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.
