligan. Tosha Mullgian, 19, has attention deficit disorder. She says her mind wanders when she drives. Getting a driver's license is a rite of passage for many teenagers, but the process was a bit more challenging for 19-year-old Mulligan of Acworth, Georgia. When she gets behind the wheel, she said, "Sometimes my mind wanders off." She's not alone. Researchers reported driving can be a serious problem for teens with ADD and attention deficit hyperactivity disorder. Motor vehicle accidents already are the leading cause of death among teenagers in the U.S., according to the National Highway Traffic Safety Administration. Experts such as Russell Barkley say ADD and ADHD compound the problem.

Barkley, a psychiatry professor at the Medical University of South Carolina, is a widely recognized expert on ADD and driving. He has investigated the topic for 15 years and conducted a half-dozen studies, some of which have been published in peer-reviewed journals. Teen drivers with ADD or ADHD "are impulsive, highly distractible and clumsy, can't pay attention to the roadway and they get bored easily," he said.

Mulligan's driving instructor, Jerry Thielemann of Freedom and Mobility Driver Training and Evaluation in Marietta, Georgia, experienced that firsthand. He works with teenagers with ADD three to four times a week. "A person with ADD pays attention to someone walking down the street rather than a car coming toward them," Mulligan said. "They don't know what to focus on." Barkley sees speeding as a key problem. "In general, people with ADHD speed four times more often than those without ADHD," he said. His research shows that those with ADD or ADHD are two to three times more likely to have an auto accident, three times more likely in the first five to eight years of driving to have their licenses revoked and five times more likely to get a parking ticket. In all three instances, Barkley pointed to the impatient and impulsive nature that is common among people with ADD or ADHD.

Chris Zeigler Dendy, author of "Teenagers with ADD and ADHD," raised a son and a stepson with the condition. "We were worried sick about our kids when they started driving because both had ADHD," Dendy recalled. "They both started getting speeding tickets and having car wrecks. One of them even had his license suspended." That was nearly 20 years ago. Today, Dendy said, she understands what was behind their troubles. "I think the good news is that parents today are so much better informed than we were, plus laws have tightened up so you get one ticket or step out of line and your license is gone," she said. Dendy credited proper medication with helping get her sons back on track. "Research tells us that with medication they are more likely to pay attention to road signs and less likely to have road rage," Dendy explained. She worried about parents who may not be as vigilant when it comes to monitoring their teen's driving behavior, especially during high-risk times. "One is after school from 3 to 6 and the other is on weekend evenings," she said. She mentioned those are often the hours when medication starts to wear off or when teens may be more likely to skip a dosage.

Barkley acknowledged the parents who decline to medicate their children who have ADD or ADHD, but he believes "Medication is more effective than any other treatment." Barkley also cautioned that people with ADD are more sensitive to the effects of alcohol and are unable to drive safely after drinking. He told teens to put away their cell phones, MP3 players and other items that might distract them while driving. Barkley suggested parents closely monitor their teenagers and provide sign-in and sign-out sheets in the garage to track their whereabouts.

Dendy eventually drew up a contract with her children, spelling out specific rules and expectations for driving the family car. Dendy and Barkley both recommended that teenagers with ADD or ADHD stay in a learner's permit program longer, at least a year, and put off getting their license until they have more experience behind the wheel. That's what Tosha Mulligan did. She finished her last driving lesson the day before she left for her freshman year in college. She passed her driver's test on the first try and got her license. She said waiting to get her license made a big difference. She said "It kept me focused." She reported no wrecks, no tickets and no problems so far.