Christopher Shearer

Christopher Shearer

Accommodating Employees with AD/HD

Note: People with AD/HD may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with AD/HD will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Questions to Consider:

1. What limitations does the employee with AD/HD experience?

2. How do these limitations affect the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine accommodations?

5. Can the employee provide information on possible accommodation solutions?

6. Once accommodations are in place, can meetings take place to evaluate the effectiveness of the accommodations? Can meetings take place to determine whether additional accommodations are needed?

7. Would human resources or personnel departments, supervisors, or coworkers benefit from education, training or disability awareness regarding learning disabilities? Can it be provided?

Accommodation Ideas:

Time Management: Individuals with AD/HD may experience difficulty managing time, which can affect their ability to mark time as it passes incrementally by minutes and hours. It can also affect their ability to gauge the proper amount of time to set aside for certain tasks. It may be difficult to prepare for, or to remember, work activities that occur later in the week, month, or year.

• Divide large assignments into several small tasks
• Set a timer to make an alarm after assigning ample time to complete a task
• Provide a checklist of assignments
• Supply an electronic or handheld organizer, and train on how to use effectively
• Use wall calendar to emphasize due dates
  • Develop a color-coded system (each color represents a task, or event, or level of importance)
  • Allow co-worker or supervisor to add entries on the calendar, or to double-check entries added by the employee with AD/HD

Memory: Individuals with AD/HD may experience memory deficits, which can affect their ability to complete tasks, remember job duties, or recall daily actions or activities.

• Provide written instructions
• Allow additional training time for new tasks
• Offer training refreshers
• Use flow-chart to indicate steps in a task
• Provide verbal or pictorial cues
• Use post-it notes as reminders of important dates or tasks

Concentration: Individuals with AD/HD may experience decreased concentration, which can be attributed to auditory distractions (that can be heard) and/or visual distractions (that can be seen). People with AD/HD report distractions such as office traffic and employee chatter, opening and closing of elevator doors, and common office noises such as fax tones and photocopying.

• To reduce auditory distractions:
  • Purchase a noise canceling headset
  • Hang sound absorption panels
  • Provide a white noise machine
  • Relocate employee's office space away from audible distractions
  • Redesign employee's office space to minimize audible distractions
• To reduce visual distractions:
  • Install space enclosures (cubicle walls)
  • Reduce clutter in the employee's work environment
  • Redesign employee's office space to minimize visual distractions
  • Relocate employee's office space away from visual distractions

Organization and Prioritization: Individuals with AD/HD may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work.

• Develop color-code system for files, projects, or activities
• Use weekly chart to identify daily work activities
• Use the services of a professional organizer
• Use a job coach to teach/reinforce organization skills
• Assign a mentor to help employee
• Allow supervisor to assign prioritization of tasks
• Assign new project only when previous project is complete, when possible
• Provide a "cheat sheet" of high-priority activities, projects, people, etc.

Social Skills: Individuals with AD/HD may have limitations in adaptive skills, such as communicating with others, or exhibiting appropriate social skills. This might manifest itself as interrupting others when working or talking, demonstrating poor listening skills, not making eye contact when communicating, or inability to correctly read body language or understand innuendo.

• Provide a job coach to help understand different social cues
• Identify areas of improvement for employee in a fair and consistent manner
• Make attendance at social activities optional
• Use training videos to demonstrate appropriate behavior in workplace
• Encourage employees to minimize personal conversation, or move personal conversation away from work areas
• Provide sensitivity training (disability awareness) to all employees
• Encourage all employees to model appropriate social skills
• Adjust the supervisory method to better fit the employee's needs
• Allow the employee to work from home
• Adjust method of communication to best suit the employee's needs
• Use role-play scenarios to demonstrate appropriate behavior in workplace

Hyperactivity/Impulsivity: Individuals with AD/HD Hyperactivity-Impulsive type may exhibit over-activity or impulsive behavior. This could be disruptive to the work environment or could inhibit efficient and effective work performance.

• Provide structured breaks to create an outlet for physical activity
• Utilize a job coach to teach/reinforce techniques to control impulsivity
• Allow the employee to work from home
• Review conduct policy with employee
• Adjust method of supervision to better prepare employee for feedback, disciplinary action, and other communication about job performance
• Use services of EAP
• Provide private workspace where employee will not disturb others by tapping, humming, or fidgeting

Multi-tasking: Individuals with AD/HD may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks or the frequency of performing the tasks.

• Separate tasks so that each can be completed one at a time
• Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order
• Provide individualized/specialized training to help employee learn techniques for multi-tasking (e.g., typing on computer while talking on phone)
• Identify tasks that must be performed simultaneously and tasks that can be performed individually
• Provide specific feedback to help employee target areas of improvement
• Remove or reduce distractions from work area
• Supply ergonomic equipment to facilitate multi-tasking
• Clearly represent performance standards such as completion time or accuracy rates

Paperwork: Individuals with AD/HD may experience difficulty completing paperwork efficiently and effectively. This is due in part to workplace distractions and difficulty with time management, disorganization, or prioritization.

• When possible, automate paperwork by creating electronic files
• Use speech recognition software to enter text or data into electronic files
• Save time filling out paper forms by completing information in advance, using pre-filled forms, or adhering pre-printed stickers
• Use checklists in place of writing text
• Supply large quantities of regularly-used forms
• Color-code forms for easy identification
• Re-design commonly used forms
  • Use large font
  • Double space or triple space
  • Provide adequate space for hand-written response

Situations and Solutions:

A journalist with AD/HD experienced sensitivity to visual and auditory distractions. The employer provided the individual with a private, high-wall cubicle workspace in a low-traffic area. The employer added an environmental sound machine to mask office noise.

A social worker with AD/HD had difficulty completing handwritten paperwork in a neat and timely fashion. The employer created electronic forms for the employee, which allowed him to type responses. The employer arranged computer files labeled by month to help the employee prioritize open cases. The employer also sent email reminders of deadlines.

An office worker with AD/HD experienced impulsivity and often interrupted co-workers by entering offices without knocking. The employer helped identify appropriate techniques for approaching co-workers, such as keeping a daily list of tasks to discuss with others, then emailing or calling to set aside time to talk about work-related projects.

A retail employee with AD/HD often forgot the closing and cash-out procedures, which resulted in missed printouts of daily sale reports. The employer created a numbered checklist that identified each step for proper closing procedures and identified which reports to run from cash registers. This accommodation benefited all employees.

A delivery person with AD/HD had difficulty with time management. She spent excessive time making deliveries and would forget to return to the warehouse between daily runs. The employer provided a personal organizer watch that could be programmed to beep and display a written message many times throughout the day. This auditory and written prompt helped the employee move quicker from task to task, and helped remind her to return to the warehouse to gather her next load.

A teacher with AD/HD experienced disorganization in her classroom due to clutter from many years of teaching. The employer provided a job coach to help the teacher learn organization techniques, to help separate and store items, and to dispose of previous student work and projects from yesteryear.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC.

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved October 28, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Fram, David. (2004). Resolving ADA workplace questions: How courts and agencies are dealing with employment issues. National Employment Law Institute Publication, 17th edition.
National Institute of Mental Health (NIMH). (2003). Attention deficit hyperactivity disorder. Retrieved February 20, 2006, from http://www.nimh.nih.gov

National Institute on Neurological Disorders and Stroke (NINDS) (2006). NINDS attention deficit-hyperactivity disorder information page. Retrieved August 23, 2006 from http://www.ninds.nih.gov/disorders/adhd/adhd.htm

More Info: http://www.jan.wvu.edu/media/adhd.html#ADA

Christopher Shearer

BORROWER FREQUENTLY ASKED QUESTIONS

UPDATED MARCH 18, 2009

What is "Making Home Affordable" all about?

Making Home Affordable is part of President Obama's comprehensive strategy to get the housing market back on track. Through the Making Home Affordable Program, up to 9 million American families may be eligible to refinance or modify their loans to a payment that is affordable now and into the future.

HOME AFFORDABLE REFINANCE

1. I'm current on my mortgage. Will the Home Affordable Refinance help me?

Eligible borrowers who are current on their mortgages but have been unable to take advantage of today's lower interest rates because their homes have decreased in value, may now have the opportunity to refinance. Through the Home Affordable Refinance Program, Fannie Mae and Freddie Mac will allow the refinancing of mortgage loans that they own or that they placed in mortgage backed securities.

2. How do I know if I am eligible?

You may be eligible if:

• You are the owner occupant of a one to four unit home,

• The loan on your property is owned or securitized by Fannie Mae or Freddie Mac (Don't know? See below),

• At the time you apply, you are current on your mortgage payments (current means that you haven't been more than 30-days late on your mortgage payment in the last 12 months or, if you have had the loan for less than 12 months, you have never missed a payment),

• You believe that the amount you owe on your first mortgage is about the same or slightly less than the current value of your house,

• You have income sufficient to support the new mortgage payments, and

• The refinance improves the long term affordability or stability of your loan.

3. How do I know if the refinance will improve the long term affordability or stability of my loan?

Your lender will give you a "Good Faith Estimate" that includes your new interest rate, mortgage payment and the amount you will pay over the life of the loan. Compare this to your current loan terms. If it is not an improvement, refinancing may not be right for

you. Also consider that refinancing from an adjustable rate to a fixed rate loan or eliminating higher risk loan terms such as interest only payments or balloon payments may also provide long term stability.

4. How do I know if my loan is owned or has been securitized by Fannie Mae or Freddie Mac?

You should call your mortgage lender or servicer (the organization to whom you make your monthly mortgage payments) and ask about the program.

Both Fannie Mae and Freddie Mac have established toll-free telephone numbers and web submission processes to make this data available. Borrowers will provide or enter information to determine if either agency owns or securitized the loan. This information is not a guarantee of eligibility for the refinance program, as other qualifying criteria must also be met.

• For Fannie Mae,

• 1-800-7FANNIE (8am to 8pm EST).

• www.fanniemae.com/loanlookup

•

• Freddie Mac

• 1-800-FREDDIE (8am to 8pm EST)

• www.freddiemac.com/mymortgage

5. I owe more than my property is worth. Do I still qualify to refinance under the Making Home Affordable Program?

Eligible loans will include those where the first mortgage will not exceed 105% of the current market value of the property. For example, if your property is worth $200,000 but you owe $210,000 or less on your first mortgage you may qualify. The current value of your property will be determined after you apply to refinance.

6. I have both a first and a second mortgage. Do I still qualify to refinance under Making Home Affordable?

As long as the amount due on the first mortgage is less than 105% of the value of the property, borrowers with more than one mortgage may be eligible for a Home Affordable Refinance. Your eligibility will depend, in part, on agreement by the lender that has your second mortgage remain in a second position, and on your ability to meet the new payment terms on the first mortgage.

7. Will refinancing lower my payments?

The objective of the Home Affordable Refinance is to provide creditworthy borrowers who have shown a commitment to paying their mortgage, the opportunity to get into a mortgage with payments that are affordable today and sustainable for the life of the loan. Borrowers whose mortgage interest rates are much higher than the

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current market rate should see an immediate reduction in their payments.

Borrowers who are paying interest only, or who have a low introductory rate that will increase in the future, may not see their current payment go down if they refinance to a fixed rate and payment. These borrowers, however, could save a great deal over the life of the loan by avoiding future mortgage payment increases. When you submit a loan application, your lender will give you a "Good Faith Estimate" that includes your new interest rate, mortgage payment and the amount that you will pay over the life of the loan. Compare this to your current loan terms. If it is not an improvement, a refinancing may not be right for you.

8. What are the interest rate and other terms of this refinance offer?

The rate will be based on market rates in effect at the time of the refinance and any associated points and fees quoted by the lender. Interest rates may vary across lenders and over time as market rates adjust. The refinanced loans will have no prepayment penalties or balloon payments.

9. Will refinancing reduce the amount that I owe on my loan?

No. The objective of the Home Affordable Refinance is to help borrowers get into more affordable loans. Refinancing will not reduce the principal amount you owe to the first mortgage holder or any other debt you owe. However, refinancing should save you money by reducing the amount of interest that you pay over the life of the loan.

10. Can I get cash out to pay other debts?

No. However, borrowers whose loans are owned or securitized by Fannie Mae may be eligible to finance all closing costs and obtain a small amount of cash (2% of the mortgage amount not to exceed $2,000) through the refinance if there is sufficient equity. For borrowers whose loans are owned or securitized by Freddie Mac, transaction costs (not to exceed $2,500) such as the cost of an appraisal or title report, may be included in the refinanced amount.

11. How do I apply for a Home Affordable Refinance?

You should call your mortgage servicer or lender and ask about the Home Affordable Refinance application process. The number is on your monthly mortgage bill or coupon book. Please be patient. Lenders and servicers are implementing the program now and it may take time before they are ready to process all applications. In the meantime, it will help your lender and speed up the application process if you gather some information and documents before you call.

Additionally, beginning April 4, 2009, borrowers whose loans are owned or securitized by Fannie Mae may also apply through any Fannie Mae approved lender.

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Nearly all major banks and mortgage brokers are approved to work with Fannie Me. Ask the lender you choose if it is authorized to provide a Home Affordable Refinance.

12. What documentation will I need?

It will help your lender if you gather some information and documents before you call. You will need:

• Information about the monthly gross (before tax) income of all the borrowers on your loan, including recent pay stubs if you receive them or documentation of income you receive from other sources.

• Your most recent income tax return.

• Information about any second mortgage on the house.

• Account balances and minimum monthly payments due on all of your credit cards.

• Account balances and monthly payments on all your other debts such as student loans and car loans.

13. I am delinquent on my mortgage. Will I qualify for a Home Affordable Refinance?

No. Borrowers who are currently delinquent or have been 30 days overdue more than once during the past 12 months will not qualify. You should contact your servicer to see if a Home Affordable Modification is an option for you.

14. Will I need mortgage insurance?

If your existing loan has private mortgage insurance, you will need the same amount of insurance coverage for the refinanced loan. If your existing loan does not have private mortgage insurance it will not be required as part of the Home Affordable Refinance.

15. How long will the Home Affordable Refinance be available?

The program expires on June 10, 2010. Your refinance transaction must be closed and funded on or before that date.

More info: http://www.makinghomeaffordable.gov/refinance_eligibility.html

Christopher Shearer

Computerized Training Of Working Memory Is A Promising Therapeutic Strategy In ADHD

ScienceDaily (Oct. 15, 2007) - ADHD is an increasingly frequent complex mental disorder in children with partly devastating consequences for the child's further development and the families. There are ew and very promising strategies of research to develop more appropriate treatments that specifically refer to the patient's basic neuropsychological dysfunctions and mechanisms.

Attention-deficit/hyperactivity disorder (ADHD), a state of serious impairments in both learning ability and social functioning, is one of many labels for one of the most prevalent conditions in child psychiatry, and, undoubtedly, the most controversial, which partly persists into adulthood. ADHD is conservatively estimated to occur in 3,0--7,5% of school-age children (Goldman et al., 1998), but more permissive criteria yield estimates of up to 17% (Barbaresi et al., 2002). Up to 20% of boys in some school systems receive psychostimulants for the treatment of ADHD (LeFever et al., 1999). Partly in response to legitimate concern about an apparent rapid increase in its prevalence in the 1990s, investigators have unsuccessfully attempted to formulate a single theory of ADHD, that would facilitate the development of an objective diagnosis test.

Aetiological factors of ADHD include not only genetic variations or mutations, but also environmental factors (brain injury and stroke, severe early deprivation, family psychosocial adversity and maternal smoking during pregnancy) and, most importantly and most difficult to identify, interactions between genes, and between genes and the environment. These factors are the initial causes of the multiple conditions that manifest symptomatically as ADHD, and their eventual identification should be accorded high priority.

The current criteria for the diagnosis of ADHD, published by the American Psychiatric Association in the 1994 Diagnostic and Statistical Manual of Mental Disorders (fourth edition; DSM-IV), are the most widely used and form our starting point. Other proposed criteria include those for the International Statistical Classification of Diseases and Related Health Problems (tenth revision; ICD-10) diagnosis of hyperkinetic disorder, which represents a more severe and 'refined' subset of DSM-IV ADHD, but which does not recognize the DSM-IV predominantly inattentive subtype (Castellanos & Tannock, 2002).

Terms applied to ADHD include:

• attention-deficit disorder (ADD)
• hyperactivity
• hyperkinesis
• hyperkinetic syndrome
• minimal brain dysfunction and
• minimal brain damage.

ADHD & Working Memory

Research on ADHD has, mostly, been descriptive and atheoretical. The imperative to discover the genetic and environmental risk factors for ADHD is motivating the search for quantifiable intermediate constructs, termed endophenotypes. It could be concluded that such endophenotypes should be solidly grounded in the neurosciences.

Three such endophenotypes a specific abnormality in reward-related circuitry; deficits in temporal processing that result in high intrasubject intertrial variability; and deficits in working memory Are most amenable to integrative collaborative approaches that aim to uncover the causes of ADHD.

Working memory (WM) capacity is the ability to retain and manipulate information during a short period of time. This ability underlies complex reasoning and has generally been regarded as a fixed trait of the individual. Children with attention deficit hyperactivity disorder (ADHD) represent one group of subjects with a WM deficit, attributed to an impairment of the frontal lobe.

A previous preliminary study indicated that training of WM tasks can enhance executive functioning including working memory, response inhibition, and reasoning in children with ADHD (Klingberg et al., 2002b).

A randomized, controlled, double-blind trial to investigate the effect of improving working memory by computerized, systematic practice of WM tasks including 53 children with ADHD revealed a significant treatment effect both at intervention and follow-up (Klingberg et al., 2005).

The method evaluated in this study differs from that of previous ones in that it focuses entirely on training WM tasks. Moreover, the training is computerized, which makes it possible to automatically and continuously adapt the difficulty level to the performance of the child to optimize the training effect. Executive functions were measured and ADHD symptoms were rated before, immediately after, and 3 months after intervention.

A significant effect was shown for the span-board task, a visuospatial working memory task, that was not part of the training program, as well as for tasks measuring verbal WM, response inhibition, and complex reasoning. Moreover, parent ratings demonstrated significant reduction in symptoms of inattention and hyperactivity/impulsivity.

Working memory can be improved by training in children with ADHD and could be of clinical use for ameliorating the symptoms in ADHD. Altogether, the effect sizes for reduction of inattention are clinically strong.

Clinical implications

Deficits in executive functioning, including working memory deficits, have been suggested to play an important role in attention-deficit/hyperactivity disorder (ADHD).

A current study showed that working memory can be improved by training. In addition, there were effects on reasoning, response inhibition, and a decrease in parent-rated symptoms of ADHD.

The subjects that would be expected to benefit from training of working memory are presumably those individuals for whom executive deficits and inattention problems constitute a bottleneck for everyday functioning or academic performance.

It is also possible that training of working memory will be useful in other conditions in which working memory deficits are prominent, such as after traumatic brain injury and stroke affecting the frontal lobe.

References

Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. JAMA 1998;279(14):1100-7

LeFever GB, Dawson KV, Morrow AL. The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools. Am J Public Health 1999;89(9):1359-64

Barbaresi WJ, Katusic SK, Colligan RC, et al. How common is attention-deficit/hyperactivity disorder" Incidence in a population-based birth cohort in Rochester, Minn. Arch Pediatr Adolesc Med 2002;156(3):217-24

Castellanos FX, Tannock R. Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nat Rev Neurosci 2002;3(8):617-28

Klingberg T, Fernell E, Olesen PJ, et al. Computerized training of working memory in children with ADHD--a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2005;44(2):177-86

Klingberg T, Forssberg H, Westerberg H. Training of working memory in children with ADHD. J Clin Exp Neuropsychol 2002;24(6):781-91

More Info: http://www.sciencedaily.com/releases/2007/10/071014163641.htm

Christopher Shearer

JACKSON ANNOUNCES $3 MILLION TO PROTECT MIAMI CHILDREN AND FAMILIES FROM DANGEROUS LEAD AND OTHER HOME HAZARDS
Funding builds on remarkable success of HUD programs in healthy housing

MIAMI - Lower income children and families in Miami will live in healthier homes because of $3 million in grants announced today by Housing and Urban Development Secretary Alphonso Jackson. The grants are part of nearly 168 million awarded around the nation to help local communities to conduct a wide range of activities to improve the conditions of families living in lower income housing, including:

• To remove potentially dangerous lead from lower income homes;
• To stimulate private sector investment in lead hazard control;
• To educate the public about the dangers of lead-based paint;
• To fund model programs promoting healthier and safer home environments; and,
• To support scientific research into innovative methods of identifying and eliminating health hazards in housing.

"Every family deserves a safe and healthy home to raise their children," said Jackson. "The funding we announce today will help protect children from dangerous lead, fund important research into healthier housing and will create other public and private investment to improve the living conditions of thousands of homes." (See attached summary)

Lead Hazard Control Grant Programs

The funding announced today includes more than $145 million to eliminate dangerous lead paint hazards in thousands of privately owned, low-income housing units. These funds are provided through HUD's Lead-Based Paint Hazard Control and the Lead Hazard Reduction Demonstration grant programs. In addition, HUD's Operation LEAP (Lead Elimination Action Program) will provide $8.9 million to stimulate private sector contributions that will enable children to grow up in homes that are free from lead-based paint hazards. HUD will also award $1.9 million in Lead Outreach grants to support public education campaigns on the hazards of lead-based paint and what parents, building owners and others can do to protect children. Further, $1.7 million will assist local research institutions to study ways to drive down the cost and increase the effectiveness of lead hazard identification and control.

HUD's lead hazard control program has a remarkable track record. Since the program began in 1990, more than 26 million fewer homes have lead-based paint. The Centers for Disease Control and Prevention estimates that the number of lead-poisoned children in the U.S. declined by half in the past decade. Today, HUD's program is active in over 115 communities, helping to clean up lead hazards in low-income, privately owned housing.

Healthy Homes Initiative

Every year, children are harmed or become ill at home from a variety of preventable health and safety hazards. For example, childhood diseases such as asthma can be triggered by excessive dust or moisture in the home. Simple home repairs can often prevent injuries from scalding, electrical shock or carbon monoxide poisoning. HUD's Healthy Homes Initiative addresses a multiple of these and other childhood diseases and injuries in the home by taking a holistic approach and addresses housing-related hazards in a coordinated fashion, rather than addressing a single hazard at a time.

The funding announced today includes more than $6.7 million in demonstration grants to identify and eliminate housing conditions that contribute to children's disease and injury, such as asthma, lead poisoning, mold exposure, and carbon monoxide contamination. HUD is also investing more than $2.6 million to support scientific research into new ways of identifying and eliminating health hazards in housing.

HUD is the nation's housing agency committed to increasing homeownership, particularly among minorities; creating affordable housing opportunities for low-income Americans; and supporting the homeless, elderly, people with disabilities and people living with AIDS. The Department also promotes economic and community development as well as enforces the nation's fair housing laws. More information about HUD and its programs is available on the Internet at www.hud.gov and espanol.hud.gov.

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City of Miami, Florida

Amount of Award: $3,000,000
Contact: Robert Ruano (305) 693-3135

The City of Miami will be awarded $3,000,000 to establish Miami Unleaded, a comprehensive lead program that will address its aging housing stock, diverse population and high risk of lead hazards in seven targeted communities. The primary goal for Miami Unleaded is to provide a comprehensive approach to lead hazard control in the City, by making it a part of every rehabilitation, renovation and repair on units built before 1978 where lead-based paint is present. Partners will include the Mayor's Office and Departments of Communications and Neighborhood Enhancement Team. The City's Community Development Department will provide overall management of Miami Unleaded. Additionally, the City of Miami will be working with the Florida Children's Environmental Health Alliance of Florida International University, Coalition to End Childhood Lead Poisoning, Miami-Dade County Health Department Childhood Lead Poisoning Prevention Program, Miami-Dade Head Start/Early Start, and Parents United Against Lead Poisoning to provide outreach, education, referral, and research expertise to the program. The total number of children residing in high-risk areas is 17,827. The City of Miami will provide $1,773,301 in matching funds.

Christopher Shearer

The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination.

However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.

Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. Long-acting or extended release forms often allow a child to take the medication just once a day before school, so they don't have to make a daily trip to the school nurse for another dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends, too.

A list of medications and the approved age for use follows. ADHD can be diagnosed and medications prescribed by M.D.s (usually a psychiatrist) and in some states also by clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists. Check with your state's licensing agency for specifics.

*Not all ADHD medications are approved for use in adults.
NOTE: "extended release" means the medication is released gradually so that a controlled amount enters the body
over a period of time. "Long acting" means the medication stays in the body for a long time.

Over time, this list will grow, as researchers continue to develop new medications for ADHD. Medication guides for each of these medications are available from the U.S. Food and Drug Administration (FDA).

What are the side effects of stimulant medications?

The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is lowered.

• Decreased appetite. Be sure your child eats healthy meals. If this side effect does not go away, talk to your child's doctor. Also talk to the doctor if you have concerns about your child's growth or weight gain while he or she is taking this medication.
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• Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose of the medication or a shorter-acting form. The doctor might also suggest giving the medication earlier in the day, or stopping the afternoon or evening dose. Adding a prescription for a low dose of an antidepressant or a blood pressure medication called clonidine sometimes helps with sleep problems. A consistent sleep routine that includes relaxing elements like warm milk, soft music, or quiet activities in dim light, may also help.
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• Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may have a personality change, such as appearing "flat" or without emotion. Talk with your child's doctor if you see any of these side effects.

Are stimulant medications safe?

Under medical supervision, stimulant medications are considered safe. Stimulants do not make children with ADHD feel high, although some kids report feeling slightly different or "funny." Although some parents worry that stimulant medications may lead to substance abuse or dependence, there is little evidence of this.

FDA warning on possible rare side effects

In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data found that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications.

The review also found a slight increased risk, about 1 in 1,000, for medication-related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include an initial health history, including family history, and examination for existing cardiovascular and psychiatric problems.

One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another warning. Studies show that children and teenagers who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take it. If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child's behavior every day. Ask other people who spend a lot of time with your child to tell you if they notice changes in your child's behavior. Call a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.

Do medications cure ADHD?

Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Medications can help a child pay attention and complete schoolwork. It is not clear, however, whether medications can help children learn or improve their academic skills. Adding behavioral therapy, counseling, and practical support can help children with ADHD and their families to better cope with everyday problems. Research funded by the National Institute of Mental Health (NIMH) has shown that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child's needs.¹²

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http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml