ADHD on the World Wide Web

1. ADHD on the World Wide Web The Best, The Worst, and the Confusing By, Tina D’Alessandro, MSN, ARNP

2. Objective Summarize information available on the Internet regarding ADHD. Patients routinely search the internet regarding treatment options and for education regarding disorders. Providers with knowledge of this information can better serve and guide their patients.

3. Where To Begin • 15,900 choices for ADHD on Google • 76,700 choices for ADHD on Yahoo • It’s enough to confuse anyone!

4. What’s Out There? • Testimonials • Vitamin Supplements • Biofeedback • Books • Drug information from Pharmaceuticals • Diagnostic and Treatment Information

5. Supplements • Secret ADHD Formula http://www.neu-be-calm.com/index.html • NeuroGenesis: Science for the Mind and Body http://www.neurogenesis-inc.com/45029 “Neu-BeCALM'd is the only product that restores the brain by providing basic building blocks it needs for focus and calm. In order to focus you need certain amino acids. Many people have attention problems lack the essential amino acid, Phenylalanine.”

6. Supplements • Clarocet CS “complementary and alternative medicine designed to provide full-day cognitive support • http://www.clarocet.com/cs/#destinations • $42.50 for 1 month supply, $35.50 for one month supply with automatic refills.

7. Supplements • Efalex: Supports all aspects of brain and eye function. Supplements the intake of long chain polyunsaturated fatty acids (LCPs) needed for healthy brain and visual development, including learning ability, concentration and co-ordination. Supplies DHA and AA - important building blocks of the brain, nervous system and eye. Helps support all aspects of brain and eye function. • Approximately $20.00 per bottle, #90 capsules, recommended dosage = 8 capsules/day

8. Supplements • Native Sun – Natural Remedies • http://www.nativeremedies.com/search_results.php?query=adhd • Homeopathic products, supplements and testimonials – “Focus Formula”

9. ADHD Information Library • Promotes the use of a supplement – Attends; encourages “ADHD diet” • Cites “clinical trial” evaluating effectiveness of Attends in 30 day trial – TOVA scores compared pre and post tx. No placebo group was used. • http://newideas.net/adhd/attend-alternative/study-results

10. Personal Testimonials • Three Steps to Conquering ADD http://3stepsadd.com/index2.html • Table of Contents to book - $89.99! • My Struggle with ADD-ADHD (testimonial for the above book). http://add.natural.googlepages.com/

11. Lets compare online videos • http://3stepsadd.com/index2.html • http://familydoctor.org/online/famdocen/home/children/parents/behavior/118.html

12. The Fear Factor Testimonial • ADHD Fraud: http://adhdfraud.org/ • *Here are some facts that are being withheld from parents that could possibly alter their life decisions and outcomes. • Did you know that schools receive additional money from state and federal government for every child labeled and drugged? This clearly demonstrates a possible "financial incentive" for schools to label and drug children. It also backs up the alarming rise/increase in the labeling and drugging that has taken place in the last decade within our schools. • Did you know that parents receiving welfare money from the government can get additional funds for every child that they have labeled and drugged? In this way, many lower socio-economic parents (many times single mothers) are reeled into the drugging by these financial incentives waved in front of them in hard times, making lifestyle changes possible. • Did you know that by labeling your child with ADHD, you are actually labeling them with a mental illness listed in the DSM-IV, the unscientific billing bible for psychiatry?

13. Death by Ritalin • Did you know that a child taking a psycho-tropic, psycho-stimulant drugs like Ritalin after the age of 12 is ineligible for military service? • Under the new standards, ADD/ADHD is disqualifying only if the applicant has been treated with ADD/ADHD medication within the previous year and/or they display signs of ADD/ADHD. • Did you know that the subjective checklists that are being used as criteria for diagnosis are very similar to the checklists used to determine Gifted and Talented Children? These two checklists are almost identical.

14. Death by Ritalin (continued) • The Drug Enforcement Administration clearly states in their report on Methylphenidate: "However, contrary to popular belief, stimulants like methylphenidate will affect normal children and adults in the same manner that they affect ADHD children. Behavioral or attentional improvements with methylphenidate treatment therefore is not diagnostic of ADHD." (p.11) This statement thoroughly contradicts what is being told to many parents by the many "professionals" that have a vested stake in the diagnosis itself. • The DEA further states that: "Of particular concern is that most of the ADHD literature prepared for public consumption by CHADD and other groups and available to parents, does not address the abuse potential or actual abuse of methylphenidate. Instead, methylphenidate (usually referred to as Ritalin by these groups) is routinely portrayed as a benign, mild substance that is not associated with abuse or serious side effects. In reality, however, there is an abundance of scientific literature which indicates that methylphenidate shares the same abuse potential as other Schedule II stimulants." (p.4) • In fact, research suggests that children with ADHD who are treated with stimulants have lower degrees of abuse compared to children with ADHD who are not treated.

15. Death by Ritalin • Did you know that there are studies such as the Berkeley Study that contends that Ritalin and other stimulants further raise the risk of drug abuse? From the Wall Street Journal, Monday, May 17, 1999 by Marilyn Chase: "Nadine Lambert, a professor of education, followed almost 500 children for 26 years. She argues that exposure to Ritalin makes the brain more susceptible to the addictive power of cocaine and doubles the risk of abuse.“ • Habit-forming illnesses can be associated with a high comorbidity with ADHD, expressed in the form of alcohol abuse and also in consumption of illegal drugs. The results underline the great importance of early and adequate diagnostics and therapy of ADHD for the prevention of habit-forming illnesses. (Ohlmeier MD, Peters K, Te Wildt BT, Zedler M, Ziegenbein M, Wiese B, Emrich HM, Schneider U.2008. Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder.Alcohol Alcohol. May-Jun;43(3):300-4.) • What does make it into many parents' hands is research indicating that if children go "untreated", which corresponds with "unmedicated" they will "self-medicate" or end up as juvenile delinquents. Sadly many of these parents are not aware that many of this biased and unproven research (one such is the Beiderman study) infiltrating our schools are actually being distributed by pharmaceutical companies, such as Novartis. This in itself is another red flag and conflict of interest surrounding our children's health. • Beiderman’s longitudinal studyconcluded that unmedicated subjects with ADHD were at asignificantly increased risk for any SUD at follow-upcompared with non-ADHD control subjects (adjustedOR: 6.3 [1.8 –21.6]). Subjects with ADHD medicated at baseline were at a significantly reduced risk for a SUD atfollow-up relative to untreated subjects with ADHD (adjusted OR: 0.15 [0.04–0.6]).

16. Conspiracy Theory! • National Alliance against Mandated Mental Health Screening and Psychiatric Drugging of Children: http://ritalindeath.com/states/florida.htm • “We have all been working together to inform State, and Federal Government on the fact that psychiatric brain disorders have no scientific validity, the Dopamine theory and others are nothing more than wishful thinking on the part of the psychiatric industry, there is no proof of any organic brain abnormality based on sound science.”

17. Biofeedback • ADHD and Biofeedback – this site recommends a holistic approach including a combination of medication/therapy and 40 or more EEG neurofeedback sessions (average 2 visits/week) – site does not acknowledge the experimental nature of biofeedback in ADHD: http://www.biofeedback1.com/add1.html

18. More biofeedback • EEG Spectrum International: an educational and research institute. Includes a disclaimer; “The material to be presented in this page and all subsidiary pages at this site includes many results which have been obtained in a clinical setting, and they do not yet have grounding in research under more controlled conditions. They must therefore be regarded as preliminary and experimental.” • http://www.eegspectrum.com/

19. Provider Websites • James Lehman, MSW • “A guaranteed simple way to stop your child’s impulsive, out of control behavior RIGHT NOW!” • http://www.thetotaltransformation.com/?utm_medium=cpc&utm_source=msna&utm_campaign=ttadhd&dsource=msna&utm_term=ADHD&utm_content=mkwid|p6UdkLz2k|pcrid|43665030

20. MD website – Dr. Saunders • “How You Can Banish Hyperactivity, Cure Inattention And End The ADHD Nightmare For Good. . . Safely, Naturally And Without The Use Of Harmful ADHD Drugs...” • Downloadable manual – reduced from $39.95 to $19.95! • http://www.treatadhdnaturally.com/

21. PhD Web Site • “The Myth of ADHD” • Dr. Armstrong, PhD • Website: http://www.thomasarmstrong.com/bio.htm • Theory of multiple intelligences and awakening the inner genius

22. Help My Parents Find Accurate Information!

23. MD’s Web sites – Dr. Amen Dr. Amen is an Assistant Clinical Professor of Psychiatry and Human Behavior at the  University of California, Irvine School of Medicine http://www.amenclinics.com/clinics/information • Treats a wide variety of conditions including • ADHD/ADD • Anxiety and Depression • Brain Trauma • Substance Abuse • Alzheimer’s and Memory Loss • Marital Problems • Aggression • Autism based upon Spect Scan results: Cost of evaluation $3,375.00

24. Spect pictures • Healthy brain

25. Imaging Studies and ADHD • Currently there are no accepted uses for imaging in diagnosing ADHD other than ruling out identifiable medical or neurologic conditions that may mimic ADHD. • A diagnositic imaging test may some day reduce under and over diagnosis of ADHD and improve treatment. • Identification of the neural substrates underlying ADHD subtypes can be approached empirically using brain imaging, but the issue is complex. Data need to be viewed within a developmental context to determine if ADHD identified in youth is the same as that seen in adults, and consideration needs to be made for overlap with comorbid conditions.

26. Imaging Studies • Questions: • 1. How well does the test identify the condition of interest (ADHD)? • 2. How well does the test distinguish the condition from other similar disorders? • 3. Is the test feasible and cost-effective? • 4. Sensitivity and specificity • What are the true positives the test identifies (as compared with the gold standard)? • What is the proportion of true negatives correctly identified? (Bush, G. 2008. Neuroimaging of Attention Deficit Hyperactivity Disorder: Can New Imaging Findings Be Integrated in Clinical Practice? Child and Adolescent Psychiatric Clinics of North America, 17(2),385-404.)

27. MD and PhD Collaborative Site • Addvance • Patricia O. Quinn, MD and Kathleen Nadeau, PhD – “Internationally recognized authorities on ADD (ADHD) and authors of many books for children, teens, and adults. “ • Site addresses the varied needs of all people with ADD (ADHD) across the lifespan – coaching suggestions. Simple, easy to read. • http://www.addvance.com/

28. On-line magazine • ADDitude • ADHD Medication Strategies: Avoiding Side Effects of ADD Drugs | • ADDitude - Attention Deficit Information and Resources

29. Warehouse • A.D.D. Warehouse • http://www.addwarehouse.com/shopsite_sc/store/html/articles.html • Books and videos for sale • Printable free handouts – easy to find • Links to other sites

30. Trusted Sites • American Academy of Family Physicians http://familydoctor.org/online/famdocen/home/children/parents/behavior/118.html • Web MD: “Better Information, Better Health” http://www.webmd.com/add-adhd/

31. National Organizations and Medical Sources • National Institute of Mental Health http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml • Includes in depth information, research and science news. • Medline-Plus: A service of the U.S. National Library of Medicine and the National Institutes of Health. • Includes information in Spanish. • Information from the basics of ADHD to research, legislative efforts, alternative treatments and sections specifically for children, teenagers, parents. MedlinePlus: Attention Deficit Hyperactivity Disorder

32. Attention Deficit Disorder Association • The world’s leading adult ADHD organization • A national organization whose role is to educate and advocate for the needs of • individuals with ADHD • http://www.add.org/

33. Since I work here… • Teens Health from Nemours: ADHD http://kidshealth.org/teen/school_jobs/school/adhd.html • Parent’s site from Nemours: http://kidshealth.org/parent/medical/learning/adhd.html Kids Health from Nemours: ADHD http://kidshealth.org/kid/feel_better/things/ritalin.html

34. American Psychiatric Association • Fact sheet on common childhood disorders, including ADHD • Brief descriptions of depression, ADHD, and conduct disorder • http://www.healthyminds.org/factsheets/LTF-CommonChildhood.pdf

35. Duke University affiliated Scientist • Up-to-date information on ADD symptoms and treatments, from David Rabiner, Ph.D. • Helpful for clinicians, parents and educators – information regarding the latest studies and most efficacious treatments • http://www.helpforadd.com/

36. National Organizations and Medical Sources • Children and Adults with Attention Deficit Hyperactivity Disorder http://www.chadd.org/ The nation's leading non-profit organization serving individuals with AD/HD and their families. Provides support and information to families with children with ADD and ADHD, and assists parents and others interested in starting support groups. It holds an annual conference and publishes both a magazine and quarterly newsletter. Includes Spanish language resources. • National Resource Center on ADHD (a program of CHADD): Clearinghouse for science-based information about all aspects of attention-deficit/hyperactivity disorder (AD/HD). Funded through a cooperative agreement with the Centers for Disease Control and Prevention. http://www.help4adhd.org/

37. NAMI • The nations voice on mental illness • http://www.nami.org/ • Article from their newsletter addressing Facts and Fiction regarding AHDH • http://www.nami.org/Content/ContentGroups/Youth/Beginnings-Summer03.pdf

38. American Academy of Pediatrics • Dedicated to the health of all children • Parent page • Tool kits (for clinicians) • Info. Re. the safety of medications –last updated 2006. • American Academy of Pediatrics Children’s Health Topics: ADHD http://www.aap.org/healthtopics/ADHD.cfm

39. Child Development Institute • CDI was founded by Dr. Robert Myers, PhD –University of California • “ADHD information for parents based on current research with practical suggestions to help kids be the winners they are meant to be. “ • ADHD news updated daily, developmental, parenting and psychological information scientifically based. • http://www.childdevelopmentinfo.com/ADHD/index.shtml

40. NYU Child Study Center • Signs and symptoms, diagnosis, treatment, real life stories, helpful hints/pdf downloads • http://www.aboutourkids.org/families/disorders_treatments/az_disorder_guide/attentiondeficithyperactivity_disorder

41. Helpful and trustworthy • Mayo Clinic http://www.mayoclinic.com/health/adhd/ds00275 • One of the nation's premier medical facilities defines and explains ADHD symptoms, diagnosis, treatment, and coping strategies

42. Websites • Internet Mental Health (includes self-diagnosing - Computerized psychiatric diagnostic assessment, Computerized cognitive assessment - $59.00 for 2 months or $89.00 for 12 months!) • No funding for site from corporate sponsors • Accurate information, good lay-person’s article –”Life in Overdrive” from Time. • Link to Statistical help for clinicians (and PhD students) • http://www.mentalhealth.com/

43. Pharmaceutical sites • Concerta web site: http://www.concerta.net/concerta/home.html?utm_campaign=Overlap%20-%20Unbranded&utm_source=msn&utm_medium=cpc&utm_content=ADHD%20General&utm_term=adhd • Medication Guide • For Healthcare Professionals • For Children & Teens • Adult Home • Could it be ADHD? • Diagnosed with ADHD? • Understanding ADHD in Adults • Treatment with CONCERTA

44. Pharmaceuticals • Vyvanse • Coupons • Research information • Information for providers http://www.medscape.com/infosite/vyvans public

45. More pharmaceuticals • Daytrana • ADHD educational material • Links to other websites • Provider information http://www.daytrana.com/hcp/

46. Other Websites with helpful information • ADHD General Information • Google Directory (1 page, includes fact sheets and behavioral interventions): ADD & ADHD • Wikipedia : Attention-deficit hyperactivity disorder • Yahoo Directory (2 pages – very manageable search): Attention deficit disorder • US Department of Health and Human Services - healthfinder® : Attention deficit disorder • ADHD Pictures • Brain imaging (in ADHD) – information regarding research and pictures. Bruce Roseman, White Plains, New York • Neurobiology of ADHD – easy to visualize pictures and a link for kids to learn more about the brain. New Zealand ADHD support group, Tauranga, NZ

47. Other helpful websites • ADHD Symptoms • Attention deficit hyperactivity disorder (ADHD) symptomsNancy Reid, HealthWise / Yahoo health • Attention-deficit hyperactivity disorder (ADHD) : SymptomsAetna InteliHealth / Harvard Medical School • http://www.lib.uiowa.edu/hardin/MD/adhd.html Hardin MD – updated frequently at the University of Iowa – links to other sites, general information including medications and controversies

48. That’s All Folks!