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
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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 –
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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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