ADHD/ADD

“A Hypothetical Poll”

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.

Follow-Up to “ADHD? Perhaps”

In last week’s post we noted that there were many factors that can lead to erroneously hypothesizing that a child has ADHD/ADD. https://shutdownlearner.com/adhd-perhaps/

There were  a number of  comments posted.

Dr. M., a developmental pediatrician, reminded us to remember an important variable:

“Perhaps the child has an auditory or language processing disorder and therefore doesn’t pay attention to non-meaningful information.”

Kathryn A., a former teacher, stated:

“Great list of possibilities, Dr. Selznick!
As a former teacher, I know that anxiety about anything will present like some ADD symptoms and everyone at some time does something ADD-like. I wasn’t diagnosed until age 52! The real deciding factor, as I learned, was do these symptoms happen everywhere, not just at school, not just at home, but at swimming lessons, Boy Scouts, class trips…does it consistently impact negatively no matter the setting.”

Stanley S., also a former teacher, cautioned to remember effects of fear of embarrassment:

“One of the great obstacles in all of education… for each individual student… is the fear of embarrassment. We are all capable of convincing ourselves… with areas where we are weak… that EVERYONE ELSE “gets it” and we don’t… which will often lead to NOT asking for help, or not asking questions in class. A great challenge to teachers is to try to create a safe environment in their classrooms … so that each child feels “protected” in some way. A teacher I knew, once told a “shy” student that each time she asked a question in class, at least half the class was grateful, since they didn’t understand it either!!”

Adina B.,  also voiced her frustration with the  ADHD diagnosis (***Note she references the Vanderbilt, which is a checklist typically used in pediatric practices.)

“OMG! If I see one more “evaluation” written up in an EMR (i.e., electronic medical record) format of course and conducted by a neurodevelopmental pediatrician (and sometimes by a nurse practitioner) with “results” from the Vanderbilt (because it’s free), I am going to lose it!”

Takeaway Point

Thrilled that the comment section of the website is back in action.  (Your comments help to take the pressure off of me for new content!!!!  Keep ’em coming!!!


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.

ADHD? Perhaps.

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” lurking.

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, 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.  In addition, 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 certainly 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 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.
  • Perhaps the child is struggling with anxiety and the excessive worrying looks like inattention.
  • Perhaps the child is feeling like they may have social issues as they go on TikTok and Instagram and sees friends doing stuff 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 ADD/ADHD.


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.

“ADD-ing”

Over the last couple of decades ADHD (commonly referred to as “ADD”) is frequently diagnosed with struggling children.  Within the doctor’s office, the child’s history is reviewed along with the parent filling out a rating scale (typically the Vanderbilt Scale, which is not norm-referenced).

When it comes up positive for things like “overly distractible” and “inattentive” a diagnosis typically follows.

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

Let’s look at Liam, a  fourth grader I recently evaluated who was previously diagnosed with ADHD  based on the Vanderbilt Scales) and it was recommended that he be put on medication.

Once getting “diagnosed,”  the mom pushed the school to set up a 504 Plan and also came to came to me to get my perspective.  (They heard of my “Pushback Disorder.”)

While evaluating Liam,  he didn’t present as inattentive or distractible.  In fact, in many ways he was quite focused, particularly for hands-on tasks.    The mom rated him pretty high on the inattentive side of things.

I saw Liam, at best, as “quasi-ADHD” (a term I made up). In other words,  it wasn’t a “slam dunk” to label him as having ADHD.

What I did learn from Liam was he was overly caught up in a myriad of screen preoccupations (e.g., YouTube, Fortnight, etc.).  School and homework were just basic annoyances that he had to deal with primarily get his mom off of his back.

Liam’s mom complained that he never seemed to know what he had to do for school and her blood pressure rose daily over Liam’s obliviousness. Frustrated that Liam never wrote down any assignments (“Why should I,” says Liam.  “It’s online 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 Liam has to do (while Liam plays Fortnite).

Liam thinks that it’s pretty cool his mom has the Google Classroom App, so she can keep track of what he’s supposed to do, rather than continually ask him.

It’s the mom’s view that the school should be relaxing the deadlines in a 504 Plan due to his “ADD.”

I pushed back some on the mom.  I wasn’t buying that Liam 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 Liam the message that he can hand in homework when he chose to  or not at all because of his “diagnosis.”

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

Why stress when his mother was doing all the stressing.


(***Please note:  All blogs represent the opinion and perspective of Dr. Richard Selznick.  Comments and questions are welcomed, but are blocked by the hosting site.  Please email questions or comments: rselznick615@gmail.com)  

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

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

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

 

“‘Bright Kids Who Couldn’t Care Less'”

A common complaint that parents bring to me is some variation on the theme of the child being poorly motivated.

Parents will say things like, “He just doesn’t seem to care about anything (other than screens).  We’ve tried everything and nothing seems to motivate him.   Now, if it’s something he likes doing like surfing at the beach, he will get up early and do it all day. For that, he’s motivated.”

One of the things that gets my back up is when professionals fall to simplistic explanations after the parents have checked off a few of the classic items on a rating scale at the doctor’s office that point to “ADHD.”

While the child may have this neurodevelopmental disorder, I could easily come up with about 20  different things that contribute to the child having low motivation.

A favorite author of mine who has written a number of excellent books on learning issues and struggling children is Dr. Ellen Braaten.

While cruising around Barnes and Nobles recently (yes, people still go to real bookstores sometimes), I came upon her latest book whose title says it all:  “Bright Kids Who Couldn’t Care Less:  How to Rekindle Your Child’s Motivation.”

Even though we don’t know each other, I’d like to think we are kindred spirits.

While parents often want to focus on the question, “How do we fix it,” I try and push back and remind parents that their children are not car engines and that there’s nothing broken.

I encourage parents to follow the child’s strengths. (That is the theme of The Shut-Down Learner.”)

Following the child’s strengths is a lot easier said than done and getting a child through the rigors of school can be extremely challenging  (The last time I looked surfing wasn’t a part of most school’s curriculum.)

Dr. Braaten also emphasizes building on strengths to help break the cycle of low motivation.

One of the things I particularly liked about Dr. Braaten’s book is a chart that she includes that highlights what low motivation looks like at different ages.  For example,  how does low motivation look with a five year old compared to a 17-year-old?

If you’ve been frustrated as many parents are with issues of motivation, I strongly encourage you to get a hold of Dr. Braaten’s book.  It’s loaded with great ideas and offers good food for thought.

I believe your perspective on why your child is unmotivated will broaden once you go through her book.


(***Please note:  All blogs represent the opinion and perspective of Dr. Richard Selznick.  Comments and questions are welcomed, but are blocked by the hosting site.  Please email questions or comments: rselznick615@gmail.com)  

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

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

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

 

“504 Realities (Part II) – Raising My ‘IQ'”

In last week’s post we talked about some of the basics involved with 504 Plans (504 Plans – The Reality : Part I ).

Remember, that a 504 does not offer any interventions,  but accommodations. It is intended to provide equal access to the mainstream to those identified as having a disability.  By far, ADHD is the disorder that receives the most 504 plans in school.

Of the things (among many) that raises my “IQ” (i.e., Irritation Quotient), are 504 accommodations that seem rubber-stamped or given by default.

A classic example is the provision of extra time, which is the top of the list of accommodations typically offered to ADHD children. (Not sure I’ve ever seen a 504 Plan that doesn’t give extra time as its top accommodation.)

To illustrate and expand upon my irritation, let’s look at Carl, an impulsive child who rushes through his work (and practically everything else he does).  Diagnosed by his pediatrician with ADHD, the parents took the physician’s prescription with a request for a 504 to the school.

The team met with the parents and set up a 504.  Among a few other accommodations at the top of the list was the provision of extra time (i.e., double time) on tests and classroom activities.

Given Carl’s characteristic impulsive style, the last thing Carl needs (or wants) is extra time.

As Carl blitzes through everything, it’s unclear how double-time helps Carl, as he is finishing a typical fifteen minute task in under three minutes (without checking any of his work).

Perhaps, rather than giving Carl extra time, which doesn’t help him at all, they can have the teacher’s assistant slowly go through his answers to help him to double check them, something he rarely to never does.

As you go into yo.ur 504 meetings  try and have an open and honest conversation (admittedly, not easy to do) regarding your child.

To guide the discussion there should be one central question.   That is, “What are the few things that can be done  to  help the child to function more effectively in the classroom?”  If time extension isn’t helpful, then don’t put it in the 504.

Takeaway Point

Be practical and realistic.  Come up with two or three things that you think would legitimately help your child

Keep it simple.  Keep asking the central question.


(***Please note:  All blogs represent the opinion and perspective of Dr. Richard Selznick.  Comments and questions are welcomed, but are blocked by the hosting site.  Please email questions or comments: rselznick615@gmail.com)  

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

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

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

504 Plans – The Reality: Part I

Parents will come to me loaded with terms only partially understood,  like referring to “504 Plans.”.

I will hear things such as the following:

“We just need to get him a 504.  so he can start reading better.”

“Yesterday, she had a meltdown in school and no one wants to play with her.  The 504 just isn’t working.”

Listen folks.  We need to get real.  Even if you are able to obtain a 504 Plan, that does not result in giving the child the help that may be needed.

It’s not the purpose of a 504 Plan.

Tack this on your office wall and repeat it as a mantra:  A 504 does not provide any service or intervention!!!  

This point is absolutely essential to keep in mind.

The notion of the 504 is that the child identified by an outside professional as having a disability necessitates developing reasonable accommodations so that the child can function as free as possible of any handicapping barriers  in the mainstream setting.

The word “reasonable is  open to a great deal of interpretation.

So is the word “adequate,” which comes up a lot in special education lingo.

Second mantra to post on your wall:

Schools are not required (by law) to provide the “best” education when it comes to special education, but an adequate one.

The Toyota – Lexus analogy has been used frequently to explain this.  While the Toyota may not have all of the features of a Lexus, it certainly is adequate to get you from here to there.

Takeaway Point

504 Plans do not offer services.

504 provides accommodations, not interventions.

More next week.


(***Please note:  All blogs represent the opinion and perspective of Dr. Richard Selznick.  Comments and questions are welcomed, but are blocked by the hosting site.  Please email questions or comments: rselznick615@gmail.com)  

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

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

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

“Hemming & Hawing”

OK… Among other disorders that I seem to have, readers of this blog know I have confessed to my  “PBD” or “Pushback Disorder.”

PBD usually manifests whenever parents tell me something that has a hypothesis (i.e., an opinion) as to why their child is doing or not doing something.

Usually, there is some type of disorder attached to the hypothesis.

Some examples include:

  • “My child is sensory seeking.”
  • “My mother’s uncle has clear ADHD and it runs in the family, so I see it coming out with our 7-year old when she refuses to do her homework.
  • “Emotional self-regulation is challenging for William – he always demands to be first in everything.”
  • “Her dyscalculia is running rampant – she just can’t do math word problems.”
  • “George hates reading so much – all he can focus on are video games. I think his dyslexia trips him up and he escapes to video games for safety.”

While all of these hypotheses may be true to a greater or lesser degree, ultimately they are opinions, guesses as to what’s going on.

Even with decent testing, there’s still guesswork involved with “the diagnosis,” which leads to another of my numerous disorders.

I haven’t seen it in the research literature, so I may be the first person to discover it – I am calling it “Hemming and Hawing Disorder” or “HHD.”

“HHD” manifests in my corner of the universe around questions of ADHD, Dyslexia, Anxiety and Asperger’s, among others, for example.

Recognizing that  there is no definitive test for any of these commonly raised concerns, I often find myself “hemming and hawing” after I’ve done a hefty dose of pushing back.

HBD is correlated highly with “Squeamish Disorder” (SD), which I freely own.

Not being a neurologist (who must have steelier nerve than I have with much more science behind them), I am uncomfortable saying that I child has a neurological disorder.

What I am not squeamish about, however, are stating facts that emerge in an assessment: .

For example:

“The fact is your child rushes through tasks.”

“Your child has a significant reading, spelling and writing problem and is well below the norm on these skills.

“Your child has superior visual intelligence, but is much weaker with verbal skills which are likely to impact things like reading comprehension or understanding lectures.”

“Following directions is very difficult for your child which came out in many of the portions of the testing.”

“Clear deficits with reading rate, accuracy and fluency were seen on all of the tests.

Takeaway Point

I clearly need help with all of my numerous disorders, such as PBD, HHD and SD, among others, however, stating the facts clearly keeps these disorders at bay.

For statements like these, I don’t show any HBD or SD.


***Please note:  All blogs represent the opinion and perspective of Dr. Richard Selznick.  Comments and questions are welcomed, but are blocked by the hosting site.  Please email questions or comments: rselznick615@gmail.com)  

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

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

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

Why Ask ‘Why?'” (Part II)

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Frequently, I hear from parents that they just want to know “why” something  is taking place (e.g., a behavior or a learning problem) .  As I hear their question, I understand they are seeking a “diagnosis,” such as ADHD or dyslexia.

For many parents when they get the diagnosis, they find comfort in it, believing that they have gotten to the root of the problem.

As we discussed last week, (“Why Ask ‘Why'”) the concern of of “why” is that the answer is highly speculative.

Related to this, I would like to offer a couple of quotes from Dr. William Carey, the late, renowned pediatric researcher from CHOP.

“‘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.’”

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, presuming  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.”

Parents may feel a degree of comfort relative to getting a “why,” but I can’t shake Dr. Carey from ringing in my ears.


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

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

 

 

 

“Why Ask ”Why?” (Part I)

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.

 

 

 

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