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
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Not a Broken Bone #Dyslexia #ADHD #LD

Each week (probably every day) of my professional life, I grapple with the concerns that parents bring to me.  Usually, they involve questions of learning disability, dyslexia and ADHD/ADD.

Why grappling?

I mean, I’ve been in this business a while.  Shouldn’t it be a piece of cake?  Just give the kid the equivalent of the “Dyslexia or ADHD X-Ray,” and wisely pronounce while scratching my beard, “Yes, Mr. and Mrs. Jones, your child is dyslexic,” or “Your child is ADHD and needs to be on medication.”

Ah, to be so wise.  Life would be so much easier and clearer.

Not for me.  I live in the gray zone where things are rarely clear cut.

Young Marla, age 9, is a lovely and spirited child, but she is starting to get on people’s nerves.  Singing at inappropriate times during recess, chatting a little too much during quiet periods in class, others’ patience toward her is starting to wear thin.  In short, Marla is getting a bit annoying and people (parents and teachers) are raising the ADHD question.

I meet Marla and can see some of the areas of concern – she’s a bit too hasty on different tasks when she should be thinking a little more deliberately. She’s a little too exuberant. Rating scale data completed by parents and teachers are elevated on the ADHD factor, but not all that much. So, is she “disordered?”  Certainly, most neurologists would have called her so with little hesitancy.

Perhaps this 9 year old does not need to be on medication, though. Perhaps she needs a little more time to grow up?

Then there’s George, age 8, who is having some difficulty with reading, spelling and writing.  I evaluate George and find most of his scores clustering in the dreaded “average range,” a little left of strict average, but not all that alarming.  I see he has some trouble with reading, spelling and writing and his phonological processing scores are also tilted to the left side of the curve, but not all that much.

So, is he “dyslexic?”  Is he disabled?  When I tell parents that he may not be dyslexic and that with some focused instruction the gap may close, they almost seem disappointed.

I certainly understand the movement (#saydyslexia) to bring awareness of dyslexia forward and to more comfortably use the term and we are now in the decade of dyslexia. (For the longest time dyslexia had Voldemort status and was “that which should remain nameless.”)  But I still maintain there are many kids who show signs of struggling with reading, spelling and writing who may not be dyslexic.

Takeaway Point

Learning disabilities, ADHD, dyslexia are just not broken bones that show up on an X-ray.  It’s often falling in the gray zone.


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On 504 Plans & Finding the Right Accommodation

Many people come in inquiring about a 504 Plan for their child.  It’s important to know what you are seeking.

With 504 plans (which come out of Americans with Disabilities Act  legislation  or ADA , we are saying that the child  has a disability and needs to have accommodations to assist the child enough so that the playing field becomes leveled.

The notion is that without such accommodations, it would be fundamentally unfair for the child with the disability.

Finding the right accommodations for your child can be tricky.  Too often a 504 Plan becomes a boilerplate check-off exercise that is not necessarily related to the child’s needs or may be simply too accommodating.

For example, some years ago I remember a mom insisted that the school provide an extra set of books for the child because his ADHD precluded him (theoretically) from being able to remember to take his books home for his homework.

I happened to know this kid quite well.  When he left the school building carrying nothing (because the school had to supply an extra set of materials at home), I imagined this kid was saying something to himself like, “Haha you suckers…you have to carry your books home, but I get to go home without them.”

For this individual, even if he did have “ADHD,” which I questioned, I never thought the accommodation was necessary and always perceived that it fit into his general sense of over-entitlement.

In short, the accommodation was the wrong message to give the kid.

Another child tested recently was extremely rapid on almost all of the tasks that he completed.  Calling him “impulsive” was an understatement.

The parents reported that he was given a 504 plan because of his ADHD (previously diagnosed by the neurologist.)  At the top of the accommodation list on the boilerplate document was “extra time.”

Extra time???  As he  blitzed through his work at light speed, the last thing he needed was extra time.

Takeaway Point

Accommodations are tricky.  Sometimes they just don’t hit the mark. 504 Plans are meant to be individualized (in theory).  Ask yourself what can be done to help “level the playing field?  What does my child legitimately need to help him function better in the classroom?”

Draining the Car Battery – #ADHD

When it comes to kid issues, too often I hear simplistic answers to issues that can be very complex.

My favorite answer to almost everything is,  “My kid has ADD.”

Listen up everyone.  With determining ADD/ADHD  it’s not like a dental X-Ray, where there is objective proof of something  like a cavity or some other dental anomaly.

Even when some doctors trot out fancy (very expensive, I might add) electrode type of testing with the semblance of objectivity (“See it says here on this bar graph based on the electrode neuro- testing that we did that your child has this thing called ADD or ADHD.”), there may be many, many other reasons why kids are not functioning well with school.  I listed many of them in a recent post so I will not repeat here (see  20 REASONS KIDS DON’T PAY ATTENTION) .

Think of kids’ brains somewhat like a car battery.  There are a slew of things that can be draining the battery.

Part of what inspired this post was a 13 year old girl that I consulted with recently who has a myriad of “girl drama points” occurring in her life.  All of these drama points are draining her mental energy.

She recently underwent one of these fancy neuro-electrode types of ADHD assessments and was told, “Yep, you’ve got it.  You’ve got ADHD,” as the physician scratched his beard,  wisely.”

When I probed further and asked about her social life and how she was feeling about it, she started to cry.  When I asked if any of the professionals that “diagnosed” her asked her about her social life, she shook her head no.

From where I was sitting, her social life was greatly draining the car battery.

Takeaway Point

It’s really easy hooking electrodes up to a kid’s head.

Travels in 3rd Grade Boy Brain: On the Rougher Side of the Road

It’s not easy being a kid.  It’s particularly tough if you’re one of those types that are on the rougher side of the road.

If you’re one of those types you have lots of people getting irritated with you or making fun of you.

Let’s travel in George’s brain for a little bit and get a glimpse of some of his 8 year old boy thoughts while he is in his third grade class.

George thinks:

“Wait, did the teacher just say something?  I see kids getting books out.  What did she say?  Oh, right. Open up your journals and start writing something.  I didn’t hear what.  I heard the word Thanksgiving.  I will ask Malik…Jeez….he just told me to shut-up.  What did I do? Maybe Zinnia knows.  She always knows what to do.  She just gives me a dirty look and tells me to stop tapping my pencil and that I’m ‘so annoying.’”

Mrs. Pryor comes over to talk to George. She sounds a little irritated.

“Wow.  I’m in trouble again.  Mrs. Pryor said she might have to send a Class Dojo*** message to my mother telling her I’m not paying attention again.  She said we’re supposed to write something about Thanksgiving.  Like, what’s our favorite part of Thanksgiving.  I have no idea what to write.  What can I say?  I write, “turkey.”  I can’t think of anything else.  Zinnia laughs at me and says I’m so stupid and to stop playing with my pencil because it is getting on her nerves.  I don’t know what’s so annoying.  I was just clicking it.”

Mrs. Pryor tells George that he will either have to finish his Thanksgiving essay during free play or for homework.  Mrs. Pryor puts something on the top of his paper.

“Oh no!!!!! A frowny face on my paper.  I wrote, “turkey.”  What else is there?  Writing during free play!!!  Oh man, she’s getting out class Dojo again….I think I’m in trouble…my mom told me I needed to pay attention more or she was taking me to this doctor…Malik tells me to cut it out…I don’t know what he means.  He says I was picking my nose.  I was not.  He’s lying again.  Oh no, Mrs. Pryor is asking people to start reading their Thanksgiving papers out loud.  I hate Zinnia….she’s all done and she wrote a whole page.  I just wrote “turkey.”  I hate Zinnia.”

Mrs. Pryor says it’s time to line up to go to library.

“Oh, man.  I’m almost at the end of the line again.  I hate being at the end of the line.  I’m never first.  It’s not fair.  Mrs. Pryor said I was pushing somebody.  I was not. I just bumped into Spencer.  Spencer yelled out, ‘He hit me!’  She’s going to Class Dojo again.  I didn’t do anything.  Nobody believes me.  Zinnia is all the way in the front.  I hate Zinnia.”

Takeaway Point

It’s not easy being a kid, especially if you are on the rougher side of the road.

(***Class Dojo is an online tool that keeps track of behavior.)


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20 Reasons Kids Don’t Pay Attention

In no particular order here are 20 reasons why kids don’t pay attention:

  1. Perhaps the work is too hard.
  2. There may be are far too many worksheets – perhaps the kid has worksheet burnout.
  3. Maybe the kid is asked to write when he has little capacity to even write a sentence.
  4. Perhaps his reading skills are weak.
  5. Some might be spatial thinkers (Lego Kids) and their language system isn’t well tuned while there is a whole lot of talking to sort out in the classroom.
  6. Maybe he is one of those “all boy” types (yes, they exist) and the curriculum isn’t matching their interests.
  7. There may be a lot of distraction in the atmosphere.
  8. For many kids, it’s just a long day – their batteries run down.
  9. Maybe they have become a bit too wired to “screens.”
  10. Perhaps the work is boring – for some kids it may be fine, for others it’s not
  11. Perhaps the kid is just one of those variable types – significant highs and lows in the profile that lead to inattention.
  12. Maybe the kid is the the worrying type.
  13. Perhaps he has bad sleeping habits.
  14. It could be that there is stuff going on in the family.
  15. Perhaps he is not understanding what he  read and the content is not connecting with him.
  16. Perhaps he really hates math (especially all of the word problems that they have to sort through).
  17. It could be that some of the other kids have been mean and have made some unkind comments.
  18. Perhaps the teacher is on the boring side.
  19. It might be that the kid is day dreaming about all kinds of things other than the task in front of him – it’s kind of human nature to do that.
  20. Maybe he doesn’t follow directions too well – it’s just not one of his top strengths.

Oh, yeah.  I almost forgot.  Maybe the kid has ADD/ADHD.

Too bad, though,  we often jump to that conclusion all too quickly before considering all kinds of other factors like in the above list.

Take Away Point

There’s a lot going on inside and outside a kid’s head.

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The Anger River Below the ADD Swamp

Do you know about the river that lies below the ADHD/ADD swamp?  It’s the Anger River and it lurks down below, often unseen, but detected at times by certain actions or behaviors from either child or parents.

How do we detect the Anger River?

  • Punishments have increased – (“That’s it. You’re  off your video games for the next month.”)
  • There is a lot of forgetting and last minute revelations about a test or project the next day. (Think Sunday night at 9:00 p.m.)
  • There has been increased parent monitoring of homework. Parents feel like they are the “Homework Police.”
  • Teachers will report, “If only he/she paid attention more…”
  • There is a general tone of disconnection to school work.
  • Control battles are being waged.

To show the Anger River in action, below is a near verbatim talk I had recently with a teen, Charles,   who I sensed had the Anger River lurking below the ADD Swamp.  By his own admission Charles was unmotivated and had little energy for school.  (Charles was in high level classes by the way and there were no indicators of learning disabilities or dyslexia in the assessment I did.)

After the testing I chatted with Charles.  “I have a theory, Charles,” I started, “that your brain is kind of like a car battery and that in order to take on the demands of school the battery needs to be pretty charged.  Just like a car battery, there are many things that drain it or deplete it of energy.”

Charles looked like I perked his interest slightly.  I wasn’t giving him the usual “try harder” or “you need to take your medication” talk, both of which he had heard many times in the past.

“Yeah, like I know your parents are going through a tough time lately and that drains your battery.  You also feel like your sister is overly demanding and ruling the house which gets you mad.  On top of it you feel loaded up with hours of work and since I tested you I see that you work very slowly and methodically, so that doubles the time you have to put in. Finally, you are angry about getting punished all of the time and feeling like your parents have you on too tight a leash.  You feel over-controlled.  So with all of that going on you basically say to yourself, ‘screw it  I am not doing it.’  Does that sound on the money?”

A pretty tight kid, who was not the most verbally forthcoming, Charles gave me a nonverbal green light with a pretty good nod of his head with a slight smile.  He even admitted to lying to his parents at times about school.  (“I just tell them I did my homework to get them off by back.  I figure I’ll deal with it later when they find out.”)

“So, you see, Charles, it’s like there is this pie chart of different variables draining your battery and increasing the Anger River that lies down there. I bet you are operating at about 15% efficiency.  That F.U. River can really do some damage.”

(Keep in mind a try and use humor where I can to get the kid to lighten up and “buy in,” hence the use of the “FU River”  with Charles.)

I know.  I know.  The questions I get all of the time – “So, what do we do about it?  How do we fix it?”

I will continue more next week (I need some time), but for now at least 70% of the “fixing” (there is no fixing), is in the understanding.

Takeaway Point

Only understanding drains the river.


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The ADHD “Test”

Rating scales frequently are used as the “tests” to determine whether or not the child has  ADHD (as if ADHD  can be diagnosed like a broken bone).  (“Yep, it says here on these scale that your child has ADHD.”)

The fact of the matter is the vast majority of kids struggling (for various reasons) with school would have elevated spikes on scales like the Connor’s Rating Scale, one of the commonly used scales in ADHD assessment.  It would be a rare day that a child with a reading or writing disability is able to adequately pay attention in school.

There are a so many variables that contribute to compromised attention in the classroom.  Let’s look at a few of these in no particular order:   (Kid commentary follows the variable)

  • Language processing. (“I get overloaded with too much language and it makes me zone out.”)
  • Weak vocabulary knowledge (“Too many words make my head ache.”)
  • Poor fine motor skills. (“She wants me to write what?  I’m out of here and going off to explore the universe again.  First stop Jupiter. ”)
  • Weak reading skills (“These long boring stories really make me lose attention. I can’t read them.  There are a lot of stupid words on the page that I just skip over.”)
  • Spatial style preferred (“Give me more Legos!!!!”)
  • An energetic (perhaps chaotic) classroom environment. (“Hey, we’re all bouncing around in here.”)
  • Deadening worksheets (“Planet Jupiter is calling again.”)

I could go on, but I think you get the idea.

My basic point is that kids can have a cluster of these variables leading them to look awfully disordered in the attention arena.  High scores (in the negative direction) on scales such as the Connors will result.

I am not suggesting that rating scales aren’t helpful.  They are very helpful and tend to offer insight into variables not easily seen during the more structured assessment.

I am just cautioning you not to think you got “the test” or “the diagnosis” based primarily on the  Connor’s, the  Vanderbilt or whatever.

Takeaway Point
There’s much more that needs to be understood beyond the rating scales.

Planet Jupiter is looking better every day.

Screens, Distractability & ADHD

“Children surrounded by fast-paced visual stimuli (TV, videos, computer games) 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 Jana, age five, a kindergarten child who is coming in for an assessment because her school thinks she is having trouble “paying attention.”

“Hi Jana, “I say in the upbeat style that usually gets kids engaged and comfortable.

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

We go back and I offer Jana some toys (old school ones in a box – you know, different human figures animals, cars and trucks) that she shows no interest in playing. 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 Jana may start doing the same the same with the iPad – ‘My precious…my precious.’)

Jana’s mom, Beth, starts talking about Jana’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 plays 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.)

There is a skill to greeting someone in the waiting room. There is a skill to playing with toys or interacting in a restaurant. These skills need development and practice.
If we don’t give kids a chance to practice these skills, the skills will not develop.

Simple as that.

Takeaway Point
Create “No Screen Zone” blocks of time.

Detox them.

Be firm. Be brave.


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