Hi,

here in Germany a doctor (who is an ADDer himself) established a reha program for ADD with comorbidities or ADDers who are unable to work/ go to school. Before, there were in-patient treatments only for children. My ADD coach asked me to translate the program, as she does not speak German.

Anyone of you interested in the English version?

I did not find anything similar in the US or UK, do you know more?

In general, what do you think about in-patient rehabilitation?

Thanks,

Pia

I think its a hoot.

I'm sorry, I don't understand. ADD can be treated but one doesn't "rehabilitate" from it.

The program sounds very interesting. What does it consist of? Does it teach people new skills? I know that ADD Coaching where people meet in groups or individually for an hour or so a week can be very helpful to people. I can only imagine how benefical a 4-6 week in patient program could be to a person with ADD.

I am very interested in the English translation of this.

I'm with EyeForgot. We are certain now that the root cause of ADD itself is neurological and biological. Just look at what they used to say about Chronic Fatigue Syndrome! Now they discover it is a form of encaphalitis! We have a phrase over here in the United States - 'you can't teach an old dog new tricks' and 'a leopard doesn't change his spots'. I think you might be able to have some success with your program but you are really dodging a few serious research issues.

Let me share my own example. I am considered a well adjusted or high functioning ADHD person. Why? Because I have built up a whole matrix of defenses, strategies, techniques and procedures over time that help me compensate for my deficit. The side effect of this is poorly documented by the establishment - burnout, exaustion, secondary depression, poor esteem, poor social networks etc.

Now is this caused from the extra cognition that's going on in order to general better coping strategies - neuro burnout??? Ever considered your approach might in this regard be iatrogenic?

Doctor's harp on about how other disorders are often secondary to ADHD. This is why in the United States stimulant treatment has been often so touted as successful. This is because the meds treat the central feature of the disorder and therefore effect secondary outcomes. The meds also help the brain neuro compensate for the excess strains involved in learning new tasks (ie Inpatient treatments). I recall reading a research outcome from some Jewish ADHD Clinic in New York City that supports these premises.

In THAT study kids were treated for ADHD while undergoing intensive education programs and then withdrawn from treatment some 2 years later. The study found that these kids 'burned' new frontal lobe neural pathways during those two years and were better adjusted now being off the meds. In other words they 'learned how to learn' and the change was physical and permanent. This is encouraging because it suggests that ADHD might be curable down the track.

What I am basically getting at is that I think your approach needs to be on the cutting edge if it's going to be worthwhile. See also http://www.playattention.com/attention-deficit/articles/adhd-brain-growth-and-development/

I read about a similar program in Germany last year. In Bad-Something-Or-Other, right?

If it's the same program I read about, it advocates a multi-pronged approach to treating ADD: behavioral therapy and life coaching together with the right meds and treatment of co-morbid disorders.

I read about a similar program in Germany last year. In Bad-Something-Or-Other, right?

If it's the same program I read about, it advocates a multi-pronged approach to treating ADD: behavioral therapy and life coaching together with the right meds and treatment of co-morbid disorders.
Oh ok then... why didn't he just say so?

Sorry for the confusion. I should have explained better.

Yes, it is in Bad Bodenteich....

As in children and adolescents, the complex problems of ADHD and comorbid disorders require a multimodal therapy with individual help to learn to deal with problematic situations. This treatment includes medication, psychoeducation, psychotherapy, help for selfhelp and counseling for social problems. Furthermore, it prepares medical care, psychotherapy and connection to selfhelp groups at home. It seems important to us that the patient is able to take an active role in the treatment, that there are clear goals for the therapeutic process and that all steps and planned measures in the therapy are transparent.



Problems with self-worth and identity, ongoing struggles in the everyday life and comorbid disorders are often far more disabling than ADHD itself.

While deficiencies in the self-concept and patterns of thinking can be treated with psychotherapy, the biologically caused impulsivity, affective instability and inability to filter … have to dealt with coping strategies such as self-management and help with organisation of everyday tasks.

In this process emotions can and should be mobilised to assess the own possibilities more realistically. In a protected environment, new experiences can be acquired and new coping strategies can be trained.



The goal of the in-patient rehabilitation is to be able to use the individual potential as much as possible, to improve social abilities (such as in communication and dealing with conflicts) and to strengthen self-worth.



Parts of the therapy:



- psychoeducation

- a new assessment of comorbidities and the biography regarding the ADHD

- definition of goals for the treatment and development of a treatment plan for both the in-patient time as the following out-patient treatment

- Specific guidance to learn better compensation strategies

- Improving self-worth by looking at individual strengths

- Possibilities to stabilise through mindfulness, positive activities and re-discovering own resources and fields of interest

- Teaching selfmanagement/ coaching strategies

- Learn how to cope with stress and emotional instability

- Recognizing and changing distorted patterns of perceiving and thinking

- Reducing negative behaviour in conflict situations (training of social competence and dealing with conflicts)

- Techniques to solve problems in everyday situations or when overwhelmed

- Active strategies of compensation to avoid new problems and protect from decompensation (plans for emergency situations)

- Long-term strategies how to change living circumstances to adapt to ADHD



Patients can be treated with different stimulants as well as antidepressants (if necessary)



In psychotherapy, they use the neuro-cognitive approach by Kathleen Nadeau



I hope I did not make to much mistakes when I translated it....

I think you did a good job translating! Can I ask what the German term is for "neurocognitive approach?" I'm not familiar with the term in English but might know it in German.

if it's the same program I heard of - and it sounds like it - they even have a day care facility for kids of ADDers. That would probably make treatment much easier for single parents or stay-at-home parents whose partners can't take a month off of work to look after the children.

(I'm not advocating that people go to Bad Bodenteich and try it out, mind you - I only know what I read online and I know that the program is run by doctors who have decent reputations. I've never been there or seen how things are run.)

"neurokognitive Therapie"

it is a concept developed by Kathleen Nadeau. You can find a German version at adhs.ch, and if you look for neurocognitive and Nadeau, you should find the English one.

here is the link:

www.addvance.com/help/professionals/neurocognitive.html

I think this program sounds very promising and am very curious to see how adults do in a live in program like this. To me its doesn't sound like they are trying to rehabilitate the AD/HD itself but the person as a whole and how he or she fits into society. Just like Vocational Rehab doesn't try to "cure" people of their disabilities it helps them get and keep jobs.

In THAT study kids were treated for ADHD while undergoing intensive education programs and then withdrawn from treatment some 2 years later. The study found that these kids 'burned' new frontal lobe neural pathways during those two years and were better adjusted now being off the meds. In other words they 'learned how to learn' and the change was physical and permanent. This is encouraging because it suggests that ADHD might be curable down the track.
Sounds very interesting -- I sure would like to hear more about it. I've never heard of anything before that claimed to be developing a cure. I'm sure learning better coping strategies would be helpful and make one better adjusted even off meds -- heck, my parents managed to do a good bit of that for me even without meds -- but as a cure, even down the track, I question that because of the genetic biochemical issues involved. Anyone more knowledgable than me care to address this question? I know that behavioral techniques have been shown to make a difference on scans in the way the OCD folks brains operated and it would be great if the same thing was true of ADD.

Scattered

And on the flip side of the coin....
ADHD is not a skills deficit. This is not something that you can unlearn. I would like to see any "study" replicated in a scientific journal. You just won't see it.

You can find crazy alternative treatments all over the world.

Maybe the problem is quite simple: in Germany, rehabilitation (we actually use the very same word) is not meant to be a cure, but to help people adjust... If you translate the word from Latin, it actually means "re-adjustment" or "getting new habits" or "re-integrating", at least if my 9 years of Latin do not fail me :rolleyes:

"the biologically caused impulsivity, affective instability and inability to filter … have to dealt with coping strategies such as self-management and help with organisation of everyday tasks."

"The goal of the in-patient rehabilitation is to be able to use the individual potential as much as possible, to improve social abilities (such as in communication and dealing with conflicts) and to strengthen self-worth."

Maybe my translation is misleading or implicates something the original text does not :confused:

If yes, could you please tell me the mistakes? Honestly, at the moment I have to write my thesis in English, so any corrections to improve my English are very welcome!!!!!

I'll try to explain a little bit more:

They do not promise any cure, they say that ADD is a life-long condition one can learn to live with.

In their opinion, improving self-esteem and treating comorbid disorders already leads to a huge improvement.

They want to teach selfmanagement, how to deal with emotional instability and want to improve social skills.

:confused: Better like this:confused::confused::confused:

@ scuro:

Concerning ADD, you are probably right. There is far less knowledge in Germany. Maybe because people strongly dislike the idea of "having to perform" ????
I do not know, but I have the feeling that according to our history, we feel it is very important to accept that people are different.
So people who are not (or only slightly) affected are suspicious doctors and pharmaceutical companies want to remove traits that are not "useful for performance".

Whether this really leads to acceptance of different people, one might doubt, but it is originally well meant.

We do have lots of people who believe in the most stupid crap, as long as it is promised to be more "gentle" or "natural" than school medicine.

I do not know whether there are more or less than in other countries.

I've been at school in Northern Norway, spent some time in Rome, did a research internship in Australia and now I study in Switzerland.

From what I've seen, only in Northern Norway (above the Polar Circle) the people believed less in such things. But this is similar in rural areas in Germany.

That was very clear -- but then so were your other posts! :) I was actually questioning someone else's response to your post. It sounds like a good program -- I do believe there are a lot of life skills that could be learned in an intensive setting -- the only problem being kind of the one I faced (which doesn't negate the value of such a program) is that even with the best coping skills, it's pretty easy down the road as responsibilites continue to pile up higher and higher to reach that place where doing it without meds is very difficult. Thomas Brown in his book Attention Deficit Disorder: The Unfocused Mind in Children and Adults and John Ratey in his book Shadow Syndromes both discuss a lot about how very intelligent ADDers with good environmental influences/training can make it a long way with few problems, but how often in the arena of marriage, especially after one or two kids (possibly ADD) are added to the mix, the combination can be overwhelming to all their adaptations.
Again this program sounds great -- I got that training from my parents, but not every ADDer is so lucky. It sounds like it could really better many ADDers lives. Medication by itself still frequently falls short of helping the person achieve all they can. I'm very glad I was able to succeed in a number of arenas without medication for many years. I'm also very glad that now that my life challenges have increased beyond my coping mechanism, meds are availabe. I just hope they don't insist that graduates come off meds or feel like failures -- that's all I'm really getting at I guess.

Thanks for sharing about this!

Scattered

There is no magic bullet, there is no "rehab"...for the vast of majority of people having ADHD. I know that you stated that it wasn't a cure from the start but the title suggests otherwise. Having said this, organization and coping strategies can't hurt, just make sure you're not paying top dollars for something like this and that your expectations are not too high either.

But it is related to not learning essential skills. Because of the inattention and other AD/HD relations symptoms many people with ADD never learn and develop the same skills that others do. This is quite apparent in terms of organizing, time management, and social skills.

From what I have hear even Barkley reccomends ADD Coaching.

[i]And on the flip side of the coin....
ADHD is not a skills deficit. This is not something that you can unlearn. I would like to see any "study" replicated in a scientific journal. You just won't see it.

I think your translation was great. I think some people are really turned off by the term rehab. I think people are looking in more a long the lines of a drug rehab instead of a program like Vocational Rehab.


Maybe the problem is quite simple: in Germany, rehabilitation (we actually use the very same word) is not meant to be a cure, but to help people adjust... If you translate the word from Latin, it actually means "re-adjustment" or "getting new habits" or "re-integrating", at least if my 9 years of Latin do not fail me :rolleyes:

"the biologically caused impulsivity, affective instability and inability to filter … have to dealt with coping strategies such as self-management and help with organisation of everyday tasks."

"The goal of the in-patient rehabilitation is to be able to use the individual potential as much as possible, to improve social abilities (such as in communication and dealing with conflicts) and to strengthen self-worth."

Maybe my translation is misleading or implicates something the original text does not :confused:

If yes, could you please tell me the mistakes? Honestly, at the moment I have to write my thesis in English, so any corrections to improve my English are very welcome!!!!!

I'll try to explain a little bit more:

They do not promise any cure, they say that ADD is a life-long condition one can learn to live with.

In their opinion, improving self-esteem and treating comorbid disorders already leads to a huge improvement.

They want to teach selfmanagement, how to deal with emotional instability and want to improve social skills.

:confused: Better like this:confused::confused::confused:

I would be very interested in such a program.

Developing an effective medication regimen, learning new skills to help cope with the disorder, and meeting others in the same boat would all be marvelous!

I often feel very alone in handling this disorder (even since I've been diagnosed - last June), and so few people understand. A program such as the one you describe sounds terrific in many ways!

Pia, thank you for telling us about this! :)
Cheers.

...Because of the inattention and other AD/HD relations symptoms many people with ADD never learn and develop the same skills that others do. This is quite apparent in terms of organizing, time management, and social skills.

From what I have hear even Barkley reccomends ADD Coaching.
Yes, Barkley does recommend ADHD coaching, let me explain.

I have taught several academic skill classes with mostly ADHD kids. In this class we worked on organizing, time management, and social skills. At the end of the semester these kids knew how to use a planner, their notebooks were organized, and they even knew what steps to take when they were getting angry.

Yet outside of the class, the planners were never used, their notebooks reverted back to normal, and they still had emotionally impulsive outbursts. The difficulty is in doing what they know. ADHD is a performance deficit. There are several executive functions involved with these processes and they have all been shown to have developmental deficits in this area. This is why teachers pull their hair out. They teach s dkill 1 on 1 to an ADHD kid, say... how to organize their desk and 3 days later it reverts back to the way it was. Now the teacher thinks the kid is lazy or willfully disobeying him.

So..Barkley recommends coaching/ tutors more for the daily/ weekly maintenance of folks with ADHD, rather then to actually teach them skills that they can take with them into their lives. Some of these skills just don't stick because developmentally, they just are not there yet.

I'm with EyeForgot. We are certain now that the root cause of ADD itself is neurological and biological. Just look at what they used to say about Chronic Fatigue Syndrome! Now they discover it is a form of encaphalitis!
First, encephalitis has been suspected in CFS for a long time.

Second encephalitis IS neurological and biological!!!

It's inflammation of the BRAIN. Usually caused by a virus, but not always.

I recall reading a research outcome from some Jewish ADHD Clinic in New York City that supports these premises.

In THAT study kids were treated for ADHD while undergoing intensive education programs and then withdrawn from treatment some 2 years later. The study found that these kids 'burned' new frontal lobe neural pathways during those two years and were better adjusted now being off the meds. In other words they 'learned how to learn' and the change was physical and permanent. This is encouraging because it suggests that ADHD might be curable down the track.
I would be interested in reading this study if you can give us a citation.

I am willing to bet that there is no control group.

Children's brains are developing, ADD or no ADD, treatment or no treatment. In fact, adult's brains "burn" new pathways all the time, too.

If there is no control group, there is absolutely nothing encouraging about it.

You can find crazy alternative treatments all over the world.

This is SO true......

Play Attention hasn't been substaniated beyond the principal investigators/ company that owns it.

I read an interesting review on it last week,however, it's going to take outside investigators to see if it meets the accepted standard of longitudinal validity & reliability.

Apart from the ADD program, I really like the concept of the hospital concerning comorbid disorders.
They say you cannot treat ADDers the same way as you would others with the very same disorder. At the moment, they are publishing a lot in Germany about a link between bulimia and ADD and how to treat if both occur together.
Personally, I'd be interested in their program about depression and probably PTSD as well.
I have the strong feeling you'll always fail if you do not see the whole picture. And some therapeutic approaches may simply fail if you do not take other problems into account.
Apparently, about 90% of the patients in the program are women with recurring depression. Apart from that, the responsible doctor says that ADDers seem to be extremely vulnerable to trauma. I feel I am traumatized, although the trauma might not be that "strong".
So the major reason for going there would be that they seem to know something about my "potpourri".

The whole picture concept is a good approach. There is a strong connection between many disorders and ADHD. Put good and knowledgable Dr.'s in a place like this and you could make progress with some dysfunctional folks and their comorbid conditions.

This concept is good, this sounds much better.

I would be interested in reading this study if you can give us a citation.

I am willing to bet that there is no control group.

Children's brains are developing, ADD or no ADD, treatment or no treatment. In fact, adult's brains "burn" new pathways all the time, too.

If there is no control group, there is absolutely nothing encouraging about it.<!-- / message --><!-- sig -->

__________________
Barb

Well I was kinda hoping someone out there might be better informed than me on this point. I only remember reading this publication last year and getting really excited about it. I really wish I had a link for you but I can't seem to find it. I do not know if there was a control group or not. If you can find the link please post it.

Yes you are definately right about there being all kinds of alternative approaches. Remember the Feingold diet? I also heard a rumour that the British Home Office is getting excited about vitamin D deficiecy. Mind you that is from last year as well. The HO were referring to impulsive criminality I think and not necessarily ADHD.

I have found some links on neuroplasticity but I think that's slightly different.

Yes you are definately right about there being all kinds of alternative approaches. Remember the Feingold diet?
lol..... there's a thread on here with a heated debate about it!:rolleyes:

Guess who provides a lot of the heat...:o

I'll see if I can find the study you were talking about. It could turn out to be something interesting, but I won't hold out much hope. Something tells me if it were a well-done study we'd all have heard about it.... :)

Am I really "waffling" or did the admin find it necessary to summarise my last post? Nothing wrong with a heated debate it's healthy for the brain. Might even "burn" some new neural circuits! :)

Now listen - my screen name was assigned to me by my buddies. Please do not read anything into it. It is not my intent to 'wind anyone up'.

I have quite a few resources at my disposal include indexes of nearly every peer-reviewed journal (and many non-peer-reviewed) known. I couldn't find anything that fit your description.

Perhaps you read it on a website?

The last nutritional study I read on ADHD was English.

What it said was that the dietary changes produced no measurable improvements (in whatever task they used ),however, the parents seemed to think there was.

Placebo effect perhaps…..the study I have access to during one of my continuing education things estimates 4% may benefit from a diet change but those are most common in those who have a family history of migraines..

I do not have the resource sources as you guys so feel free to correct me if I am in error….

This 4-6 week program thing maybe is off assistance in that stops the life merry go round long enough for people to get off!!!

Now what am I doing and how did I get in here…that working memory thing forgot to work again going to have to get that fixed…

No I don't have access to a journal database. I think the study had something to do with Neuroplasticity or Neurofeedback? I couldn't find it via google. To find the study might require a serious diggin exercise in a research library.

No I don't have access to a journal database. I think the study had something to do with Neuroplasticity or Neurofeedback? I couldn't find it via google. To find the study might require a serious diggin exercise in a research library.
Ah. It was probably feedback. There's a TON of stuff out there on this.

Okay, the most widely discussed/famous research study involving dietary interventions indicated that 5 % of pre-school children with ADHD were found to have "sensitivities" to certain foods (translated as food allergies).

Treating the food allergies improved the food allergies but did NOTHING in ameliorating the ADHD symptoms.

Here here!!

My son has been on a NO processed sugar diet his whole life, he has never had preservatives and is only allowed minimum amounts of juice etc...etc. It has done nothing whatsoever to ease his ADHD symptoms - that said, a glass of red cordial would turn him into the sporn of satan.

Hi everyone!

I am this "German doc" with the neurocognitive rehabilitation program... Since I was looking for more news on adhd I found this forum...

Here some basic facts
1. We started two years ago in a small hospital for psychosomatic medicine. Since these kind of hospitals are unique for the German region and not known to anyone else, it is a rather different kind of therapy for adhd. We are not targeting the core neuropsychiatric symptoms of adhd with the psychotherapy approach (but will use stimulants and / or atomoxetine) and we do not promise to "cure". But we try to find a kind of adaption using ressources and positive ways of living with adhd. Later I found the ideas of Kathleen Nadeau (I like her works very much) and Safren ("Masterig your adult adhd") and we adapted our inpatient program according to their approach.
2. Our patients have a lot of comorbid disorders, including eating disorders, borderline personality disorder or severe depresssion / anxiety. Or they are affected by severe problems of social withdrawl and problems at work or school. Coaching is not known in Germany (or we only have about 5 or 6 adhd coaches here) and it is very difficult to find any helf for adult adhd.
3. We combine mediciation and a psychotherapy approach. The skills training is somehow different to other treatment programs. I think it is right to say that ADHD is not a skill deficit disorder. But sometimes it is useful to discuss and train useful adaptions for adhd and comorbid disorders.
4. There is an other German ADHD psychotherapy for outpatient therapy using the dialectic behavioral therapy approach of Marsha Linehan for borderline patients (Hesslinger and Phillipsen). This treatment program is now used in another hospital as well...

Right now we started in a new hospital only 30 km near Bad Bodenteich (Klinik Lüneburger Heide Bad Bevensen). Anyone interested in more news just post a mail...

Martin W.
www.adhs.ch (http://www.adhs.ch)
www.web4health.info (http://www.web4health.info)
www.klinik-lueneburger-heide.de (http://www.klinik-lueneburger-heide.de)

Dear Dr. W...

To me your program sounds like a Life Saving Oppertunity. I'd sign-up today if possible!
Not to be indelicate, but just how expensive would this course of treatment be for a USA resident that would not be covered by German Health Insurance. A ballpark figure is fine as I am sure each case varies a bit. Please feel free to PM me if talking further about this Therapy is not allowed on the forum.

Thank You for the Valuable Information you posted about this treatment.

Sincerely; Addeline

The costs are difficult to calculate. We have a minimum charge of 120 Euro per day. This is the regular fee for the German health insurance. If you have a private insurance costs may go up a little bit...

Martin

(1 Euro = ~$1.25)

So you combine meds with skills training and therapy for comorbid disorders? Sounds like a fairly sensible treatment. I know that most people in the US who have "coaching" or some other form of therapy or skills training do so once a week or so. I'd be curious to see whether a more intensive program like yours is more effective or not.