Feeling the Twinge

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:

Then, there is my all-time favorite,, 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
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –

“My Child Doesn’t Pay Attention – Do You Think He Has ADHD?”

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
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –



“Got My Kid On Medication”

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
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –

“Is ADHD a Valid Disorder?”

“‘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.

Rushing As a Style

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
Questions or topics email Dr. Selznick.  Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –

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

(***  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.)

“The Diagnosis,” Medication and Knowing the Limits

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.

Musing on 504, ADHD & the Pie Chart

 Accommodations in school are typically formalized in what is called a 504 Plan.

504 (Section 504 of the Rehabilitation Act of 1973) grew out of ADA (Americans with Disability Act) legislation.  Since the 1990’s, 504 found its way into the schools and has been firmly rooted there ever since.

The notion of the 504 is that the child identified by an outside professional as having a handicapping condition necessitates the development of reasonable accommodations so that the “playing field” is leveled.

Therefore, in theory the child with an identified disability can function as free of handicapping barriers as possible in the mainstream setting.

Most children given 504 Plans have been “diagnosed” with ADHD/ADD which is viewed as a medical condition that necessitates being accommodated.

Without the medical diagnosis, there is no 504.

Unlike other types of medicine where x-rays or blood tests determine in objective ways whether a medical condition exists, there is a “wild west” quality to ADHD assessment.  There are no agreed upon tests or “X-rays” and much of the “diagnosis” is based on what parents tell the doctor.

A few buzz words such as, “He doesn’t focus,”  “She can’t pay attention,” or “He can be so fidgety,”  usually gets the diagnosis  (and a prescription).

Never mind that there are almost always competing explanations and variables that are contributing.

“Wait, the parents are fighting a lot and the household has been tense?”

“What do you mean your kid is oppositional and defiant and detests all things about school?”

“You mean all he does is play video games for at least 6 hours a day and nothing else matters to him?”

It can go on and on.

Seemingly forever, I have been on one-person mission to help guide parents away from whole pie-chart thinking.

This means when it comes to kid issues there are always other pieces in the pie chart that need to be understood beyond the definitive, “Yes, we’ve determined that your child is ADHD and needs medication and accommodations,”  as if that explains  99.9 % of the story.

While 504 plans can provide some needed support and accommodation, I would encourage you to look carefully at the pieces in the pie chart.  Ask yourself (or the professional you are consulting with), “What else may be working?”

Next week  we will drill down on the issue of accommodation and finding the right balance between a reasonable accommodation and where you may be making things too nice and easy for the child.

Part II: Ryan & His “Quasi-ADHD

Last week we talked about Ryan and his “Quasi-ADHD,” inspired by a by 7th grader I had recently met who had been previously diagnosed with ADHD (see Ryan & His Quasi ADD).

Ryan was “diagnosed” following an interview with his mom and the completion of a checklist endorsing many of the typical ADHD/ADD items, such as “overly distractible,” “inattentive,” and “restless.”

That’s all it took to get diagnosed.

Recently, Ryan was taking to not handing in his work and his mother was pushing the school to extend deadlines through a 504 Plan, under the premise that his “disability” precluded him from being able to hand in his work on time.

My sense was that the mom was overreaching with what she wanted the 504 to accomplish.

As I explained to her, “504 Plans are intended to provide kids (and adults) with a disability a more level playing field.”    “The accommodations are supposed to be reasonable and pretty easy to implement,” I continued.

I knew it was a bit risky, but I asked the mom, “What if Ryan’s just blowing off his work and not handing it in because he’s choosing not to?  Do you really think that should be accommodated?”

The mom wasn’t thrilled with that question posed to her, but she decided to try and deal with Ryan without getting a homework accommodation.

Assuming the school work assigned was reasonably within the Ryan’s capability level, what could the mom do aside from her strategy of having the school accommodate Ryan?

As a parent you largely have two directions to go with the ADHD or “quasi-ADHD” style child.

You can either try to go the more positively toned direction or you can go with more negative consequences that compromise the child’s lifestyle (i.e., gaming systems, iPads, phones, etc.).  Perhaps a combination of the two is possible.

Most parents gravitate to the positive approach thinking that the child will happily work for tokens, stickers or some other tangible reinforcer.  It seems whole lot more pleasant going this way and they are often a bit squeamish with the second approach.

If you are trying to go down the positive road, I have one piece of advice for you.  Don’t get overly syrupy and lay it on too thick.  Watch overusing statements like, “Buddy, you’re so amazing!!!”  (No he’s not – he’s just finishing his homework.)  or “I’m so incredibly proud of you,” said in effusively gushy tones.

Kids readily see through those type of statements and start to tune them out.  They know that they’re not as amazing as you are making them out.

Of course you can make the positive road a bit more tangible. Try and not get too complicated.  I like getting an old-school wall calendar.  You can inform your child – “When you get started on your work and finish it in a reasonable time, you will get a green check on the calendar.”

I’m ok with accumulated checks leading to things like letting the child stay up an hour later on a Friday night or some other earned privilege, but again, you don’t want to overdo it. Parents should be close by for some assistance, but not too much.

With the compromising lifestyle approach, parents realize that kids take all kinds of things for granted.

With this approach, the child has to face his poor choices.  A statement, said calmly without a lot of heat behind it such as the following tends to work wonders, “Gee, Ryan, I’m really sorry, but since you chose not to do your work, it’s going to be a really boring night around here tonight.  All screens are off limits.  Maybe you will earn them back tomorrow.”

With this latter approach, the reality is the child needs to know that his lifestyle (except for food and shelter) are largely treats, extras that need to be earned.  Completing homework should be a part of the deal.

Takeaway Point

Managing quasi-ADHD or even full-blown legitimate ADHD kids can be quite challenging.  Take a look at the message you are sending to your kid.  There’s always room to tighten things up and put responsibility where it belongs.

Copyright, 2018
Not in the South Jersey area? For a free 15 Minute Consultation, contact Dr. Selznick: email –
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Questions or topics that you want covered in future blogs, send email to:

Ryan & His “Quasi-ADD” – Part I

Over the last couple of decades ADHD (commonly referred to as “ADD”) seems to be pretty casually diagnosed from all I can tell.  It doesn’t take much to get “diagnosed.” The parent fills out a rating scale, which usually comes up positive for things like distractible and inattentive.   The child’s history is reviewed and the diagnosis follows.

Sometimes there will be a large battery of computerized tests complete with fancy electrodes put on the child’s head that give the air of being scientific and which yield sophisticated looking data, but other than costing the patient (or the insurance company) thousands of dollars, these have never been shown to be all that valid as an approach to assessing ADHD.

As a result of the significant numbers of children diagnosed with ADHD, parents stream into schools requesting 504 Plans for their child.

Let’s take a step back and look at 504 plans.  Section 504 of the Rehabilitation Act of 1973 was written as a federal civil rights law to address discrimination against people with disabilities in the work place and in school.   Like other civil rights legislation, it was a major game-changer.

To illustrate some of the issues in the real world, let’s look at Ryan, a 7th grader I recently evaluated who was previously diagnosed by a medical practice specializing in assessing ADHD.  I was to be offering a second opinion while his mom was in the process of pushing the school to offer 504 plan accommodations.

After evaluating him,  I didn’t see all that much ADHD with Ryan.  It was my view Ryan had, at best, quasi-ADD (a term I made up).  Largely, he was so caught up in a myriad of screen preoccupations (YouTube, Fortnight, etc.) that school and homework were just basic annoyances that he had to deal with to primarily get his mom off of his back.

Ryan never seems to know what he has to do.   Mom’s blood pressure is rising over her son’s seeming obliviousness. Frustrated that Ryan never writes down any assignments (“Why should I,” says Ryan.  “It’s on line somewhere.”), to lower her blood pressure,  mom has taken to downloading the Google Classroom App on her phone so that she can try and figure out what he has to do.

Ryan thinks that’s pretty cool his mom has Google Classroom App, because it relieves him of having to write anything down, which he has stated as, “is so hard to do” (said in a plaintive, whining voice).

Recently Ryan has not been handing in homework or meeting his basic responsibilities.  It’s the mom’s view that the school should be relaxing the deadlines for turning in his work due to his “ADD.”

I pushed back some on the mom.  I wasn’t buying that Ryan wasn’t handing in his work due to a disability.

It struck me that the purpose of 504 accommodations in school was essentially to “level the playing field” for children with handicapping conditions, not to be giving Ryan the message that he can hand in homework when he chooses or not at all because of his “diagnosis.”

I have a good relationship with Ryan.  While his mother tells me what she feels the school should be doing (extending deadlines), I give Ryan one of those squinty-eyed (“come on man”) looks and he smiles back at me.  His nonverbal says to me says  something like, “I know, I know. I just don’t want to do my homework.”

It was my view that it wasn’t a 504 issue.  It was a lifestyle issue.  That is, Ryan had a pretty cool lifestyle and he wasn’t about to compromise it.

Takeaway Point

ADHD (ADD) is casually diagnosed.  There is no pure objective measure of ADHD.  As a parent you need to double check what you are asking for in a 504 and what message it is sending the child

(I will elaborate on Ryan, 504 plans and lifestyle in Part II of this blog next week.)

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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