ADHD/ADD

Brett, age 8, has difficulty behaving in his third grade class.  Frequently calling out, pushing on line and at times being rude to the teacher and other kids, his parents have been called in for the “meeting” to discuss Brett and his behavior.

They are told by the school, “We’re not doctors so we don’t know why he’s doing these things, but we think you should see a neurologist.”

The last statement is code language.

Here’s the translation – “We think Brett has ADHD and needs to be on medication.”

The parents come to consult with me about Brett, even though I am not the kind of doctor the school has in mind.

Brett’s mom says, “We just don’t know why he does these things.  If we only knew why, then it could be fixed.  Maybe it’s his anxiety or his sensory issues.”

I can’t help myself pushing back.  (It’s my own disorder – “Pushback Disorder,” I believe it’s called.)

“The problem with the “Why” question is it’s all speculation,” I say.  “Even the best neurologists are using subjective rating scales and history to determine things like ADHD.  So it becomes a “weight of the evidence” diagnosis.   Usually there are a number of variables interacting at the same time, not all of which are in the child’s head.”

“So how do we fix it?”  (A question I get all the time, but still wriggle around trying to answer it.)

“Well, they’re not car engines.  Nothing’s broken.  So there’s no fixing it. Rather than speculate, try and stay with the facts that are observed.  What happened first, second, third?  How did the adults respond?  What were the consequences?  Before starting on medication, which might be helpful for Brett, let’s get a sense of the basic facts of the behavior ”

Takeaway Point

Back in the day there was a popular TV Show, “Dragnet,” where the main detective would say, “Just the facts, Ma’m.”

Stay with the facts.  “Just the facts, Ma’m.”

Copyright, Richard Selznick, Ph.D.  2022, www.shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email rselznick615@gmail.com.

Every week I hear an array of concerns regarding distractibility and inattentiveness.

Beyond the immediate assumption that the child has ADHD/ADD (in other words a neurological disorder), I do my best to broaden the narrative and review other factors to consider that may contribute to why a child is not consistently paying attention.

There are multiple reasons why a child could be struggling to pay attention, which is not always ADHD.

Some others to consider that are commonly in the “soup pot” include:

• Perhaps the child is obsessed (addicted?) to playing video games, leaving little in the “mental tank” for sustained mental effort.
• Perhaps the child is also playing video games far too late in the evening and not getting enough sleep.
• Perhaps the school work is too hard.
• Maybe there’s been a lot of tension and fighting in the family that is unsettling to the child, contributing to a sense of distractibility.
• Perhaps the teacher is not that motivating and the work has become overly boring
• Perhaps the child is being flooded by too many worksheets (or its on-line equivalent), leaving the child feeling disconnected and unmotivated.
• Perhaps the child has significant reading problems, making it difficult to pay attention and to comprehend.
• Perhaps there is a lot of distraction in the environment (whether it be an actual classroom or at home), and the atmosphere does not lend itself to paying attention.
• .Maybe the child is struggling with anxiety and the excessive worrying looks like inattention.
• Perhaps the child is feeling like she may have social issues as she goes on TikTok and Instagram and sees her friends and she’s not included.
• Maybe the child has been made fun of or ridiculed, but no one really knows of it other than the child.

Takeaway Point

There are many more such as these, but these are some of the ones that readily come to mind when considering why a child may not be paying attention.

Sure,  the child may ADHD/ADD, but make sure you go through a checklist to see what else may be contributing to the inattention.

Copyright, 2022 www.shutdownlearner.com
Questions or topics email Dr. Selznick email: rselznick615@gmail.com.

Jacob is an endearing,  extremely verbal 7-year-old.

Whenever asked a question, Jacob talks with great enthusiasm taking you on  a verbal roller coaster ride.

In psychology jargon, Jacob also has a problem with “self-regulation.” (Don’t you love all the terms out there?)

I ask Jacob, “So Jacob, how are you doing at camp…how’s your behavior going?  Are you following the rules?”

With bursting enthusiasm, Jacob says, “Great!!!  You see, when I was born there was something wrong with my brain, so I take this pill and now it’s better.”  (Jacob has recently been put on medication for ADHD.)

To no avail, I try and counter his view. “Jacob, your brain is fine,” I say.  “The pill may help you to focus a little better, but there’s nothing wrong with your brain.”

“Right,” Jacob exclaims, “but, when I was born…”  as he continues with his neurological explanations.

It may be my issue, but for a long time my mission has been to normalize things for children and families.

I do my best to move them away from “disorder” or “disability” language  to skill-thinking, framing paying attention as a skill that can be improved like any other skill.

Takeaway Point

Try and watch for kids like Jacob who show their cards when they say something is “wrong with their brain.” While you don’t have to go over the top with tell them “you’re amazing,” (another overused word), calmly explain to them that their brain is fine and the pill is a tool to help with the “skill of focusing.”

Copyright, 2022 www.shutdownlearner.com

Questions or comments email Dr. Selznick:  rselznick615@gmail.com

Sometimes I can feel the twinge coming on.  It usually occurs when I hear the misinformation parents are given from schools or have heard through the grapevine.

Here’s a small sampling of what parents are frequently told regarding dyslexia:

• “Well, we really don’t know what dyslexia is?” (Ugh, yes we do.)
• “Only medical doctors can diagnose dyslexia.” (Really? So a neurologist will give a broad array of measures that assesses word identification, reading accuracy and oral reading fluency along with spelling and writing, all of which are necessary to diagnose dyslexia.  I don’t know too many medical doctors doing these tests.)
• “The only thing in reading that matters is comprehension.” (So, if the child reads “medichan” for “mechanic,” that’s ok as long as they can answer some questions and somehow gets the gist of the story?)
• “It’s probably all attention – maybe you should see a doctor since we can’t diagnose.” (The unspoken, but clearly delivered message is, “Your child should be on medication and that will take care of it.”  Not sure how that will help the child just mentioned who couldn’t read “mechanic?”)
• “How can it be dyslexia? He’s not reversing when he reads.?” ( Reversals – Mythology #1)

To cut through a lot of the misinformation and mythologies I would recommend that you visit a few website to help keep you on the “straight and narrow.”

These include:

• International Dyslexia Association (dyslexiaida.org)
• Learning Disabilities Association (ldaamerica.org)
• Children & Adults with Attention Deficit Disorder (chadd.org)

Then, there is my all-time favorite, www.shutdownlearner.com, where there are over 500 blog posts, interviews and other such stuff.  (OK, a little self-promotion isn’t going to hurt anyone!)

Takeaway Point

There’s a lot of buzz on the street when it comes to children and their issues.  Be careful with what you are being told as much of it does not hold up with the research and the reality.

Copyright, 2021 www.shutdownlearner.com
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email – rselznick615@gmail.com.

Practically every week I hear an array of  concerns regarding distractibility and inattentiveness.

There’s always the question of, “Does my child have ADHD/ADD.”   In the discussion with parents a lot of  territory is covered and  I do my best to broaden the narrative and review other factors that may be contributing to why a child is not consistently paying attention.

Here are some factors to consider before presuming your child has a neurological disorder:

• Perhaps the work is too hard.  If it is, it will lead to inattention
• Perhaps the child is playing video games far too late in the evening and not getting enough sleep.  Maybe the child is addicted to video games leaving little in the tank for sustained mental effort, something that I am seeing much more.
• Maybe there’s been a lot of tension and fighting in the family that is unsettling to the child,  which will lead to distractibility.
• Perhaps the teacher is not motivating.  Not to blame the teacher, but a boring teacher can certainly produce a lot of off-task behavior.
• Perhaps the child  has “W.B.D.” (i.e., “Worksheet Burnout Disorder.”) and is being flooded by too many worksheets (or its on-line equivalent), leaving the child feeling disconnected and unmotivated.
• Perhaps the child has significant reading problems, making it difficult to pay attention and comprehend.  This is an extremely important consideration.
• Perhaps there is a lot of distraction in the environment (whether it be the  classroom or at home) and the atmosphere does not lend itself to paying attention.
• Maybe the child is struggling with anxiety and the excessive worrying looks like inattention.
• Perhaps the child is feeling like she may have social issues as she goes on TikTok and Instagram and sees her friends does not feel included, leaving a sense of her upset and distractibility.
• Maybe the child has been made fun of or ridiculed, but no one really knows of it other than the child.

Oh, yeah.  I almost forgot.

Maybe the child has ADD/ADHD.

Copyright, 2021 www.shutdownlearner.com
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email – rselznick615@gmail.com.

Once parents have gotten the “diagnosis” of ADHD, typically medication is offered as the next step.   Parents will think the medication will do more than it can do in reality.

The goal of the medication is to help the child pay attention and focus better.

That’s it!

A 20% or so improvement in paying attention would be significant.

With ADHD there are  common deficits that cluster together including:

• Poor problem solving.
• Low frustration tolerance.
• Weakness “reading” cause and effect (in actual reading and in social interactions)
• Weak reading comprehension.
• Poor reading accuracy and fluency.
• Pervasive writing deficits.
• Social misjudgment.
• Low motivation.
• Difficulty getting started on tasks.
• Overcoming sense of boredom.
• Poor time management.

While medication can improve focusing, it has little impact on these variables of concern.

However, there is much that can be done with these deficits.  For example, by putting the phrase, “The skill of…” before a deficit of concern,   helps you realize that the skill can be targeted and improved.

If you say your child lacks, “The skill of frustration tolerance,” then you can start thinking about how to teach and practice this skill.

Takeaway Point

Even if the medication is working, don’t be lulled into thinking that the skill areas are improving.

The skills need to be taught and practiced in order to be internalized over time.

Copyright, 2021 www.shutdownlearner.com
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email – rselznick615@gmail.com.

“‘I think the current diagnosis of ADHD is a mess and has been wildly overdone.  It blames a variety of symptoms entirely on the child’s brain, and ignores the child’s environment and the interaction with it.’” (Philadelphia Inquirer, William B. Carey, pediatrician, researcher, and medical educator, dies at 93)

Admittedly, I am a bit of a hoarder.

This hoarding tendency of mine has overlapped with a multitude of articles I have saved  for many years, unable to toss or to even scan them on to the internet.

As part of the ritual of the New Year, I commit to going through these articles attempting to organize them better, but rarely tossing them.

I always think they would be great springboards for later blog topics.

Going through the piles one article jumped out at me that I have saved for over 20 years.  It was by Dr. William Carey, the renowned professor of pediatrics at the Children’s Hospital of Philadelphia who passed away this July at the age of 93.

Within the article,  “Is ADHD a Valid Disorder,” Dr. Carey raises many important issues that are as relevant today as they were when it was written.   As the coffee stains on the article attests, it has been reread by me many times.

While not knowing him personally or having the pleasure of attending his lectures, I have been a behind the scenes disciple of Dr. Carey.

Dr. Carey emphasizes that there is no one test or objective instrument to diagnose ADHD (often referred to in more casual terms as “ADD.”)

Typically, in the process of obtaining a diagnosis of ADHD  a parent typically will say a few common buzzwords.  Here are some of the more common:

“He just can’t focus.”

“He’s easily distracted.”

“She won’t get started.”

“He hates homework and the teacher says his attention is very poor.”

“The teachers say that they are not doctors, but… (with the clear implication that they think the child needs medication). 

 “She’s always fidgeting.”

When descriptors like these and a few others have been present for at least 6 months, the scales tilt in the ADHD direction and a “diagnosis” is typically obtained.

After receiving this diagnosis parents will often report a sense of comfort, feeling that they have “finally gotten the answer.”

As is my nature, I will push back on this “the answer,” emphasizing that there are many other factors that may not have been understood or addressed.

Just below the coffee stains on my saved article, Dr. Carey noted:

“The assumptions that the ADHD symptoms arise from cerebral malfunction has not been supported even after extensive investigations.  The current diagnostic system ignores the probable contributory role of the environment; the problem is supposedly all in the child.  The questionnaires most commonly used to diagnose ADHD are highly subjective and impressionistic…The label of ADHD, which is widely thought of as being beneficial, has little practical specificity and may become harmful.”

Takeaway Point

Don’t be too quick to toss things out.  They may come in handy one day.

In these more clinical times where most child behavior is ascribed to a “diagnosis” of one sort or another, we don’t often think about rushing as a style.

I know…I know…in modern parlance the word “impulsive” is much more acceptable, as opposed to “rushing through things.”

You may want to ask yourself, though,  “Does my child rush as a style?”  Is this his/her way (manner) of interacting?

If the answer to your question is, “Yes,” then there are implications to understand about this rushing.

If you bring the issue up with any number of professionals or medical specialists, there is almost a kneejerk view that “impulsive = ADHD.”  The child is then “diagnosed,” which leads to putting the child on medication.

As is true with the way we approach most child issues, though, something nags at me that this rushing is more of a style, that is, a way of interacting and less of a legitimate disorder or disability.

To illustrate the effects of rushing as a style, let’s look at 11 year old Logan, a fifth grader I evaluated recently.

Within the assessment there were certain questions or tasks that didn’t require much consideration or reflection.  These were usually factually-based questions that did not need the internal voice to say something like, “Hmmm, let me think about it.”

For example, when I said to Logan, “What month follows June,” or “How many states are in the United States,” Logan answered very rapidly and immediately in perhaps a quarter of a second.

However, for the questions or tasks that required a certain amount of reflection or consideration, Logan continued to answer in less than a split second.

This rushing style did not serve him well, as he was often wrong, even though he had no idea that he was.

Even with the tasks that were “hands on,” such as putting blocks together to make different patterns or to copy a series of shapes and designs, Logan continued functioning extremely rapidly, much to his detriment.

There was no consideration as to whether the task at hand was easy or more difficult.  It was all rush, rush, rush.

This rushing style had a particular impact when it came to the reading comprehension portion of the evaluation.  Logan could answer straightforward factual questions, such as, “How many ducks were on the pond.”

When it came to a question where the answer was not directly stated (“Why did the ducks leave the pond?”), Logan blurted out answers in less than a second that had nothing to do with what he had just read.

By the end of the assessment, I was literally out of breath having experienced this style of Logan’s.

There are no easy answers to this “rushing style,” as it usually comes across as parental nagging, (“Take your time…slow down…stop rushing.”)

Perhaps play a “game” (anything with the word “game” associated with it makes it more fun) to sensitize the child to reduce the rushing.

This could be the, “Let Me Think About It Game.”

In this game put out two cups. One represents questions or problems that can be answered immediately (e.g., factual type of questions) and the other requires more consideration.

Have marbles or coins close by.  Let them assess which cup the marble should go as they do their work.

For example, if the question involves considering or reflecting, a marble goes in the “thinking jar.”  If the child counts to three or so before answering, they get another marble in the jar. Keep track of the marbles and when they reach 100 they get small reward.

Takeaway Point       

Start looking at rushing as a style.  Watch the nagging, but find ways (games) to help the child to slow it down a little.

Copyright, 2020 www.shutdownlearner.com
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email – rselznick615@gmail.com

To purchase a signed copy of  “What To Do About Dyslexia: 25 Essential Concepts” & Dr. Selznick’s other books and to receive blog updates go to https://shutdownlearner.com.

(***  Please note: Dr. Richard Selznick is a psychologist, clinician and author of four books.  His blog posts represent his opinions and perspectives based on his years of interacting with struggling children, parents and schools.)

The  advice in the blogs and in practice is governed by one overriding principle – “If this were my child, what would I do?”   The goal of the blogs and the website is to provide parents and professionals with straight-forward, down-to-earth, no-nonsense advice to help cut through all of the confusion that exists in the field.)

If you have followed this blog a while, you know there are emerging themes that reoccur.

One of the big ones that I find myself continually beating the drum over is pushing back on “the diagnosis” (typically “ADHD” or “ADD”) after a few choice “buzz word” have been said by a parent.

Recently, a mom, said a few of these about her 10 year old daughter, Regina, to a medical specialist, regarding concerns that she has had for some time.

Here are some of the items endorsed in  rating scale the mom completed:

“Has difficulty making and keeping friends.”

“Avoids difficult tasks like homework.”

“Can be argumentative.”

“Doesn’t read ‘cause and effect,’ both in social situations and in reading comprehension.”

“Gives up quickly.”

“Can be too hasty – doesn’t think before doing.”

“Has difficulty with problem-solving.”

After sharing these concerns, the mom was informed by the practitioner, “I think Regina has ADHD and we should put her on medication.”

There was no discussion about some of the top concerns such as, reading “cause and effect,” avoiding homework or the difficulty that Regina has keeping friends.

What was implied was that the medication would take care of all of these concerns.

Let’s get it straight.

If a medication such as stimulant is effective it will probably do one thing – increase the capacity to focus more effectively.

That’s it.

While the medication may help a child focus, the skills of concern will not be impacted.

When explaining these things to parents, frequently I draw on sports analogies.

Let’s say you’re a golfer who isn’t the most focused while going through a round.  You decide to try a stimulant to help you focus better.  After taking the stimulant,  there is no doubt that your concentration is improved.

The problem is your swing had significant flaws prior to taking the medication.  What happened to these flaws once the medication was started? Did the flaws go away?

Of course not.

The only thing that will improve the skills will be to work with a coach/teacher who can target the skill areas and have them practiced over time.

Schools will state that once the child has gotten “the diagnosis” that the child has a medical problem and they should return to the medical practitioner to have the child managed.

Medical practitioners are not functioning in the role of coach/teacher, so the child is in a loop that goes round and round.

For Regina, there are specific things that she can do for example that would help her make and keep friends.  Social skills can be taught and practiced.

Takeaway Point

It’s ok to get “the diagnosis.”  Stimulants may help your child focus better.

Specific skills are not impacted by medication.

Know the limits.