ADHD/ADD

“We’re Not Doctors…We Think You Should See a Neurologist”

by | Jun 28, 2024 | ,

Oliver, age 8, has difficulty behaving in his third grade class.

They were 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 Oliver has ADHD and needs to be on medication.”

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

Oliver’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.

“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.  There are many variables that are external, too.”

“So how do we fix it?”  (Ugh…the question I hate, but get all the time.)

“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,  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.”

Feel free to make comment below. 

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

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

“Gradations from the Middle” (#Dyslexia #ADHD #Other Stuff)

by | May 10, 2024 | , ,

Parents commonly come in with common questions such as,  “Does their child have ADHD?” or “Is my child dyslexic?”

Difficulty  with reading and attention occur on a continuum or a spectrum from below the mid-point of average (see bell-curve picture above), to more moderate and severe.

Just because a child is struggling to a degree with reading doesn’t necessarily mean the child is “dyslexic.”  There could be a myriad of reasons why the child is delayed in reading that are not necessarily dyslexia.

The lower portion of the average range (around the 25th – 30th %ile) is what I call, “the dreaded portion of the bell-shaped curve,” meaning it is neither here nor there or clear cut whether the difficulty represents a legitimate learning disability like dyslexia or an attention disorder with questions of ADHD.

Dyslexia or ADHD are not something like COVID where you can take a test that tells you “yes” or “no” (has it – doesn’t have it). There is no one test for either of them.  (Sometimes I wish that I had the one “Dyslexia Test”.  It would certainly make my life easier.)

Adequate diagnosing i somewhat like detective work requiring a weight of the evidence in order to more confidently state the presence of a disorder.

With dyslexia and ADHD the weight of the evidence includes things like a review of the child’s history  and family factors such as whether either or both  of the parents had similar struggles in their own development.

Evidence such as this helps to tip the balance one way or the other along with other quantitative (objective) and qualitative (subjective) assessment data.

Takeaway Point

Reflect on the bell-shaped curve.  Just because a child is somewhat left of the mid-point (i.e., 50th %ile) in a given area does not mean the child has a disability or a disorder.

(Next week we will discuss how dyslexia (reading disability) is more than a score.)

Feel free to make comment below. 

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.

“The Power of Nonchalance” (#ADHD; #Executive Function Disorder)

by | Apr 26, 2024 | ,

Synonyms for “nonchalance:”   apathy, complacence, indifference, unconcern, torpor

Antonyms for “nonchalance:”  concerned, interested, motivated

A parent came to talk to me about her 14-year-old-son, Brett.  Previously “diagnosed” with ADHD of the inattentive variety, various stimulant medications have been tried with him without much benefit.

“Look,” the mom said, “I don’t really know if he’s ADD.  The doctor spent about 15 minutes with us after we completed this rating scale. I do know he’s nonchalant.  It’s like he’s just indifferent to everything, especially anything school-related and it’s driving me up a wall.”

(“Nonchalant.”  Now, that’s a word I don’t hear very often, certainly not used in clinical terms or descriptions.)

Upon meeting Brett, I knew exactly what the mom was saying.  It was a very long hour trying to find out what his point of view was on the topic.  It’s not easy to talk to someone who shows indifference and apathy.  Essentially, the session involved Brett having little to say with a fair amount of shrugging when asked various questions.

“All he cares about are his game systems and phone,” his mom nearly shouted in the session.  (All the while Brett sat their blasé’ and nonchalant.)

The mom’s frustration brought to mind a famous short story I had read many years ago by Herman Melville, called  “Bartleby, the Scrivener.”  (“Scrivener,” talk about a dated word.)

As I recall, Bartleby was the 19th century version of a paralegal working in a law office.  Whenever he was asked to do something by his office superior, Bartleby had a standard response – “I would prefer not to.”  Bartley basically did nothing and just stared out the window ignoring his boss with nonchalant indifference.

This, “I’d prefer not to,” position gave Bartleby a lot of power and resulted in making Bartleby’s boss bonkers.

Another example told to me was about 11-year-old Jackson who was asked to help his mom to pull weeds in preparation for some landscaping.

Since he was engaged with playing Grand Theft Auto, he was not interested in helping, offering his own version of,  “No, I’d prefer not to.”

With his stance, the mom’s anger thermometer skyrocketed while Jackson’s power increased.

Psychologists and other behavioral types will have all kinds of systems to try and get the motivation going in the right direction, but it’s a tough battle.

If you have a Bartleby, my best advice is to try and side-step the control battles  that inevitably ensue, as challenging as this may be may be.

Recognize that ultimately it’s your child’s choice whether to engage with the requested task or not.  You might want to have an honest sit down and speak in very direct tones delivering a clear message.

“Look, there’s no give and take here.  It’s all a one-way street.  Things you take for granted such as your phone and game system are paid for by us.  They are privileges, not rights like food and shelter.  Ultimately, it’s your choice.  However, unless things change we’re putting your game system and phone in our safe until you’ve earned the privileges back.  If you don’t want it to go that way, then choose differently.  Get in the game.  Either way is fine.”

Takeaway Point  

Go buy a safe if you don’t have one.

They come in handy when you need them.

Feel free to make comment below. 

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.

 

“Not Reading the Signals”

by | Apr 12, 2024 | ,

An issue often overlooked with children diagnosed as  ADHD is a frequently occurring underlying variable of social judgment and difficulty with “reading” cause and effect.  Difficulty with reading cause and effect impacts both social and academic functioning, such as understanding inferences with reading comprehension.

This is one of the reasons I struggle with the notion of treating ADHD as if it represents a whole pie chart with one treatment to consider (i.e., medication).  There’s always more in the pie chart that medication will not address.

Stimulant medication’s purpose is to help one focus better.  That’s its job.  It’s not  to help you “read the signals” in social interaction.

Let’s take Brent,  a 12-year-old I saw recently who has been diagnosed with “ADHD” by medical practitioners and being treated with medication.  When I meet Brent and start to review what’s going on with him it is clear that there’s a lot more than the broad conclusion of, “He’s ADHD.”

For example, it was noted that Brent had a tendency to do the following:

  • Blurt out inappropriately.
  • Not realize certain actions bothers others.
  • Class clowns  to excessive degree
  • Challenges with reading comprehension.

In other words, in this ADHD soup pot there was a good helping of other stuff.

Brent had been prescribed medication, but there had been little talk about these other variables, leaving the parent with the impression that the medication would take care of all.

What does Brent need?

From my perspective, Brent needs to begin to understand and practice the skill of cause and effect.  When it’s framed as a skill, that means it can be directly taught and practiced.

For example, Brent recently mouthed off to a coach of his who ended up sitting him on the bench as a result.  From Brent’s point of view, he was being treated unfairly and the coach “benched him for no reason.”

Even when his parents tried to explain it to him, Brent was outraged by the unfairness of it all.

Perhaps with a therapist, Brent needs to have these interactions broken down in ways that he can have them pointed out to him in ways that he does not get overly defensive in order for him to potentially process what went wrong and where the break down occurred.

As you can imagine, since people are defensive by nature and (adolescents particularly so), this is not easy work and will take a takes a long time with lots of back and forth for a kid like Brent to begin to look at himself.

Keep in mind that It may take an outside person to help in the teaching of this skill, as the interaction with a parent trying to do this can be fraught with danger.

Takeaway Point

If your child is “diagnosed” with ADHD and the primary (and perhaps only) recommendation is to be put on medication, you may want to ask something like, “Well, how will this address his difficulty with social cues and reading comprehension?”

Feel free to make comment below. 

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.

Podcast Interview Released

by | Feb 23, 2024 | , , ,

As a changes of pace, I am excited to share a recent interview that was conducted with me by “Beautifully Complex:  Navigating Neurodiverse Parenting.”

The interview is only about 30 minutes.  Would love to get your feedback on it.

If you enjoy it, please share it with others.

Here’s the link:     (Selznick Podcast Interview)

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Feel free to make comment below. 

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.

 

 

 

“Pictures Telling the Story”

by | Feb 2, 2024 | , ,

Largely supported by the medical model, when parents have their child assessed they are often  focused on “the diagnosis.”    Such a model embodies a, “Yes, they have it,” or “No, they don’t have it,” (whatever “it” is) perspective.

In my corner of the universe, I wish things were that straight-forward.  I am hopelessly mired in identifying a pie-chart of interacting variables.

Less important than a “diagnosis,” a good assessment should  identify major “red flags” of concern and  guide you with  “next-step thinking.”

For example if the child has a reading problem, what type is it?  Is it primarily based in decoding/fluency or is it a comprehension based problem? What are the next steps?

If the child shows inattentiveness and distractibility, can that be clarified more specifically?

Just saying a child is “ADHD” doesn’t tell us much.  What situations pull for greater inattentiveness?

If the child’s behavior can be challenging, what seems to trigger the difficulty?

More than the diagnosis, what do the snapshots in the assessment tell us about the child?

I understand that I am sadly dating myself by citing a great song by Rod Stewart, but remember, “Every Picture Tells a Story?”

What are the pictures that are telling the story?

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

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

 

 

“Floaters”

by | Jan 12, 2024 | ,

 

A common concern raised by parents (well, mostly the moms) is their child’s lack of what they label as “executive function deficits (EFD).”

With EFDs there’s always the underlying question of whether these issues are a biproduct of immaturity, skill deficits or a legitimate neurologically based disorder?

I’ve met a gazillion of these kids and by now I should have an answer to that question, but I’m embarrassed to admit I still am not sure.

What are the signs of  EFD?

A low level of  “sustained mental effort” is one of the big indicators. With low sustained mental effort, there may be a degree of reasonable effort put toward a task at the beginning, but this effort quickly fades.

Another sign of EFD is the characteristic of not being a “self-starter.”   That is, excessive parental (or teacher) reminders are needed to get started on a task.

Predominant disorganization, coupled with inattentiveness are other qualities pushing parents over the edge.

In basic terms, a good way to think of these kids is that they are “floaters.”  Effectively, there’s not much of a rudder steering them.  As the wind blows, so goes their boat.

Recently, I came upon an article called “ADHD & Executive Function Deficits:  Identical Twins or First Cousins.”

I think the title of the article sums up the dilemma pretty well.

What do you think?  Are you in the camp that these floaters represent more of a neurological disorder or a function of maturation or lack of skill.

Feel free to make comment below. 

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.

“Beyond the Power Struggle” (Structure & Leverage)

by | Nov 17, 2023 | , , ,

As noted in the previous blog, with children showing challenging behaviors causing you tremendous stress, you were encouraged to adopt a mantra helping you remain in  your center, as you speak one “Didja” (e.g., “Didja you do your homework?”) after another.

The mantra  (“They need structure; I need leverage.”) is meant to keep things simple.

Of course, each child and family situation are different, but from what I can tell the leverage with modern kids really comes down to one thing – their screen usage.

Screen access (in whatever form) is the ruling passion, therefore it’s your leverage.

As I note in my soon to be released new book (yay!!!), “Beyond the Power Struggle: A Guide for Parents of Challenging Kids,”  without resorting to punishment you are encouraged to look at your child’s landscape of what they take for granted.

By about nine or ten or so, most kids have easy access to gaming systems, iPads, and many have their own phones.

For those children who are not sustaining mental effort, showing poor time management, ask yourself have they really earned the right to all of those screen distractions.  Are they really supporting your child’s “executive function deficits?”

While they gorge on Fortnite, TikTok or YouTube, and while you are exhausted trying to get your child to complete schoolwork or to do some reading  do you feel that things are out of whack?

My guess is the answer is a resounding, “Yes.”

Look at the family landscape.  What’s the structure?    Is it all one sided toward the child receiving pure pleasure while they give little in return?

Keep repeating, “They need structure! I need leverage.”

Feel free to make comment below.  To receive future blog posts, register your email: https://shutdownlearner.com.

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

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

“They Need Structure…I Need Leverage”

by | Nov 10, 2023 | ,

Following up on last week’s Selznick Poll discussion on what percentage of boys show signs of “executive function” deficits (click here: See “A Hypothetical Poll”) ,let’s emphasize some points:

• Using a bell-shape curve perspective, if about 85% of the boys in the 10- to-15-year-old range show issues with organizing, taking initiative, paying attention, following through, and sustaining mental effort (the usual issues with executive functioning), then this puts them in an average for their age.

• Even though they’re in the norm and what would expected, that still leaves you exhausted and depleted with their embodiment of these qualities.

• Of this 85%, probably about 99.9% of them are addicted (i.e., to their various screens and gaming systems).

In response, you as parent are constantly bringing out the “Didja’s,” as in “Didja pack your bag,” “Didja do your homework,” “Didja you put your stuff away.”

It’s no wonder that you want to retreat to bed by 7:00!!!

What do these 85 percenters need?

While “executive function coaching” has its value, this group is still pretty immature to take advantage of it.
Keeping things simple, here are the two essentials that are needed for them and for you:

1. They need structure.
2. You need leverage.

Trust me, you can do a lot worse than tuning out all the noise out there and just reflecting on these two variables.

In fact, that can be the mantra you may want to  repeat to yourself – “They need structure; I need leverage. They need structure; I need leverage. They need structure; I need leverage.”

(More next blog.)

Feel free to make comment below.  To receive future blog posts, register your email: https://shutdownlearner.com.

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

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

 

“A Hypothetical Poll”

by | Nov 3, 2023 | ,

Let’s take a random group of 100 boys, roughly between ages 10 – 14.

You know nothing about them, but their moms are asked a simple poll question:

On a scale of 1-10 (with 10 being the most negative) how would you rank your son on his taking initiative, organizing himself, keeping track of assignments, following directions and paying attention?

What would be your guess of the percentage of these boys being rated 7 or higher?

Now, ask the same question of the girls.

(I know. I know.  I’m not supposed to generalize, but I will proceed ahead anyway.)

Here’s my guess as to the Selznick Poll results:

Boys:  85% (+/- five percentage points)

Girls: 30% (+/- five percentage points).

Presuming I’m correct within a margin of error, what are the implications of the poll?

Well, I have a parade of beleaguered parents who are doing everything they can (from positive reinforcement to more punitive approaches) to try and get their disorganized and lackadaisical sons more in the game, but nothing seems to move the needle.

When I talk to them about the hypothetical poll, I  usually see a moment of recognition that conveys something like, “Ah, I get it.  So what you’re telling me his behavior is not that unusual, that maybe he’s not as disordered as I thought – that it’s part of the typical boy makeup, a type of  boy immaturity. ”

“Exactly.  Right on the money! That’s my message to you. Understanding this can be quite liberating.”

(We will continue this discussion next week.)

Feel free to make comment below.  To receive future blog posts, register your email: https://shutdownlearner.com.

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

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

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