Fred A. Baughman Jr., M.D. critiques the views of child psychiatrist,
Dr. Harold S. Koplewicz, recently expressed on Parentsknow.com.
Much has been in the news of late of an epidemic of West Nile Fever,
mainly in New York and elsewhere on the eastern seaboard. West Nile
encephalitis is among the many types of arbovirus encephalitis and is
spread by mosquitos. The mosquito in this and other infectious diseases
is said to be the vector. Likewise, mosquitos are the vector in other
forms of viral encephalitis and in malaria, while ticks are the vector
of Rocky Mountain spotted fever, Colorado tick fever, and other viral
illnesses.
At the National Institutes of Health, Consensus Conference, November
16-18, 1998, the Panel, having weighed all of the evidence, concluded
(11/18/98), “we do not have an independent, valid test for ADHD, and
there are no data to indicate that ADHD is due to brain malfunction.”
In my essay The ADHD Consensus Conference: End of the epidemic (The
Brown University Child and Adolescent Behavior Letter, February, 1999),
I wrote: “Failing to ask whether or not ADHD is an actual disease, with
a confirmatory, physical abnormality (the definition throughout
medicine), the media remains a vector essential to the persistence and
spread of the ADHD epidemic, and it is persisting and it is spreading.
Below I critique the views of child psychiatrist, Dr. Harold
Koplewicz, Author of “It’s Nobody’s Fault: New Hope and Help for
Difficult Children and Their Parents” recently expressed on
Parentsknow.com .
Parentsknow.com Parenting Chat with Dr. Harold Koplewicz
Author of "It's Nobody's Fault: New Hope and Help for Difficult
Children and Their Parents"
[Dr. Baughman:
In Harold S. Koplewiczs "It's Nobody's Fault: New Hope
and Help for Difficult Children and Their Parents," we read: "People
who wouldn't dream of blaming parents for a child's asthma or diabetes
are often quick to blame bad parenting for a child's hyperactivity,
depression or school phobia" (coverleaf). "The fact that the symptoms
of these disorders are behavioral doesnt change the fact that there is
a neurobiological basis to them. Parents are no more to blame for a
childs psychiatric disorder than they are to blame for his epilepsy
or his red hair" (page 48). Koplewicz explains, "neither parents nor
children cause these problems. No one does. If your child has one of
these 'no-fault' brain disorders, it is simply the result of 'DNA
Roulette;' your child's brain is wired differently because of his or her
genetic makeup" (coverleaf).
There can be no doubt that Koplewicz, from his position of leadership
in child psychiatry, is claiming here that children with ADHD have both
a genetic abnormality and a brain abnormality and that they are
'diseased.' Thus the claim that the child's life-circumstances--their
homes, schools, parents and teachers--are not factors in their
development of ADHD symptoms. This utterly baseless claim is the
lynch-pin of the fraud of 'biological psychiatry. With no proof of
disease, i.e. of causal physical factors, Koplewicz and all proponents
of the ideology of biological psychiatry deny the obviousthat the
only possible causes of the ADHD behaviors, therefore, are the child's
life-circumstances--their homes, schools, parents and teachers.
Koplewicz is Head of the Child Study Center at the New York University,
School of Medicine, my alma mater. He and Stephen E. Hyman of the NIMH
were lead presenters at the recent White House Conference on Mental
Health, both are leading purveyors of ADHD and all child/adolescent
psychiatric disorders as biological, as diseases.
]
Monday, April 10, 2000, 67 PM ET
[http://home.att.net/~cp_volunteers/images/koplewicz.jpg]
MODERATOR: Hello everyone. We will be starting in a few minutes. In
the meantime feel free to submit questions to our guests and talk
amongst yourselves.
MODERATOR: Welcome to the AT&T WorldNet ® Community Port(sm) Chat. Dr.
Koplewicz and Donna LeSchander, we're very excited to have both of you
here today. How are you doing?
SPEAKER_Doctor Koplewicz: Doing great. I'm delighted to be here also.
SPEAKER_Donna LeSchander: Thanks very much and I'm happy to be here.
doe berrick: What is Attention Deficit Disorder / Attention Deficit
Hyperactive Disorder and what causes it? What help is available to the
ADD/ADHD patient?
SPEAKER_Doctor Koplewicz: Attention Deficit Hyperactivity Disorder is
the most common psychiatric disorder in children and adolescents.
Essentially, it comes in three flavors:
SPEAKER_Doctor Koplewicz: combined, inattention only, and residual.
SPEAKER_Doctor Koplewicz: It also has three forms: mild, moderate, and
severe, as does every medical condition.
[Dr. Baughman:
Here, Koplewicz slips in that ADHD is 'medical,' as if to say
that it is a 'disease,' just like diabetes, epilepsy, cancer, rheumatic
fever. The only difference is that the later are real diseases with
confirmatory physical or chemical abnormalities by which to diagnose
them, while ADHD has no proven abnormality within the person by which to
diagnose it.
]
SPEAKER_Doctor Koplewicz: The good news is that there are many treatments that work, and this is one of the most researched areas in all of pediatrics.
[Dr. Baughman:
One cannot discuss cause (etiology), prognosis (course a
disease will follow) or treatment before one has proven a disease
exists, i.e., that it is a disease with a confirmatory abnormality, one
by which to diagnose it person-by-person. The fact that this or that is
the 'most researched' proves nothing. This is rhetoric with no place in
scientific discourse.
]
SPEAKER_Doctor Koplewicz: The most extensive research project in this area is the MTA: Multimodal Treatment of Attention Deficit Hyperactivity Disorder. It is the largest area of research funded by National Institutes of Mental Healh for children and adolescents.
[Dr. Baughman:
The MTA study of ADHD does nothing to validate ADHD as a
disease or anything organic or physical. Its results, favoring
medication therapy (in normal children, mind you) are hopelessly biased
in favor of medical/medication intervention by virtue of the fact that
virtually all members of the lay public (including all patients)
believe, as per psychiatric-pharmaceutical propaganda, that ADHD is
medical, that it is a 'disease.' Further the informed consent documents
used in this NIMH-coordinated study are worded in such a way as to have
the research subjects and their parents believe that ADHD is
'biological,' that it is a brain 'disease.' Such a belief, however
vague, would bias subjects and patient, as it does, toward 'medical'
treatment, away from psychological and social interventions.
]
SPEAKER_Doctor Koplewicz: There was one group of kids who got medication only, one group got medication and psychosocial interventions, which included parent training, organizational skills, and school involvement; and one group got an evaluation and then referred to the community, where some got medication and some just got psychosocial interventions. SPEAKER_Doctor Koplewicz: The kids all received active treatment for one school year and were followed up at 14 months and at two years. SPEAKER_Doctor Koplewicz: Medication worked as well as medication and psychosocial treatment combined, and both of these were more effective than the community treatment. SPEAKER_Doctor Koplewicz: It's important to note that about 75 percent of the kids on medicine and about the same amount on combined treatment got better. SPEAKER_Doctor Koplewicz: And only about 45 percent of the kids on the community treatment improved. SPEAKER_Doctor Koplewicz: What we do know is that this is a real disorder caused by brain difference and not by inadequate parenting, absent dads, or working mothers. However, being the parent of one of these children requires special skills and super parenting.
[Dr. Baughman:
Here again is the baseless, unproven claim of disease, and
with it, as if true,and to buttress it, the companion claim that ADHD
behaviors are not due to inadequate parenting, absent dads, working
mothers, or, as is usually addedpoor teachers or schools.
]
SPEAKER_Donna LeSchander: Dr. Koplewicz, do children simply ever outgrow ADD as they grow older? SPEAKER_Doctor Koplewicz: There seem to be three outcomes. There is a certain group that outgrows itabout 30 percentand develops a milder version, simply inattention, without impulsivity or hyperactivity. SPEAKER_Doctor Koplewicz: A third that have a terrible outcome of antisocial behavior, problems with the law, and frequently, very poor work performance and impaired social relations. SPEAKER_Doctor Koplewicz: A third keep the symptoms and require treatment during adulthood.
[Dr. Baughman:
This is the prognosis or course of ADHD which I spoke of
above. When no causal factors other than things situational--schools,
homes, teachers parents and peers are known but are said to
non-existent, claiming, instead that a disease, an abnormality within
the child is present, is wholly responsible and must be medically
treated, is it not understandable that the prognosis would be
poor-to-grim. What would your outcome be if you were depressed over the
divorce of your parents but you were treated, instead, as if your
depression was due a chemical imbalance of the brain needing nothing but
a balancer, a pill. The divorce of your parents was of no relevance.
It did not need to be discussed with you; your feelings did not have to
be explored, understood. All that was required was that you understand,
and accept, that you had a brain disease (fictional) due to a chemical
imbalance (fictional) for which, at all costs, you had to take and keep
taking the chemical balancer (which would cause the first and only
physical/chemical abnormality of the child/persons brain). Is it any
wonder the prognosis of most of biological psychiatrys diseases is
often so grim. Moreover all worsening or side effects while on such
chemical balancers-pills, is claimed not to be due to the drug at
alland never requires stopping itbut to worsening of the disease
(non-existent)
]
SPEAKER_Donna LeSchander: Do adults with ADD take the same drugs as children with ADD? What are the drugs? SPEAKER_Doctor Koplewicz: Yes. The medications are the same. They work slightly differently. SPEAKER_Doctor Koplewicz: There are several different categories of medicine. They are known as psychostimulants. The most common is Ritalin, but Dexedrine and Adderal are also effective.
[Dr. Baughman:
All are DEA, Schedule II addictive substances. Ritalin is
amphetamine-like. Dexedrine and Adderal are forms of amphetamine. All
three are also dangerous and sometimes deadly.
]
SPEAKER_Doctor Koplewicz: There's another class of medicine that also works, and that is Wellbutrin, which happens to be marketed under another name, to stop smoking, called Zyban. And there's some evidence that an antihypertension medication known as Tenex is also effective. SPEAKER_Doctor Koplewicz: It's a bit unusual, but it's a fact that adults seem to metabolize or use this medicine much more quickly and therefore need to take the medicine at higher doses but also multiple times a day. SPEAKER_Donna LeSchander: How do these drugs chemically affect the child's brain? SPEAKER_Doctor Koplewicz: As many people know, there are many neurochemicals in the brain that move back and forth and affect our behavior. Dopamine is the chemical that is most involved with attention. SPEAKER_Doctor Koplewicz: The theoretical idea is that kids who have ADHD or ADD metabolize or eat up their available dopamine faster than average. Therefore we give them medicines that will make their dopamine hang around longer. The reason why we don't give them pure dopamine is that every human being has something called the blood/brain barrier, which protects our brain from being exposed to everything that enters the body.
[Dr. Baughman:
No chemical or physical defect has been identified in
children manifesting the behaviors said by psychiatry to constitute
ADHD. Normals and those said to have ADHD respond alike to Ritalin,
Adderall and Dexedrine. A trial of medication does not establish the
diagnosis. No disease = no abnormality = no diagnosis.
]
SPEAKER_Doctor Koplewicz: So if we ate pure dopamine, it would be flushed through our kidneys and out of our bodies without ever affecting the brain. So we have to give medicines that can pass the blood/brain barrier and affect the dopamine secondarily. MODERATOR: As a follow up to your answer on the research among the groups of children you mentioned that one had community treatment. albatross1 is curious as to..... albatross1: What exactly do you mean by community treatment? SPEAKER_Doctor Koplewicz: That's a good question. SPEAKER_Doctor Koplewicz: Essentially, the parents were referred back to their community with a recommendation for them to obtain treatment for ADHD. However, the reason we added this group to our study is that we wanted to take a look at what was being offered to the average patient in the United States. What we found was that while 70 percent of that group received the medicine, it wasn't as carefully adjusted or monitored, and the psychosocial treatment was not manualized, and was very general. In other words, it was psychosocial treatment that could have been used for other psychiatric treatment as well. SPEAKER_Doctor Koplewicz: It's a worrisome finding, since the treatments we were offering are not very complicated, and yet it demonstrated for us that the general practitioner, whether a psychologist, psychiatrist, or pediatrician, was not using this approach. MODERATOR: How do we detect ADD? Doe berrick asks: doe berrick: What are some symptoms we should be looking for in our children to see if they have ADD? SPEAKER_Doctor Koplewicz: First of all, one should know the symptoms of ADHD do occur before the age of 7. Therefore, we should know that people who start complaining at the age of 30 or 40 that they have ADHD and the symptoms are of a new onset or have just started, that just doesn't ring true. SPEAKER_Doctor Koplewicz: What we look for are three major symptomsinattention, impulsivity, and hyperactivitythat interfere with functioning and that are inappropriate for the child's developmental age. SPEAKER_Doctor Koplewicz: Therefore, a 6-year-old boy who is in constant motion at school and at home, who can't sit still at dinner, who's always out of position in soccer--in fact, making up new positions like being on top of the goal or behind the goal--a child who misses social clues, and yet can still watch Pokemon or play video games for an hour at a time, is a child that I would consider needing an evaluation. SPEAKER_Doctor Koplewicz: Because most six-year-olds can sit still, can wait their turn in school, can listen to their teacher give a lesson, and most of the time can stay in position, can pick up the social cues from their friends.
[Dr. Baughman:
And because most six-year-olds can sit still,
can wait their turn in school, can listen to their teacher give a
lesson, and most of the time can stay in position, can pick up the
social cues from their friends, and, for no other reason, psychiatry
has decided to call those who do not, at school or sometimes at home,
to have a disease, a chemical imbalance of the brain, a no-fault
disorder.
]
SPEAKER_Doctor Koplewicz: Some of them can't sit still for dinner, but they don't have this type of cross-situational problem that occurs in school, at home, and at play. SPEAKER_Donna LeSchander: Is it best to take the child to a family doctor first, or should parents take the child to a specialist? SPEAKER_Doctor Koplewicz: I think the first stop should be your primary care physician, whether a family care practitioner or pediatrician. But the most important part of this process is the evaluation and the diagnosis, because we all know the number one reason that children are inattentive at school is a boring teacher, not ADD.
[Dr. Baughman:
Having said "we all know the number one
reason that children are inattentive at school is a boring teacher,
not ADD," I would challenge Dr. Koplewicz to show me a case of
inattentiveness in a child diagnosed and placed in the school record as
being due to a "boring teacher." How does Dr. Koplewicz distinguish
such a case from what he calls true, neurobiologically-caused ADHD?
]
SPEAKER_Doctor Koplewicz: Therefore, medication for the child is not going to make the teacher any more entertaining. MODERATOR: Doe berrick asks another interesting question: doe berrick: Who is more likely to have ADD? Does gender make a difference? Is it hereditary? SPEAKER_Doctor Koplewicz: That's a great question. SPEAKER_Doctor Koplewicz: There are several sites in the United States that are close to identifying a group of genes that are related to or are the cause of ADD or ADHD. But we are about ten years away.
[Dr. Baughman:
When asked any scientific question, such as this one about
genetics, they always respond they are close to identifying this that
or the other thing. After approximately 40 years of biological
psychiatry not a single biological, physical or chemical abnormality or
fact has been determined about ADHD or any other psychiatric disorder.
The only thing biological about psychiatry is its research. Without
this body of pseudo-biological research there would be no public
perception of psychiatric diseases or of chemical imbalancesthose
things which today required 5 billion dollars worth of chemical
balancers-pills.
]
SPEAKER_Doctor Koplewicz: In the meantime, it's worthwhile looking at something called concordance rates--that is, what happens when you have identical twins versus fraternal twins, and how often a disease occurs in these different pairs. SPEAKER_Doctor Koplewicz: If you have ADHD, the chances of your identical twinsomeone who has identical genetic materialhaving it is 99 percent. If you are a fraternal twinin other words, someone who shares the same amount of genetic material as any set of siblingsit drops to 65 percent. SPEAKER_Doctor Koplewicz: So we know that there is a genetic influence, we just don't know if there's a specific gene. albatross1: so it's not environmental!
[Dr. Baughman:
This is where they were going all along with their biological
research. Again, there has been not a single biological proof regarding
ADHD or any psychiatric disorder; for this reason, the causal or
determining factors in such things can only be environmental.
]
SPEAKER_Doctor Koplewicz: The other part of the question--boys are about 6 to 1, particularly when you're looking at hyperactivity, and possibly, girls are more frequent, but they are missed because they just have inattention. SPEAKER_Doctor Koplewicz: Someone just said "it's not environmental." That's absolutely right, because we've actually done studies looking at the effects of an average teacher vs. great teacher vs. bad teacher on normal kids, kids with mild ADHD, and with severe ADHD. As expected, they all do better with a great teacher.
[Dr. Baughman:
Environmental can never be ruled out. Teachers and parents
have everything to do with all childhood behaviors. Until a disease,
that is a physical or chemical abnormality has been proved it cannot be
said to be a co-existent determinant in children with ADHD-like
behaviors.
]
SPEAKER_Doctor Koplewicz: We've also looked at the role of structure vs. chaos in all kids, but in particular the ones with ADHD do better in a structured setting. CP_HostAmyloo: Follow up on girls and lack of hyperactivityhow can teachers be coached to notice this more? SPEAKER_Doctor Koplewicz: I think that everyone in the United States has to become better educated about mental disorders in children and adolescents. Nearly 10 million kids suffers from one of these disorders in the US, and only 1 in 5 ever get treatment. So teachers are the group that needs the most education in this area, and they have to be aware that middle school is a time when it becomes most obvious for children who have ADHD without the Hwithout the hyperactivity. SPEAKER_Doctor Koplewicz: The reason for this is that middle school disorganizes all of us, and so if you have a deficit in attention, it's going to be a particularly hard time for you. SPEAKER_Donna LeSchander: What kind of training might teachers might undergo to recognize kids with ADD? In other words, how are teachers going to spot it? SPEAKER_Doctor Koplewicz: This really necessitates a major effort for school systems. Currently, New York City has a pilot study with the NYU Child Study Center to train key personnel in every school district on mental health issues for kids and to test their knowledge and then ask them in turn to teach others in their school district. It takes time and funds to develop these types of curriculum and to make sure that the people you're training are then knowledgeable to train others. But it's a worthwhile effort. MODERATOR: What about the parents? We have an interesting question from pine cajun and kerry8446: pine cajun: What kind of special parenting skills are needed to handle children with ADD? kerry8446: Do you feel that parenting programs really work? SPEAKER_Doctor Koplewicz: Parent training does work, but unfortunately, it has never been proven effective unless the child is also taking medication.
[Dr. Baughman:
Medication, always medication. Follow the money trail. Who
pays the researchers? Who funds the research? Who pays the medical
school? The department of psychiatry? Pediatrics?
]
SPEAKER_Doctor Koplewicz: Medicine works, but not always, and it seems in some cases to need parent training. SPEAKER_Doctor Koplewicz: Now as to what kind of skills...behavioral therapy. Recognizing how to reward your child for appropriate behavior and how to provide consequences for off-task and inappropriate behavior. SPEAKER_Doctor Koplewicz: It sounds simple, but it isn't, because unfortunately, we get angry and impatient, and sometimes our punishments are too severe or are given at the wrong time. SPEAKER_Doctor Koplewicz: The best person to teach you these skills is a behavioral psychologist. The best books on these skills have been written by Russell Barklay, and a good Web site for these topics is aboutourkids.org. SPEAKER_Donna LeSchander: Dr. Koplewicz, where would a parent find the kind of help they need to deal with an ADD child? SPEAKER_Doctor Koplewicz: As I said before, I would start with a family practitioner, but if you're looking for a mental health expert, I would start with the American Academy of Child and Adolescent Psychiatry (AACAP), 1-800-333-7636. MODERATOR: Albatross1 has an interetsing comment: albatross1: Is there any connection between ADD and depression? Why do so many deporessed kids get ritalin from their doctors? SPEAKER_Doctor Koplewicz: ADHD can occur with other disorders, most frequently learning disabilities. There is a group of kids who have anxiety or depression along with their ADHD. Ritalin is not a good medicine for the treatment of depression. SPEAKER_Doctor Koplewicz: What I believe happens to a lot of children who have ADHD is that they become demoralizednot necessarily depressed. In other words, people are always telling them that they're off base, they're not being picked to be on the team, they're being yelled at by teachers. Life is more challenging, especially in middle school. There is no medicine that gets rid of demoralization. MODERATOR: Along the same line of "relation," one of our users asks: PunkRockGrrl: Does ADHD have any relation whatsoever to developing bipolar disorder later in life? It seems to me that there is a pattern with children who experience this disorder and get to be in their early 20's and experience bipolar disorder. SPEAKER_Doctor Koplewicz: There's a lot of controversy surrounding this. One research group at Harvard is absolutely convinced of this and claims that nearly 60 percent of the children that they've treated for ADHD will develop bipolar disorder. SPEAKER_Doctor Koplewicz: However, two studies--one at Montreal Children's and the other at Long Island Jewish--have followed ADHD children for 28 years and compared them to a matched group of normal kids. There is no increased rate of bipolar disorder or of depression in the ADHD group as compared to the normal controls. SPEAKER_Doctor Koplewicz: Therefore, bipolar disorder is really a different illness and possibly masquerades as ADHD-like in a small group of kids but is not related to the disorder. SPEAKER_Donna LeSchander: Dr. Koplewicz, how long have doctors recognized ADD and ADHD as diseases? SPEAKER_Doctor Koplewicz: The first time it was mentioned in the literature goes back to the early 1900s, where it was considered a moral defect. SPEAKER_Doctor Koplewicz: But by 1937, it was called "minimal brain dysfunction," and it was reported to be successfully treated with benzedrine, another psychostimulant. SPEAKER_Doctor Koplewicz: Throughout the years it has changed its name from hyperkinetic syndrome to attention deficit disorder with or without hyperactivity, to the current name of Attention Deficit Hyperactivity Disorder, with the recognition that it is the inattention that is the most important symptom. MODERATOR: daddyo has a question that I'm sure some of our users will be interested in. daddyo: How does the L-ADD Assessment Wheel work, and what part can it play in assessing the ADD/ADHD patient? SPEAKER_Doctor Koplewicz: There's a whole group of tools that are available to help in the assessment of children with ADHD. However, none of them are diagnosticin other words, we don't have a blood test, we don't have a paper-and-pencil test of any kind that is valid and reliable. SPEAKER_Doctor Koplewicz: Frequently, we get false positives, meaning we pick up kids who don't have it on this test, and more often, we get false negatives, meaning we miss children that have it. SPEAKER_Doctor Koplewicz: At the current time, whille we have neuroimagingCAT scans, MRIsthat we can use in researchfor instance, we found that the brains of kids who had ADHD and their fathers who had ADHD look very different from normal controlsthe only tool that we can use presently is a history. SPEAKER_Doctor Koplewicz: But that's not much different from the rest of medicine, because before we had cardiograms and blood tests and x-rays, everyone did it the old-fashioned way, which is taking a comprehensive history on the symptoms, their duration, a birth history, and a family history. PunkRockGrrl: In your opinion, do you think that ADHD has become somewhat of a scapegoat for children who behave badly? SPEAKER_Doctor Koplewicz: No, I honestly don't think so. I think that there are lots of children out there who have poor manners, poor sportsmanship, and an inability to wait their turn. But they are significantly different than the children who have ADHD, who whether they want to or not can't pay attention, can't help themselves, and are very fidgety, but not necessarily mean-spirited. SPEAKER_Doctor Koplewicz: The saddest part of the story is that while we know how to diagnose these children and have very impressive treatments, the myths and misconceptions about this and other psychiatric illness prevents the overwhelming majority of children suffering from getting any help. MODERATOR: kerry8446 wants to know: kerry8446: Do you find that ADD children excell in any particular activity? SPEAKER_Doctor Koplewicz: Kids with ADHD are just like all other kids. Some of them are very bright, some are very artistic, and some are great athletes. SPEAKER_Doctor Koplewicz: More importantly is how does a parent minimize the deficits that they have that interfere with their school functioning, and how do they maximize the assets that they, like all children, have, so that they'll be successful. SPEAKER_Doctor Koplewicz: Recently, I met a medical student who told me that he had ADHD. He told me that he took the medicine when he was a kid even though he fought about it all the time. SPEAKER_Doctor Koplewicz: His parents got him a homework helper, someone who made sure his study breaks were shorter than his study periods. SPEAKER_Doctor Koplewicz: He particularly had a hard time in high school with all the requirements. In college, he flourished, but he needed special, individualized tutoring to take the exams for medical school. When I asked him what kind of doctor he was going to be, he told me, "I know what you want me to say, but I can't become a child psychiatrist. I can't sit still for 45 minutes, and I can't wait for results as patiently as you guys do." SPEAKER_Doctor Koplewicz: When I followed up and said, "So what specialty are you going to choose?" he said that was easy: Ear, Nose, and Throat. SPEAKER_Doctor Koplewicz: You come in with a big nose, I make it small. You have stuffed ears, I put tubes in it. That sounds easy to me. SPEAKER_Doctor Koplewicz: I said I thought that was an excellent outcome. MODERATOR: Thanks very much for sharing your knowledge and expertise with us, Dr. Koplewicz and Donna LeSchanderthis has been an extremely interesting chat. We have time for one more question. To help further the knowledge of our users daddyo asks: daddyo: What are some useful resources we can check out to understand more about ADD? Internet sites, books, magazines, etc. SPEAKER_Doctor Koplewicz: I think the premiere resource is CHADD. One of the fastest-growing patient support groups in the US. Children and Adults with ADD. They have their headquarters in Washington, DC and have chapters throughout the US. They have a Website as well. SPEAKER_Donna LeSchander: Thanks to everyone for joining us and thanks to Dr. Koplewicz for joining us. For more information about ADD and related subjects, visit us at www.parentsknow.com! MODERATOR: Thanks very much for sharing your knowledge and expertise with us, Dr. Koplewicz and Donna LeSchander -- this has been an extremely interesting chat. A special thanks to Parentsknow.com! Also, I'd like to thank all the users who attended and participated in the chat event; we hope to see you again soon! MODERATOR: Folks, if you missed part of this chat event, you'll be able to view the complete transcript under the link at http://home.att.net/~cp_volunteers/chat.html within the next day or so. SPEAKER_Doctor Koplewicz: You're welcome! MODERATOR: Be sure to come back tomorrow night at 9p.m. EST for our Celebrity Chat with Frankie Muniz, the irresistible young star of TV's "Malcolm in the Middle"! MODERATOR: Thanks again folks. Have a good night! This chat event and transcript is Copyright (c) 1999 AT&T WorldNet®.