ADHD/ADD

“Is the Diagnosis of ADHD a ‘Mess?'”

by | Jul 18, 2025 |

“‘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.”  (Dr. William B. Carey, pediatrician, researcher, and medical educator, Children’s Hospital of Philadelphia)

Going through a pile of articles I have saved (hoarded) for over 20 years, one caught my eye, replete with coffee stains, by Dr. William Carey, the late, renowned professor of pediatrics at the Children’s Hospital of Philadelphia.

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

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 in the early 1990’s.

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 will identify common characteristics on a rating scale or questionnaire that point in the ADHD direction.

Some of these include:

  • “Unable to focus.”
  • “Easily distracted.”
  • “Difficulty getting started on tasks.”
  • “Inconsistent effort & motivation.”
  • “Lack of sustained mental effort.”
  • “Poorly organized.”

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 notion of “the answer,” emphasizing that there are many other factors that may not have been understood or addressed, by simply completing the rating scales and reviewing the history.

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.”

Wow!  Dr. Carey is not mincing words in his taking on the ADHD industry.

Takeaway Point

Don’t be too quick to toss things out.  They may come in handy one day (coffee stains and all).

Copyright:  Dr. Richard Selznick, http://www.shutdownlearner.com

 

“Dazed & Confused”

by | Jun 6, 2025 | ,

“What is meant by the phrase, “Italy was a quilt of city states?”

“The government was like a blanket covering city-states of Italy.”

“The two spaceships, Eagle and Columbia, separate.  They orbit in sight of each other one last time.  Then the Eagle begins to descend…”  (Question:  What does the word descend mean?)

The above are exact quotes from worksheets a bewildered 8-year old, third grader received.  There were various red marks on the page.  The child, Chloe, was drowning in red ink.

Chloe had little idea what Italy was.  She certainly didn’t know wjhat a quilt of city-states meant.  She had no clue about Eagle and Columbia, no less the word descend.

As conveyed to the parent from the teacher’s perspective, the child had a probable “medical problem” that needed diagnosing (code for “She’s ADHD and needs medication.”).

From my vantage point, the child was confused, pure and simple.

The concepts and vocabulary were well beyond her.  How could she pay attention?

The issue not a “medical problem.”

 

Screens, Distractability & ADHD

by | Mar 27, 2025 | ,

“Children surrounded by fast-paced visual stimuli  at the expense of face-to-face adult modeling, interactive language, reflective problem- solving, creative play, and sustained attention may be expected to arrive at school unprepared for academic learning—and to fall farther behind and become increasingly “unmotivated” as the years go by.”
― Jane M. Healy, Endangered Minds: Why Children Don’t Think and What We Can Do About It

I go out to the waiting room to greet young Marissa, age seven, a first grade child who is coming in for an assessment because her school thinks she is having trouble “paying attention.”

“Hi Marissa,”  I say in an upbeat style that usually gets kids engaged and comfortable.

Marissa does not look up.

Her iPad is far more captivating than saying hello to this new person. To Marissa I don’t exist. The mom tries to get Marissa to say hello, but she’s not budging for her either.

We go back and I offer Marissa some toys (old school ones in a box – you know, different figures, animals, cars and trucks) and markers that she shows no interest in playing with or coloring.

Again, her iPad is holding her riveted.

(I flash on Gollum in Lord of the Rings – ”My precious, my precious,” as he would stroke the ring. I think Marissa may start doing the same with the iPad – ‘My precious…my precious.’)

Marissa’s mom, Beth, starts talking about Marissa’s focusing difficulties.

She says, “I worry that it’s all the screens. She gets in the car and the TV is on the seat panels. She can’t even go three minutes without it on. When we get to the restaurant, she demands the iPad. We give it to her – maybe it’s helping her visual skills, I don’t know. At night she never wants to play, even though we try and play games with her. When kids come over, all they want to do is have iPads.  They really don’t play with each other.   The school thinks we need to see a doctor to consider medication for her focusing.”

I don’t want to sound like an old head, but Jane Healy hit it on the head in the above quote.  (Keep in mind Jane Healy wrote Endangered Minds in 1999.)

Skills need to be taught, developed and practiced over time to be internalized.There is a skill to greeting someone in the waiting room. There is a skill to playing with toys or interacting in a restaurant.

If we don’t give kids a chance to practice these skills, the skills will not develop.

It’s as simple as that.

Detox them.

Be firm. Be brave.

“Is ADHD a Valid Disorder?”

by | Mar 21, 2025 | ,

“‘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.”  (Dr. William B. Carey, pediatrician, researcher, and medical educator)

Going through a pile of articles I have saved (hoarded) for over 20 years, one caught my eye, replete with coffee stains, by Dr. William Carey, the late, renowned professor of pediatrics at the Children’s Hospital of Philadelphia.

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

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.

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 will identify some common themes on a rating scale or questionnaire.  Some of these include:

  • “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 notion of “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.”

Wow!  Dr. Carey is not mincing words in his taking on the ADHD industry.

Takeaway Point

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

Thank you, Dr. Carey.

Venting My Spleen (Once Again)

by | Jan 30, 2025 | , , ,

Those of you following this blog for some time know there are some recurring themes in these posts.  Frequently, the blogs are my outlet for getting things off my chest that  frequently come up in my interactions with parents.

If you’re a relative newcomer, I will help to bring you up to speed with some of the predominant ones:

  1. The LD-Discrepancy Model: Easily the number one issue that gets under my skin is the LD-Discrepancy model used in many states (New Jersey being one) to classify children in special education as learning disabled.  I discussed it in a previous blog post   (LD Discrepancy Post) , but if if you need a primer on the LD-Discrepancy model, this is a great overview from Understood.org:  Understood.Org Discrepancy.
  2. Pathologizing Childhood: Not all child problems are neurobiological (i.e., “brain-based”) disabilities.   Some issues are just kids being kids. (Please see my blog on boy executive function deficits:  (Boy Executive Function Blog ).  Also, sometimes the material being given to them is inappropriate to their level of reading ability.  That is not a neurological problem (i.e., “dyslexia)   It’s a curriculum issue.
  3. “Diagnosing” ADHD Based on Small Data: Checking a few items (e.g., “Easily distractible….Inattentive, etc.”) on a rating scale like the Vanderbilt given in the pediatrician’s office is not enough.   There are a multitude of factors that could be producing the distractibility.  Many of these factors should be understood before putting a child on medication for ADHD
  4. “We can’t diagnose dyslexia – you need to see a neurologist.” Parents are reflexively told this by the school based on school regulations when they raise concerns of dyslexia.   Seriously, how many neurologists that you know give a battery of reading, spelling and writing tests that are necessary to assess dyslexia?  At its core, dyslexia is a reading, spelling and writing problem.  How can this be determined without a battery of reading (and writing) measures?  Stop telling parents it is a medical condition.
  5. “This or That Thinking:” “I just want to get to the bottom of it, ” parents will say.  “I just don’t know if it’s ADD or laziness.”   The problem as I see it is that there rarely is a bottom.  The truth is, it’s almost never,  “this or that.”  With most kids it’s almost always, “this and that and that.”
  6. Overplaying 504 Plans: Listen up, gang. The reality of 504 Plans can only do so much.  504s do not offer services, but basic accommodations (e.g., extended time, repeating directions, etc.).
  7. “Hey, Bud” Parenting: I hate to break the news to parents out there, but they are your children.  You don’t set limits with your buddies.  You set limits with children.
  8. Screen Addicts: I get it.  Times change.  I don’t get the newspaper delivered any more.  I have my phone with me most of the time, and am in a froth when I can’t locate it.  With that said, kids care about little else other than their screens.   They are becoming addicted.   We’re not facing it.

 Takeaway Point:  I understand that some may think that I am just saying these things because I am at the “get off my lawn” stage of life.  Maybe it’s compounded by that fact, but I have been repeating these themes to parents for many years, well before my current age/stage.

(Perhaps getting it off my chest helps –  it’s still cheaper than real therapy!!!)

Reading Comprehension & School Bus Problems: Common Themes

by | Jan 16, 2025 | ,

When Kids struggle with reading comprehension, often there is an overlap in “real life” and the way the child interacts in their personal world.

In this era of  automatically labeling and pathologizing an unwanted behavior  as “ADHD,” this overlap is something rarely considered.

Here’s an example.

10-year-old Lyle  is a boy who recently got into trouble when he used inappropriate language (along with other inappropriate behavior) on the school bus.  When the bus driver tried to correct him, Lyle doubled down and got mouthy and defensive, blaming everyone else around him.

In other words, Lyle showed a lot of bad judgment.

Compounding this, when Lyle’s parents attempted to discipline him, rather than become low-key and contrite, he became belligerent, while melting down.

(I know, everyone’s pulling out their, “ADHD  checklists” and thinking Lyle needs to be on medication, but I’m not so sure.  We need to dig a little deeper.)

Upon meeting Lyle, he comes across pretty straight-forwardly and readily admits he has a problem managing anger.  Particularly noteworthy, Lyle felt bad about what happened and he regretted his behavior.

So, what’s the connection with reading comprehension?

Simply, Lyle didn’t make connections while reading.  For example, Lyle couldn’t make inferences or answer “why” questions, as in “Why did a character behave in a certain way?”  Lyle tended to respond quickly without giving the question much consideration, which is not a good strategy for inference type questions or ones involving drawing conclusions.  They both require some consideration, as in, “Hmmm, let me think about it.”

What does Lyle need?  Lyle needs direct instruction and a lot of practice in the skill of making inferences, in other words helping him to read the clues better.  Similarly, in his personal world, Lyle needs help with learning to read the signals and the consequences of his actions.

Neither of these will be easy and it will take time to chisel away and develop the skills (socially and academically), but with guidance, feedback and practice, the skill of comprehension and the skill of social interaction can be developed.

When given feedback directly to Lyle and his parents following the assessment, Lyle felt good about what was said to him and his personal “battery” was recharged, since he was told he was smart and that he could improve.  Lyle was determined to start “reading the clues” better.

 Takeaway Point

Look for the common themes as to how a kid behaves on the school bus, manages emotions and comprehends while reading.

They are there for the finding.

ADHD…Maybe!

by | Nov 21, 2024 | ,

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

There’s always the question lurking of, “Does my child have ADHD/ADD?”

While talking to parents I try and  broaden the narrative,  reviewing other factors that may be contributing to why a child is not consistently paying attention.

Before presuming a child has a neurological disorder such as ADHD that is typically diagnosed in the doctor’s office by checking certain items on the Vanderbilt Scales (the gold standard scales used by physicians), here are some factors to keep in mind:

  • 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.
  • Related to the above, perhaps the child is addicted to video games leaving little in the tank for sustained mental effort (something that I am seeing much more).
  • Perhaps 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, which can produce a lot of off-task behavior.
  • Perhaps the child  has “W.B.D.” (i.e., “Worksheet Burnout Disorder” – a term I made up 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 deficits, 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.
  • Perhaps the child is struggling with anxiety and the excessive worrying looks like inattention.
  • Perhaps the child is feeling like they are being excluded, as they go on  social media and see friends doing things that they weren’t included in.
  • 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.

Perhaps the child has ADHD/ADD.

504 Plans: Avoid Templated Accommodations

by | Oct 10, 2024 | ,

In 504 Land, one of the classic (almost knee jerk) accommodations recommended is to give an ADHD child extra time.

Let me ask you this: How many impulsive, “hurry-let’s-get-it done-style” kids do you know who want extra time?

The answer is none.

The last thing that the ADHD kids want is more time. In fact, they are looking to be the absolute first one done, regardless of the work quality.

Gavin, age 9, typifies this process on a daily basis. Rushing through his school work and homework, Gavin can’t wait to be finished.  In school he’s usually the first one done.

Gavin’s mother explains to him that the school is developing a 504 plan for him so he could have extra time on tests and school work. Gavin is stunned, in disbelief.

“Extra time???” he exclaims. “What do you mean extra time? I hate those worksheets. Why would I want to spend more time on them. I want less time!!!!”

“Oh,” his mother continues. “They are also going to offer you preferential seating so you can follow directions better. You will sit right up there next to Mrs. Smith.”

“What????,” thinks Gavin. “Am I hearing this correctly? Whose preference is this? Not mine! I prefer to be as far away from Mrs. Smith as possible. Maybe my mother prefers that spot in the classroom. Not me. That’s not preferential seating.”

504 plans may sound great on paper with a lot of wonderful accommodations. Just like a football coach who has all of his game plan mapped out before going into the game, the 504 plan documents the various and sundry ways the child will be “accommodated.”

Accommodations like extra time and preferential seating may sound good on paper, but the reality may be something very different.

The most important question to ask yourself (and the special education team) is “What specific accommodations does the child need?”

Takeaway Point

504 Plans can be very helpful for a child with a disability, but they need to be personalized to the child’s needs, not pre-templated.

“Reading Comprehension Challenges & School Bus Problems: What’s the Connection?”

by | Jul 26, 2024 | ,

When Kids struggle with reading comprehension it is interesting that there often is an overlap in “real life,” that is in the way the child interacts in their personal world.

In this era of  automatically labeling and pathologizing behavior  as “ADHD,” this overlap is something rarely considered, but I think it is worth reflecting on its implications.

Here’s an example.

12 year old Logan  is a boy who recently got into a lot of trouble when he used inappropriate language (along with other inappropriate behavior) on the bus.  When the bus driver tried to correct him, Logan doubled down and got mouthy and defensive.

In other words, Logan showed a lot of bad judgment.

Compounding this, when Logan’s parents attempted to discipline him, rather than become low-key and contrite, he became belligerent, while melting down.

(I know, everyone’s pulling out their, “ADHD  checklists” and quickly putting him on medication, but I’m not so sure.  We need to dig a little deeper.)

Upon meeting Logan, he comes across pretty straight-forwardly and readily admits he has a problem managing anger.  Particularly noteworthy, Logan felt bad about what happened and he regretted his behavior.

So, what’s the connection with reading comprehension?

Simply, Logan didn’t make connections while reading.  For example, Logan couldn’t make inferences or answer “why” questions, as in “Why did a character behave in a certain way?”  Logan tended to respond quickly without giving the question much consideration, which is not a good strategy for inference type questions or ones involving drawing conclusions.

What does Logan need?  While many practitioners would quickly go to medication, Logan needs direct instruction in the skill of making inferences , in other words help with reading the clues. Also, in is personal world Logan needs help with learning to read the signals and the consequences of his actions.

Neither of these will be easy and it will take time to chisel away on developing the skills (socially and academically), but with guidance, feedback and practice the skill of comprehension and the skill of social interaction can be developed.

When given feedback directly to Logan and his parents following an assessment, Logan  felt good about what was said to him and his personal “battery” was recharged, since he was told he was smart and that he could improve.  Logan  was determined to start “reading the clues” better.

 Takeaway Point

There may be a connection as to how a kid behaves on the school bus, manages emotions and comprehends while reading.

Look for common themes.

To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email: shutdownlearner1@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

“Rubbing My Head” (#Dyslexia #ADHD #Whatever)

by | Jul 12, 2024 | ,

This blog can occasionally serve as a bit of a confessional, providing me with  a forum to voice some concerns regarding the issues that emerge while working with struggling children and their parents.

So, with that in mind here’s a confession.

Sometimes I honestly don’t know when a child’s struggling, particularly in the four to seven-year range (Pk-1st) is related primarily to immaturity (i.e., they are not ready and need more time) or whether their struggling represents a legitimate disorder/disability.

(As I write this, I hear the chorus in the back of my mind calling out.)

“Well, Mr. Big Shot.  You’re the doctor.  That’s why we are coming in to see you – to tell us what it is.  What do you mean you are not sure if it’s immaturity or a disorder? Stop rubbing your head! What’s the matter with you???”

I try talking back to the chorus.

I tell  them things like, “It’s rarely  clear cut.  There is usually a ‘pie chart or ‘soup pot’ of variables interacting.’”

At that point the chorus gets louder.  They are almost screaming, “‘A soup pot of variables!!!!!’ What does that mean??? Does she have it or not?   Does she have dyslexia???  And what about ADHD?  She pays attention to nothing!!!!  Isn’t that ADHD?  And she seems awfully anxious.  Come on, man.  Get out of your soup pot.”

Relentlessly badgered by the chorus, I think of Marjorie, age 7, a child I recently evaluated who doesn’t read very well or stay on task without a lot of reminders.

Marjorie’s  teacher vaguely spoke to the mom about her not paying attention very well in school, with the implied suggestion that she might have ADHD, always with the caveat that “We are not doctors.  We don’t diagnose.”

After running Marjorie through a bunch of tests, I  had one overall impression.

Marjorie struck me as immature.

“Immature????,”  the chorus cries out.  “Are you kidding me?”

“Yes,” I push back against the chorus.  I tell them that Marjorie seemed more like a five-year old-rather than seven in her manner and way of interacting – that her preoccupations came across as a bit babyish.

The problem with that there is no test to quantify “babyish,” such as a “Maturity-Immaturity Scale.”

It’s the same with the disorders, like dyslexia or ADHD.  Even though there are more objective tests involved in the assessment, there is no X-Ray or blood test to say,  “Yes, has it”  or “No, doesn’t have it.”  It’s still a weighing of variables that tilt the scales one way or the other.

Takeaway Point

I am sticking with the view that Marjorie needs time and perhaps some tutoring to help her mature and improve her skills.  We need to track and monitor her closely to see how she responds.

“Back down, chorus. I’m going back to rubbing my head.”

To receive future blog posts, register your email: https://shutdownlearner.com.

To Contact Dr. Richard Selznick for advice, consultation or other information, email: shutdownlearner1@gmail.com. 

Copyright, Richard Selznick, Ph.D.  2023, www.shutdownlearner.com.

Categories