Month: October 2018

The “One & Done” Child

There’s a certain kind of a child I see quite often I have come to call the, “One and Done Child.”

What are some of the hallmark features of these children?

These children lack what the shrink types refer to as “self-monitoring.”  That is, they aren’t oriented to checking themselves too readily.  Typically, when given a task (no matter what the task is), they complete it and pronounce, “done,” fairly hastily with little awareness as to whether their efforts are accurate or not.

Let’s take Katie, a nine year old girl I saw recently.  One of my favorite tests is one that has the child copy an increasingly complex series of shapes and designs.  The child isn’t given any direction beyond asking her to copy the shapes and designs.  The pencil they are given to copy the shapes has an eraser.

Well, Katie completed the copying in a fairly hurried, “done” style, as each design was copied in about two seconds flat whether it was simple or complex.  She treated each design as if they all were of equal weight of difficulty.

Imagine given a simple square to copy.  Pretty easy.  Done in two seconds.  Well what if the design was a complex three-dimensional figure.  Compared to the two seconds it takes to copy the square, it would stand to reason that a complex 3-D design would take much more time to complete, more thought and consideration.

Not for Katie.  Each design was the same – two to three seconds and “done.”  There was no erasing, no attempt to improve a design. Needless to say the more complex designs certainly were not copied very accurately, but Katie showed no awareness of the lack of accuracy, no capacity to monitor herself.

When explaining this style to Katie’s mom, she asked me whether I thought it was because she  is “impulsive” (With the subtext of does she have ADHD and should she be put on medication?”).

I said, “I think it’s more a style, a way that she approaches tasks, a habit she’s gotten herself into. These tasks require a certain amount of thought and self-reflection and she’s just not oriented that way.    It’s like these “One & Done” kids lack an internal voice, something that goes like this, ‘Hmmm., let me look this over to see how accurate I am.  Maybe I’m not done yet.’ Katie doesn’t have that voice running through her head.”

I know.  What’s the solution?

I wish there was an easy one.  Most of the time the parents (well, the moms) are just badgering these kids to, “check your work…check your work…check your work,” while the kid’s eyeballs are snapping in his/her head.  The last thing a Katie style kid wants to do is check her work.

I do think in the hand of a good tutor/teacher who understands this phenomenon, the child can be sensitized to become more reflective and more considered in approach over time.  Effectively, such a teacher would be saying something like, “Hold on, maybe we need to look that over more carefully.  What do we need to do before we say we’re done?”

A child is much more likely to be receptive to such a teacher than listen to a parent.

Takeaway Point

“One and Done Kids” are tough to manage.  So, even though it will you cost you some money find yourself a good tutor to start chiseling away at this habit of being “one and done.”

Copyright, 2018
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Modifications? Direct Instruction?

Let’s say I’m a really bad tennis player, but I want to get better.

I decide to go to a tennis pro and after sizing me up the pro gives me the following suggestions:

  • Get a tennis racket with a bigger head size so you will miss the ball less
  • Make sure to wear a headband to keep vision clear and unobstructed.
  • Get a good pair of tennis sneakers so you are sturdy on your feet.
  • Get a really good grip so the racket doesn’t turn in your hand.
  • Make sure you have a strap for your glasses.
  • Do a lot of push-ups and start running each day.

Now go play tennis and let me know how it turns out.

Wait, I’m confused.  I’m a really bad tennis player.  I don’t know how to play tennis. Shouldn’t someone teach me the skill before I start playing?

Drawing a parallel, here are some of the primary items on an IEP I saw recently for a kid who was severely struggling with reading, spelling and writing:

  • Access to electronic text (e.g., downloadable books).
  • Limit number of items student is expected to know.
  • Read test aloud.
  • Provide books on tape, CD or read aloud.
  • Go for OT & Speech and Language.

There were about 10 more of these type of suggestions, but you get the idea.

Like the tennis teacher’s ideas, these are modifications, or work-arounds.  They may be nice, just like getting good sneakers will be nice, but my tennis game is not going to be improving much with a new grip, sneakers and headband.

Neither will my reading, spelling and writing with the modifications proposed.


Copyright, 2018
Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –
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Labeling Missing the Mark

I have never been comfortable labeling children.

Labeling a child (or anyone for that matter) always seems so reductionist to me, as if the label could tell the whole story.

As a society, though, we have become increasingly comfortable and casual with their use.  Not a week goes by where I don’t hear, “He’s ADD”  or, “My kid is dyslexic,” or “Well, she’s Asperger’s.”  (Those are just some of the common ones; there are many more.)

I understand that getting “the diagnosis” or the label can be comforting on some level, but there are many factors beyond the label that need to be considered when trying to understand a child.

Let’s look at Maria, an 8 year old I saw recently.  Recently seen by a neurologist who pronounced she had ADHD after about a 20 minute assessment, the mom took that diagnosis seriously (as she should) and thought to herself, “Well, that’s that.  We finally understand what’s going on with Maria.”  She presumed that starting her on the medication prescribed would fix the problem.

Well, not too long after that, Maria started to feel overwhelmed in class describing symptoms of nervousness during tests and whenever the teacher asked the kids to write.  When it came to homework, she was quite avoidant, arguing a lot with her parents about getting it done.  Math word problems resulted in particular resistance from Maria.

When I tested Maria, she came across as a sweet style child who appeared pretty anxious, particularly with tasks that involved evaluating, considering and problem solving – in other words, tasks in which straightforward answers were not readily apparent.  With reading, she showed almost no ability to answer comprehension questions that involved inferences,  that is, “reading between the lines,” or answering questions that were not explicitly stated in the text.

About 70% of the kids are pretty self-managing. They read pretty well. They hand in their homework and are reasonably flexible in terms of their personality style.  That is, they are on a nice smooth road.

With 30% or so it’s a different story.  For them, school is an ongoing struggle (starting in first grade).  Frustration tolerance is not a top quality of theirs.  It almost goes without saying that their attention skills are variable (at best) and they don’t read, spell or write very well.  Homework is a continual battlefront.  They sometimes  annoy other people in ways they are not aware.

This latter category of kids are on the rough road.

“Rough road” is not a special education category or a psychiatric disorder, but almost all of the kids classified in special education or given diagnostic labels by medical doctors are kids who are on a rough road.

Takeaway Point

Maria is one of the 30%.  Just calling her “ADHD” doesn’t do justice to the totality of what she is experiencing.  Next week we will talk about how to approach her.

Copyright, 2018
Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –
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The Thing About ADD…

The thing about ADHD (or as it’s called more casually in the public – ADD), is that it’s pretty hard to challenge once the “diagnosis” has been given.

There are no legitimate tests that I know of for ADD.  Physicians primarily rely on rating scales, like the Vanderbilt, as a primary source for making a determination.

These scales involve opinions, not facts, usually from the parent on a set of behaviors that typically cluster on what is thought to be ADHD/ADD.

Here are a few of the items from the Vanderbilt Scales that usually will ring the “ADHD/ADD bell” inevitably leading to a diagnosis and recommendation to put the child on medication:

“Has difficulty sustaining attention.”

“Is easily distracted by extraneous stimuli.”

“Loses things necessary for tasks and activities.”

 So, let’s line up a few hundred 8 or 9 year old boys and ask their mothers (the fathers don’t usually know) how they would rate their kid on these items.  I would predict about 70% of the boys in that age range would be rated somewhat high on variables such as these.

What then?  Does this mean that most of these boys have a neurodevelopmental disorder and should be put on stimulant medication?

I recently read an article  that referred to the marked rise (16% increase over the last decade and a 41 percent increase from the previous decade) in diagnosis of ADHD.  Boys, in  particular, showed a significant increase in percentage being diagnosed.

We’ve gotten so casual with the diagnoses and the inevitable medical prescriptions.

People will think I am anti-medication.  I am not.

But, I am against the use of rating scales as the primary determinant of the “diagnosis.”  Rating scales are very helpful when used as part of a larger assessment that attempts to take many factors into consideration.  In fact, in all of the assessments I conduct rating scales are an important part of the evaluation.

However, it’s also my expectation that about 90% of the kids who land in my office are going to show high on these “ADHD/ADD’ variables.

Does that mean they should all be on medication?

Without trying very hard I could list 20 reasons that may be contributing to a child‘s inconsistent focusing or variable effort that are not related to an inherent neurobiological disability.  That is, kids have a lot of stuff (not scientific I know) that can help explain their “difficulty sustaining attention.”  (In a future blog we will list some of the “stuff” that masquerades as ADHD/ADD.)

Takeaway Point:

There is no definite “X-Ray” of ADHD/ADD. Before placing a child on medication, try and take the big picture and consider what else may be working..

Copyright, 2018
Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –
To receive free newsletter and updates, go to:

Questions or topics that you want covered in future blogs, send email to:


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