June 28th, 2013 – Another ADHD Controversy, Revisited

Don Adams Community, Head of School

Don Adams, Head of School at the YMCA Academy, contacted me about responding to his blog post, and response to the recent article by Marilyn Wedge, PhD, a family therapist based in France, and author of a recent article: “Why French Kids Don’t have ADHD.” The article tackles three key differences including: 1) the higher incidence of ADHD diagnosis in North America versus France (9% versus less than 0.5% there), 2) the belief that it is a biological-neurological disorder here but a medical condition with psycho-social and situational causes there, and 3) the much heavier use of stimulant medications here to manage impairments versus there.

As a professional certified ADHD coach working with clients across Canada and the USA, I recommend addressing the biological-neurological underpinning, plus exploring ADHD-friendly tools and strategies to help each person become the best they can be. This is our approach here. Clients who put this kind of comprehensive approach in place definitely get the best results. This includes non-judging strength-based talk elements like weekly ADHD coaching sessions, which encompasses education about this unique brain wiring.  Meeting with a therapist is often an additional piece of the strategy if a client, or their child, are depressed or anxious. Emotional disruption can sometimes be the most impairing aspect of this condition.

Within that comprehensive approach, an official medical diagnosis can be very helpful, especially if we believe that this is an inherited brain development difference as we do here. Since everyone’s ADHD or ADD is a little bit different, a diagnosis tells us exactly what you or your children are dealing with. You are also able to partner with your doctor in investigating stimulant medications like Ritalin, Vyvanse and Concerta. Research shows us that stimulants help 80% to 85% of people with ADHD so they are definitely worth exploring.

One of the key differences that stimulant medication corrects is lower dopamine levels in the ADHD brain. Dopamine is a key neurotransmitter that is like a happiness chemical. It also helps with focus and attention. It gives that internal “get up and go” feeling that that non-ADHD people have in abundance. This ADHD difference is seen on some tasks, but not all. When a person with ADHD is working in an area of interest or natural talent or strength, he or she will be able to focus, no problem. He or she may even go into hyper-focus, and have difficulty switching out of the task because he or she is enjoying themselves so much!

Stimulant medication helps when a person with ADHD is struggling with a task they find boring or uninteresting or under-stimulating. Or when that same person is struggling at performing an intellectually challenging task that is causing external psychological pressure or stress. This is when the Pre-Frontal Cortex (PFC) of the ADHD brain — which is like the steering wheel or CEO of the brain — will naturally and involuntarily shut down. (The PFC provides direction, concentration, impulse control, critical thinking and prioritization, for example.) For undiagnosed and unmedicated ADHD, the situation is exacerbated. The shutdown is a can’t versus a won’t. The more the person tries, the worse the feeling gets. For people without ADHD, there is no PFC shutdown in similar circumstances. For those taking medication, there is consistently improved PFC performance, along with consistently boosted dopamine levels.

This was proven in a landmark 10 year PET scan study – a type of radiologic imaging – done by Dr. Zametkin at the National Institute of Mental Health (NIMH). His PET scan studies showed these consistent neurological differences between the Pre-Frontal Cortex (PFC) of ADHD brains and non-ADHD brains. His study also proved that medications, like Ritalin, did not harm brain growth, but enhanced it.

Dr. Zametkin’s study is one of thousands of studies that have been done that prove that ADHD is a real neurobiological difference. Our view in Canada and the USA is that there is documented scientific proof that ADHD exists from numerous reputable health care organizations. There are more than 6,000 studies, with 1,000 published in the last 10 years alone that ADHD is a real biological-neurological disorder. Dr.  Marilyn Wedge represents a view in France which is antithetical to that.

In North America, we believe that multiple genes related to brain development are the driving factor. ADHD is not caused by environmental factors like bad parents, playing video games, watching TV or a poor diet. (A poor diet can make the impairments worse, but does not cause ADHD.) Our position is that we have to stop telling parents they have done something wrong, and blame them or their child, as so often happens. Instead, we know that ADHD is highly inheritable. 15% to 40% of parents with ADHD children have it themselves compared to 3% to 7% in the general population.

For those people who are uninterested in exploring medications, there are some natural strategies to boost dopamine, and brain function.

1) 30 minutes of aerobic exercise can provide 2 hours of extra focus time as exercise naturally increases dopamine. (Medication, plus exercise, definitely gets the best results though.)

 2) Coffee increases dopamine, and is another kind of related “stimulant.” Moderate consumption of coffee like 1 to 3 cups a day is recommended. But not too late in the day or you won’t sleep, which is also very important.

3) Eating an ADHD-friendly diet, including 20 grams of protein for breakfast to get the brain turned on for the day can help with focus — although this does not boost dopamine, as far as I know.

4) If you want your PFC to be in peak form, at least 8 and a quarter hours of sleep is needed for the brain to naturally restore and reboot itself.

These are some other pieces of a comprehensive support strategy that definitely help too.

I agree with Don Adams then that comprehensive interventions including medications as one piece are critical in helping young people with ADHD experience both success at school, and then later, reach their goals and dreams in life.  It can also help to send your son or daughter to a school such as the YMCA Academy. This is a school where young people with neurological differences are truly embraced. They are taught with compassion and understanding. Finding an extraordinary school like this is another important piece of that comprehensive strategy. I speak as a parent who has sent one of my sons to the YMCA Academy. I have found an exceptional community of dedicated professionals who truly believe in the wonderful uniqueness of each, and every one of their students. That is incredibly important too.

Ann Clarkson

June 7th, 2013 – Another ADHD Controversy

Don Adams Head of School

Thanks to Zareh Demirdji, a teacher at The YMCA Academy, I read a recent article on the relative “incidence” of ADHD in the USA and France — “Why French Kids Don’t Have ADHD”.  The article cites some very interesting statistics about the prevalence of ADHD in those two countries:

“In the United States, at least 9% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?”

Of course, the description of the author (Marilyn Wedge, Ph.D., is a family therapist and the author of Suffer the Children: The Case Against Labeling and Medicating and an Effective Alternative) must cause one to question the objectivity of her judgments.  Still, the piece is provocative.  In her view, the correct intervention is to “treat the underlying social context problem with psychotherapy or family counseling”, not drugs.

Sir Ken Robinson makes a similar observation about the frequency of ADHD diagnoses within the United States — basically very infrequent in the west, and very frequent in the east.  His point, too, is that ADHD is being overdiagnosed in the east, and the use of such medications as Ritalin and Adderall is problematical.

However, we know from experience at The Academy, and from conversations with our students and their parents/guardians, that both therapeutic and pharmaceutical interventions, together and separately, have helped a large variety of students with respect to their ADHD symptoms and behaviours.

And that, it seems to me, points to a real concern with the article in question.  It attempts to polarize by citing competing responses to ADHD:

“Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States.”

Well, actually, it doesn’t depend on where you live!  The required “yes” or “no” answer to the question “Is ADHD a biological-neurological disorder?” must be independent of the location.  It either is, or is not, a biological-neurological disorder” everywhere.  The force of this article is that the French view of ADHD as a “medical condition that has psycho-social and situational causes” is correct.  The answer to the question is therefore “no”.  So according to the author the American model of causation and treatment is incorrect.

And yet I wonder…the comments following the article in question are numerous, and many speak to the successful treatment of ADHD symptoms with psycho stimulant medications.  So where does that leave us?  It suggests to me that a variety of biological and behavioural issues are lumped together under the convenient acronym ADHD.

Don Adams, Head of School

May 15th, 2013 – Outside the Box!

Don Adams Head of School

I’m writing this blog on the morning of May 15, looking forward to a day that should be filled with amazing experiential learning opportunities.  To begin with from 2:30 to 3:00pm The YMCA Academy welcomes Justin from Share the Road: Ride and Drive with Care.  The Ride and Drive with Care program is administered through Share the Road Cycling Coalition, with support from the CAA and funding from the Ministry of Health and Long Term Care. It is a program that targets both drivers and cyclists, and encourages them to use the road responsibly together.

Then, Markus Pukonen, of the Ocean Adventure Rowing and Education team who recently attempted a crossing of the Atlantic ocean using only human power, will speak to our school community about his expedition and the important oceanographic data and documentary footage he was collecting before the boat capsized on day 73 of the adventure.

Later, Dan Lambert, from Bikes on Wheels, will be demonstrating bike maintenance and showing Academy students how to tune-up their bikes in preparation for the summer.

Finally, this evening, we will be hosting Think2Learn, who are developing both a learning assessment tool, and computer based interventions that address the specific learning needs identified in the assessment.

That’s a busy school day — but it’s rather typical here at The Academy.  An important element of our program is our experiential learning opportunities.  It’s our response to a challenge from a great educational and entrepreneurial thinker — Aron Solomon — who asked, “If you want to teach your students to think outside of the box, why do you keep them cooped up in one?”  Our students are outside of the classroom “box” on a regular basis!

I should probably mention that on Friday the entire school population will be planting trees at Downsview with Evergreen!

Don Adams, Head of School

May 10th, 2013 – Invaders from MaRS

Don Adams Head of School

Toronto is fortunate to be home to MaRS Discovery District — MaRS is essentially a social innovation accelerator, providing expertise and access to funding to entrepreneurs.  One of their main areas of interest is education. I have always felt it to be important to keep The Academy up-to-date on the latest developments in the education sphere, so a relationship with MaRS was inevitable!

As a result of our working with them, MaRS has put us in touch with many innovators.  Our teachers and students have been able to provide some of them with valuable feedback about their ideas and products.  We benefit by having the chance to be early adopters of some really amazing ideas!

In that connection, I invite you to come to The Academy at 7:00 on Wednesday, May 15 to meet Think2Learn, an innovative company developing both a learning assessment tool, and computer based interventions that address the specific learning needs identified in the assessment.  Their value proposition: Think2Learn is brain training for kids that struggle in school based on the successful Lumosity business model. It differentiates itself by being a product for the child’s parents and uses a proprietary 360 degree neuroscience-based screening process that results in targeted interventions and brain training games that have been tagged to correlate with cognitive functions.

Please join us on the 15th.  Admission is free, and there will be coffee and goodies too.

Don Adams, Head of School

May 8th, 2013 – Care or Control?

Don Adams Head of School

When I speak about The Academy, I often speak about the six core values of The YMCA of Greater Toronto, generally focussing on the value of respect — which I think is the fundamental value underlying the other five: responsibility, inclusiveness, caring, health and honesty.  It is certainly at the core of both what we teach and also what we do at The Academy.

However, I’ve been thinking a great deal of another of the core values recently — caring.  At a recent social gathering, I was asked the usual question, “What do you do?”  My response to this question is always brief — something along the lines of “I’m the principal of a high school for students with learning disabilities” or “I run a high school for students who learn differently.”  Sometimes my answer stops a conversation, but at other times it starts one.

On this occasion, it started one.  “That must be very difficult.  How do you manage the students?  How do you control their behaviour?”  At first I found it difficult to answer the questions; after a few seconds I realized that my difficulty was based on the assumptions implied in the questions themselves.  One underlying assumption — students are difficult to control — is based on an understanding of the educational dynamic that we all experienced during our schooling, where the relationship was often adversarial.  The teacher possessed the power, and enforced rules that often seemed arbitrary or irrelevant to the students.  This idea of control was fundamental to the classroom — and teachers were given classroom management advice, and judged on their ability to control the behaviours in their classes.

The dynamic is entirely different at The Academy.  Underlying all “classroom management” here is the value of caring.  There is nothing arbitrary in our expectations of behaviour; indeed, they are collaboratively created by teachers and students. Our students know that we care, that expectations of behaviour spring from caring, and that our motivation is to benefit them.  Maybe that’s the most profound difference I can offer to students entering The Academy — the core value of caring.

Don Adams, Head of School