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THERESA CERULLI, M.D.:  CHANGING THE PARADIGM FOR  TREATMENT OPTIONS FOR  ATTENTION DEFICIT DISORDER AND ATTENTION DEFICIT HYPERACTIVITY DISORDER

By:  D.A. Sears

       She is a graduate of Tufts University, the University of Massachusetts Medical School, the Harvard Longwood Residency Program in Adult Psychiatry, and the Harvard Fellowships in Medical Psychiatry and Neuropsychiatry.   She is Theresa Cerulli, M.D., a former Medical Director for the Hallowell Center in Sudbury, Massachusetts, and the co-founder and Chief Medical Officer for the ADD Health and Wellness Center in North Andover, Massachusetts where she specializes in the holistic treatment of children and adults with Attention Deficit Disorder (“ADD”) and Attention Deficit Hyperactivity Disorder (“ADHD”) and co-existing behavioral health conditions  .Dr. Cerulli is a Board Certified in Psychiatry and is on staff at Beth Israel Deaconess Medical Center in Boston and Hallmark Health's Lawrence Memorial Hospital.   A recipient of the 1997 Harvard Residency Teaching Award, Dr. Cerulli has published several journal articles in the Harvard Review of Psychiatry and was an Instructor at Harvard Medical School for 8 years where she lectured on a range of neuropsychiatric topics including Attention Deficit Disorder, Depression and Electroconvulsive Therapy.

         Dr. Cerulli has served nationally as an expert witness for ADHD and works as a consultant and speaker for Shire and Novartis Pharmaceuticals in their CNS divisions.  Currently she is a sub-investigator with East Coast Clinical Research for two Phase IV psychotropic medication trials.   Her work on ADD and ADHD has put her in the media spotlight.  Dr. Cerulli has appeared on Channel 7’s Urban Update where she participated in a debate on the use of psychotropic medications in children with ADHD and was the subject of interviews on WBCN Radio where she discussed ADHD diagnosis and treatment and on Channel 56’s Health Watch regarding ADHD and the use of Quantitative EEG.   Recently, Dr. Cerulli accepted a Medical Advisory Board position with Kiwi Magazine.

         Where did Dr. Cerulli grow up? 

           “I grew up in Melrose, Massachusetts, a northern suburb of Boston. I was born, raised and educated in Massachusetts despite my childhood idea of moving to a warmer climate. My family roots are there, and as I grew those family ties were much more important than escaping a few snow storms in our extended New England winters,” Dr. Cerulli responded. 

         When I asked Dr. Cerulli to talk about the role models that she had as she made her journey from childhood to adulthood, she quickly pointed to her mother.   Her mother has been and continues to be her source of inspiration. 

            “My mother played a significant role in shaping my journey from childhood to adulthood. I was not an easy child to raise. I was headstrong and stubborn, wanting to learn by my own mistakes rather than listening to guidance. Perhaps that is the core of my love for working with ADHD children and adults. I have special praises for their will and passion.  Mom has been and continues to be my inspiration. I distinctly remember as a child, her common household teaching, ‘Never say I can’t, say I’ll try.’  Her work ethic and strength are extraordinary. Without receiving any formal education herself, she emphasized the importance of education and kept her promise that she would find a way to shoulder four children financially and emotionally through college against significant odds.” 

       What motivated Dr. Cerulli to embark upon a career path which focuses on ADD/ADHD? 

        “I attended Tufts University in Medford, Massachusetts where I majored in biology, then I went on to attend the University of Massachusetts Medical School in Worcester, Massachusetts where I completed my psychiatry residency at the Harvard Longwood program in Boston. I was always fascinated by the interplay between medicine and psychology, and went on to do a fellowship in Medical Psychiatry at Brigham and Women’s Hospital and then a second fellowship in Neuropsychiatry at Beth Israel Deaconess Medical Center in Boston. During my neuropsychiatry fellowship I cared for clients with various underlying neurobiological conditions that led to psychological and cognitive changes such as Alzheimer’s, strokes, head trauma, and ADHD. I found working with my ADHD patients to be most energizing and rewarding – they get better! With a little guidance and structure ADHD clients will often excel. Many are creative, spontaneous and entrepreneurial thinkers once you get past the structural issues that get in their way. As fate would have it my husband was later diagnosed with ADHD as an adult – no, not by me. And so began my ADHD career personally and professionally.” 

         The discussion moved to Dr. Cerulli’s position at the national ADD Health and Wellness Center in North Andover, Massachusetts – an institution she co-founded.    What are some of the programs and services offered by the ADD Health and Wellness Center to ADHD patients? 

         “I now gratefully serve as the Chief Medical Officer for the national ADD Health and Wellness Centers which is a national organization. We currently have offices in Dallas, Austin, Houston, and the greater Boston area with plans to open several more locations in the near future including Washington D.C. Our reach is already widespread beyond the clinic walls.  We have built-in programs that we can administer 100% by phone such as ADD coaching and Cogmed Working Memory Training which is a five-week software based program the client participates in from the comfort of their own home, with the support of a trained clinician to improve attention, working memory, and academic skills.  We are an organization specializing in the holistic care of children and adults, aiming to improve attention, memory, focus, and emotional well being. We help people set and meet their personal goals, improve their minds, learning, behaviors, relationships, and happiness. Did you know that happiness could be a goal?” Dr. Cerulli remarked. 

         What is ADD?  What is ADHD?  I was surprised to learn that ADD and ADHD are the same.   

          “ADD and ADHD are one and the same,” Dr. Cerulli explained.  “The correct terminology is ADHD with qualifiers such as predominately inattentive type, predominately hyperactive/impulsive type, or combined type. ADHD is a neurobiological condition with strong genetic underpinnings. The hereditability factor is .77 which means that 77% of people who have ADHD do so based on their genes. That still means that 23% have ADHD based on non-genetic factors such as maternal smoking, birth trauma, or environmental factors. The three hallmark symptoms of ADHD are inattention, impulsivity and hyperactivity or restlessness, but these symptoms can present very differently in each individual. For example, people with ADHD may struggle with varying degrees of difficulty staying on task, paying attention in conversations, following through on details, or organizing and planning events. They may be restless and distractible, or perhaps impulsive and short tempered. Or maybe they simply have the quiet and day-dreamy type of ADHD.” 

        Is ADHD a new phenomenon?  Dr. Cerulli says “No!” 

         “ADHD is not a new condition. Though the name has changed over time, the diagnosis dates back to the 1930s. It is an old condition with new understanding, research, and awareness. With raised awareness, the term ADHD became more familiar and seemingly “over-diagnosed”. But by statistical measures, 7% of school aged children have ADHD and 4% of adults, which means we are still significantly under-diagnosing the condition.” 

        So, are there diagnostic tests for ADHD?  How is ADHD diagnosed? 

       “Diagnosing ADHD is simple yet extremely complex at the same time because so many other conditions cause problems with attention and concentration. In our overwhelmed, stressed-out culture on any given day we can all seem like we have ADHD.  To add to the confusion, there are many conditions that can co-exist with ADHD such as learning disabilities, anxiety, sleep disorders, and depression or bipolar depression,” Dr. Cerulli responded. 

         What treatment options are available for ADHD patients? 

         “Treatment options for ADHD have really broadened.  Structured therapy, ADD coaching, working memory training, natural supplements, parent training, academic supports, social skills training, family counseling, and ongoing developments in medications (both stimulant and non-stimulant) are all interventions shown to be helpful. Great news is someone diagnosed with ADHD today has many options beyond Ritalin. It’s an exciting time to be in this field of cognitive behavioral health.” 

        How effective are psychotropic medications such as Ritalin in combating ADD and ADHD? 

          “Effectiveness of stimulant medications for ADHD is approximately 70%. That means that most people can find a medication that will help if they choose. However 25 – 30% of people with either not feel benefit from taking medication, or will experience significant side effects that hinder using medication. Common immediate side effects may include loss of appetite, weight loss, jitteriness, heart racing, sleep disturbance, headaches, moodiness, and anxiety.”  

         I noted that Ritalin has been prescribed and continues to be prescribed for young children who have been diagnosed as having or perceived to have ADD or ADHD.  Are we doing more damage than good by allowing our children to take ADD or ADHD?  In what ways can Ritalin negatively impact on the physical and intellectual development of our children? 

          “The long term effects of Ritalin and other stimulant medications have been well studied. Research has shown that stimulants can cause growth delays, exacerbation of tic disorders, and increased tolerance - which means needing higher doses of the medication to get the same benefit. The greatest risk with stimulant medication is their misuse and abuse. Particularly frightening is the sharing and selling of these drugs on college campuses. However, when taken as prescribed with close monitoring by a knowledgeable physician, medication can be helpful. I strongly recommend that clients visit with an ADHD specialist who can carefully evaluate the individual needs of the client from a holistic perspective. Medication should never be the sole focus of ADHD treatment.” 

      Transcendental Meditation has been introduced as a treatment option for children and adults who have been diagnosed with ADHD.  I asked Dr. Cerulli to share her thoughts on transcendental meditation as a treatment option for children and adults who have been diagnosed with ADHD.   

        “Recent research supports the benefits of transcendental meditation as a wonderful treatment alternative for focus and concentration. Meditation has the unique dual effect of increasing ‘alertness’ brain waves to improve attention, while simultaneously inducing a physical and mental state of relaxation. A perfect fit for someone with ADHD!” Dr. Cerulli opined. 

        How can our readers contact the ADD Health and Wellness Center? 

         “Your readers can contact our ADD Health and Wellness offices at 1-866-324-2088 or visit our website at www.addhealthandwellness.com,” Dr. Cerulli commented. 

         And what’s next for Theresa Cerulli, M.D.? 

          “I hope to be on this life path for many years to come. I love my work as Chief Medical Officer for ADD Health and Wellness and strive to share our vision with as many people as possible. I’ve followed many clients for over 8 years and feel privileged to be part of their lives. I get to enjoy still working one on one with my clients, yet have the opportunity to extend what I do through teaching training, speaking, and overseeing our organization dedicated solely to this field of cognitive health and well being. We are now working on a book together with our clients who have been willing to share their stories to illustrate our personal team approach to ADHD. I give thanks to all of you who have volunteered for this important project.  Where do I go from here? Well, I have the small goal of changing the whole paradigm of how behavioral health care is administered. Why? ‘Never say you can’t, say I’ll try’.”

 

THERESA LAVOIE, PH.D.:  CREATING NEW POSSIBILITIES FOR CHILDREN AND ADULTS DIAGNOSED WITH ATTENTION DEFICIT DISORDER AND ATTENTION DEFICIT HYPERACTIVITY DISORDER

By:  D.A. Sears

          Her groundbreaking Attention Deficit Hyperactivity Disorder (“ADHD”) group treatment protocol which she pioneered at the Hallowell Center in Sudbury, Massachusetts and where she specialized in the diagnosis and treatment of ADHD won her national recognition. U.S. News and World Report, the Jane Pauley Show and Reader’s Digest have all heralded her pioneering ADHD group treatment protocol.   She is the Co-Founder and Director of Psychological Services for ADD Health and Wellness in North Andover, Massachusetts where she specializes in the holistic treatment of children and adults with ADD/ADHD and co-existing behavioral health conditions.  She is Theresa Lavoie, Ph.D.  Dr. Lavoie holds a Ph.D. in Clinical Psychology from Suffolk University where she focused on Clinical Neuropsychology and researched meditation in treating ADHD. Her internships in Behavioral Neurology were completed at the Harvard Longwood Program at Beth Israel Deaconess Medical Center and in Pediatric Neuropsychology at New England Medical Center, while her post doctoral practice included five years at the Hallowell Center where she specialized in the diagnosis and treatment of ADHD. She has served as an Adjunct faculty member in Psychology at the University of Massachusetts and Suffolk University where she has taught numerous classes in Psychological Assessment, Child and Adolescent Development, and Group Dynamics.  Sensory processing styles, treatments with diet, and fish oil supplements are just a sampling of Dr. Lavoie’s research contributions to ADHD.  She has worked as a forensic expert witness in both federal and local courts.   Dr. Lavoie has co-authored a regular column in ADDitude Magazine, supervises mental health professionals, and lectures on current topics in ADHD.  In her work as a Clinical Neuropsychologist in private practice, Dr. Lavoie has specialized in the diagnosis and treatment of children and adults with ADHD.

          Dr. Lavoie is creating new possibilities for children and adults who have been diagnosed with Attention Deficit Disorder (“ADD”) and ADHD Disorder through her specialization in the holistic treatment of ADD and ADHD at the ADD Health and Wellness Center which she co-founded.  Her refreshingly innovative approach to treating ADD and ADHD is one of the key “pieces of the puzzle” to helping ADD and ADHD patients to become well-adjusted and productive members of society. 

        Where did Dr. Lavoie grow up?  Where was she educated?

         “I grew up in Leominster, a small town in Massachusetts. I attended the University of Massachusetts in Boston for one year in 1984 but couldn’t keep up with the demands of working and going to school and withdrew after the first year. My 30th birthday prompted me to return to school and attend Suffolk University where I completed my undergraduate degree in clinical psychology. I thoroughly enjoyed psychology as an “older” student and became one of the first cohort of students to earn a Ph.D. in Clinical Psychology from Suffolk University. Edith Kaplan, Ph.D., a world renowned neuropsychologist was a wonderful mentor at Suffolk who encouraged me to pursue my clinical interests by taking the time to understand how the brain works,” Dr. Lavoie responded.

        When I asked Dr. Lavoie to identify the role models she had as she made the journey from childhood to adulthood, she pointed to her sister as her first role model.

     “My sister was my first role model. Since our mother died when we were very young, our family’s priorities seemed to be more about survival than about education and ambition. My sister changed that when she was the first in the family to attend college. Unfortunately my path was less direct. I wasn’t able to handle college successfully at first. I was supporting myself and taking loans to pay for school. My brother died during my first year of college in 1984 and I couldn’t complete school.  At 19, after withdrawing from school, I met my second mentor, George, a successful realtor who was willing to teach me everything he knew about sales, connecting with people, and business strategy. Very quickly I was winning national awards and my sales career was flourishing. However, my personal life was less successful and I was divorced by age 20. I was haunted by an unhappy childhood and a great deal of personal loss. Fortunately a close friend told me about ‘therapy’ and how it could help me heal from my pain.” 

      Who or what inspires Dr. Lavoie?    

        “I am inspired when I witness people opening up to new possibilities. When people shift awareness from their thoughts to the present moment they feel happier, more confident, and see life as filled with possibilities. I am moved when people recognize they can let go of their pain. That although pain is inevitable, the suffering they experience is optional.” 

       During her post doctoral practice, Dr. Lavoie specialized in the diagnosis and treatment of ADHD at the Hallowell Center and pioneered the Hallowell Center’s ADHD group treatment protocol which was nationally recognized by U.S. News World Report, the Jane Pauley Show, and Reader’s Digest.  When asked what motivated her to specialize in the diagnosis and treatment of ADHD during her post doctoral practice, Dr. Lavoie offered the following: 

          “My motivation began when I completed my dissertation which looked at the effects of meditation on symptoms of ADHD. It was through this work that my interest in ADHD grew considerably, especially when their symptoms improved after meditation. My Dissertation Committee helped me realize that non-pharmacological treatment approaches for ADHD were very much needed in the field.”  

            I asked Dr. Lavoie to describe the ADHD group treatment protocol which she developed at the Hallowell Center. 

           “I developed a strategies-based support group which was a combination of coaching, practical techniques for helping with everyday life and therapeutic support,”  Dr. Lavoie explained.  “What I found was that group members were eager to learn from each other – there was a way that other members had great credibility when they spoke because of their real life experiences. It was also a wonderful opportunity for individuals who have been struggling to share their experiences in a safe environment. Many people had never told anyone before that they were even diagnosed with ADHD. Finally there is a sense of ‘universality,’ in other words, people connected with others with the same struggle…kind of a ‘welcome to the human race experience’!”   

What motivated Dr. Lavoie to develop this protocol?   

           “I was struck when working with individuals with similar struggles. I found myself wishing they could talk to each other. At the time, I was working with a lot of successful entrepreneurs who felt isolated and as if they were the only one with struggles with procrastination or organization. I knew they would benefit greatly from meeting other successful people whom they would respect,” she replied.

          The conversation moved to the matter of diagnosing a condition of ADD or ADHD.  What is the criteria used to diagnose these conditions? 

          “A proper diagnosis is best achieved via both subjective and objective data. Subjective data includes reporting on behavioral features -- reliability is high -- and technically, symptoms must have occurred by age 7 according to DSM-IV – the Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition --  criteria. It is also helpful to get information from multiple informants, for example, spouses, parents, or teachers. Additional subjective data is gathered from an extensive diagnostic interview which includes historical information about one’s family, academics, as well as one’s medical and employment history. Objective data is gathered via neuropsychological evaluations which include an assessment of sustained attention, executive functioning, memory, planning, and organization. It is critical to always assess one’s emotional functioning given the high rate of mood symptoms such as depression and anxiety with ADHD.  In addition, it is critical that professionals consider what ADHD is not.  For example, being sure to understand normal disruptions in attention such as sleep deprivation, fatigue, distractions

--such as noise--, normal development and aging, difficulties with vision or hearing, and/or medications such as antihistamines.  A proper diagnosis is looking to see what a client doesn’t have or what is being ‘ruled-out’ such as: mood disorders, anxiety, petit mal epilepsy, traumatic brain injury, neurodevelopmental disorders, learning disabilities, speech and language disorders,” Dr. Lavoie stated. 

         Fifty, forty and even as recent as 30 years ago, ADD and ADHD in children as well as adults was unheard of.   Has ADD and ADHD always been around or is it a new phenomenon?   

“ADHD has always been around and it just wasn’t recognized appropriately. Actually

some would argue that ADHD remains ‘under’ diagnosis even today.  For example, compared to males, girls and woman tend to be inattentive, day dreamy type than hyperactive. It is more likely that undiagnosed ADD patients will: 

·         Drop out or change schools by college age

·         Would have done well with academic accommodations had they been diagnosed

·         Self medicate (substances, food, caffeine, nicotine, internet, gambling)

·         Have low self esteem

·         Higher rates of pregnancy (risk taking behaviors)

·         Higher risk of STD’s

·         Increased anxiety and depression

·         Suffer from imposter syndrome -- ‘know how much harder they have to work than others’.” 

        Is ADD or ADHD hereditary? 

Dr. Lavoie says, “Yes!”  According to Dr. Lavoie twin, adoption, and family studies report

that 80% of ADHD is accounted for by genetics and she offers the following statistics:

§         Three times more common in the siblings of patients with ADD

§         Five times more common in the father of patients with ADD

§         Two times more common in Male second degree relatives

§         Seven times more common in twins who are adopted”

         It is estimated that approximately 4,000,000 children in the United States have been diagnosed with ADD or ADHD.  Children since time immemorial have always been “fidgety”, energetic, extremely active and at times experience difficulty concentrating or focusing.  Are we “jumping the gun” when we diagnose “fidgety” highly energetic and extremely active children as having ADD or ADHD.  

      “Yes, that is why a proper and extensive diagnostic evaluation is necessary,” Dr. Lavoie remarked. 

Shouldn’t we scrutinize our children’s diet, providie them with activities and mental exercises that capture their attention and expand their levels of concentration, as well as examine and revamp our coping skills in dealing with “fidgety”, highly energetic and extremely active children who have difficulty focusing and concentrating? 

          “Absolutely! That is why our center has been so successful. People want to consider how to help with these behaviors regardless if a diagnosis is warranted or not. In addition, addressing our clients from a holistic perspective is critical in ultimately improving their overall well being and happiness.” 

        Are there non-pharmacological treatments for ADD and ADHD?  What are they?  How effective are they? 

           “It is my belief that a holistic approach to treatment is the most ideal.  It is with a holistic and integrated approach that we see the best results for individuals. ADHD presents differently in different people and is also impacted greatly by the demands the person is experiencing at a given time.  In addition, treatment is individualized and its efficacy will depend on a number of factors such as what symptoms the person is struggling with, how much awareness they have about their struggles, and how motivated are they to work toward changes.” 

          Dr. Lavoie provided the following examples of effective non-pharmacologic treatments:   

-          Individual Therapy with someone educated and well trained in ADHD

-          Group Therapy: Helpful for both emotional support and practical input on areas of difficulty

-          ADHD Coaching: strategic support around particular areas of weakness with specific goal setting

-          Cogmed Working Memory Training

-          Nutritional Supplementation: designed specifically for areas of difficulty for folks with ADHD

       And what’s next for Theresa Lavoie, Ph.D.? 

“Expanding to open centers in the Maryland and Washington DC areas and increasing our clinician’s training to include more focus on mindfulness,” Dr. Lavoie enthusiastically responded.

 

 

 

ATTENTION DEFICIT HYPERACTIVITY DISORDER, CHILDREN AND RITALIN 

By:  Diane A. Sears

         Are you the parent or relative of a child that has been diagnosed with Attention Deficit Hyperactivity Disorder – or ADHD? 

          Did you know that there is no test for ADHD?

          Did you know that many doctors base their diagnosis of ADHD on information gathered from parents, teachers and children? 

         Did you know that approximately 8% of children in the United States have   been diagnosed with ADHD?  Or that some form of psychiatric drug has been prescribed for 1 in 100 preschoolers who have been diagnosed with ADHD?

          Did you know that the most common psychiatric medication prescribed for children – as well as adults -- diagnosed with ADHD is Ritalin?

        And did you know that medication is not your child’s only treatment option for ADHD?

        Now, just for the record, this article is not about bashing the medical, psychiatric and pharmaceutical communities.  This article is about providing you with key “pieces of the puzzle” that will help you make informed decisions about your child’s intellectual, physical and psychological development. 

         ADHD or “Attention-Deficit Hyperactivity Disorder” has been characterized as the most common behavioral and psychiatric disorder among children.  It is believed that ADHD was first described in 1845 by Dr. Heinrich Hoffman, a physician and poet who wrote books on medicine and psychiatry.  Unable to find materials to read to his three-year old son, Dr. Hoffman authored a book of poems about children and their characteristics.  One of his works, “The Story Of Fidgety Phillip” described a child who had the symptoms of ADHD.   

          So, what causes ADHD?   It is caused by improper levels of chemicals in the brain known as neurotransmitters.   

          Children who have been diagnosed with ADHD are perceived to have difficulty learning, focusing and being attentive and in controlling their behavior.&n