ADHD/ADD

Giving the ADHD Kid Some Extra Time

by | Mar 15, 2013 |

In 504 Land, one of the classic (almost knee jerk) accommodations recommended is to give an ADHD child extra time. 

Let me ask you this, how many impulsive, hurry-let’s-get-it done, style kids that you know want extra time?  The answer is none.  The last thing that the ADHD kids want is more time.  In fact, they are looking to be the absolute first one done, regardless of the work quality.  “Ha ha, I beat everyone again,” is the probable running thought process.   “So, what if it it’s 40% accurate.  I’m done and I can put my feet up again,” thinks the ADHD style kid as he surveys the others toiling away around him.

Mark, age 11, typifies this process on a daily basis.  Rushing through his work, Mark can’t wait to be finished his homework so he can be back on Xbox 360 Live.  So, when his mother explained to him that the school was developing a 504 Plan for him so he could have extra time on tests and school work, he looked at her like she was sprouting various heads.

“Extra time???” he thought to himself.  “What do you mean extra time?  Those worksheets are the stupidest things any way….why would I want to spend more time on them.  I want less time!!!!”

“Oh,” his mother continued.  “They are also going to offer you preferential seating  so you can follow directions better.  You will sit right up there next to Mrs. Smith.”

“What????,” thinks Mark.   “Am I hearing this correctly? Whose preference is this?  Not mine!  I prefer to be as far away from Mrs. Smith as possible.  Maybe my mother prefers that spot in the classroom.  Not me. That’s not preferential seating.”

504 Plans sound great on paper with a lot of wonderful accommodations.  Just like a football coach who has all of his game plan mapped out before going into the game, the 504 plan documents the various and sundry ways the child will be “accommodated.”  It all sounds great.  Well, the coach often finds out the reality between his mapped out chart and the game itself can be very different.

Same with the 504 plan.  The kid may have other thoughts about it.  The plan may need some adjusting.  The things that you think sound helpful, may be the opposite.

On Zombie Pigs, Aliens & ADHD Boys

by | Feb 23, 2013 |

There are competing agendas out there within the professional realms that I operate.

On one hand there are the parents and the schools trying to get a segment of the population (ADHD boys) to get on track and be connected to the mandated curriculum.  Within that realm there is anxiety aplenty.  Parents get messages like, “Your child, Max, is not paying attention enough.”  “Jake’s overly distractible and not taking responsibility for his own learning.”  “Ethan isn’t serious enough about managing his homework.”

These are classic statements heard by the group of parents who are understandably anxious about what is happening in school and at home with their child.  Having consulted with an array of specialists to bring about changes to get their child more organized, focused and on track, they feel overwhelmed and bewildered.

Competing with the parent/teacher agendas are the boys of concern.  This week I had a parade of them, ranging from 6 to 9 years of age.  You could see what was happening pretty quickly.  Things like, worksheets, reading and writing are not on their agenda.  More importantly and front and center are “Zombie Pigs” and “Rock People.”

I know this because when young Max, age 7, was asked to draw a picture for me he launched into an elaborate discussion of the interaction of the “Zombie Pigs” who were battling it out with the “Rock People” who were throwing boulders down from the cliff to ward off the attacking Zombie Pigs.  The excited discussion and drawing went on for about 25 minutes.  I have to admit.  I was thoroughly charmed and entertained by Max’s elaborate explanation of his drawing.

Following Max was  young Ethan.   When I asked Ethan to draw a picture of  a house a tree and a person, he quickly answered  in excited tones, “Can I draw aliens in the picture?”  “Sure,” I said.  “Have fun…go to town.”  Off Ethan went down alien trail.  Aliens were coming in on the house, the tree and the person from every direction.

So, there you have it – the competing agenda of Zombie Pigs and Aliens, as opposed to getting your work done and paying attention.

It’s a dance that plays out day in and day out.

Takeaway Point

It’s going to take a long time for your boy to not be overly preoccupied by Zombie Pigs and aliens.  This sort of thing has a lot more pull than the state curriculum.  Might as well put your feet up and enjoy the ride.

ADHD: The Trouble With Boredom

by | Nov 26, 2012 |

When was the last time your kid came home and said, “Mom, guess what, I got a really cool worksheet today!!!”

My guess is it has not happened to date.    Frankly, the worksheets that I see (and I see tons of them) can be pretty dreadful stuff.  Kids get multiple worksheets over the course of a day, many over a week.

No one enjoys boredom, but for about 50% of the population,  they tough it out and tolerate the boredom.  For these kids who manage who manage the boredom, you may hear something like this,  “Ugh, not another worksheet.  I can’t stand doing worksheets, but I have to do it or else the teacher will give it to me for homework and then my parents will be all over me.”  These kids meet their boredom squarely and complete the task.

This is not so easy for the ADD/ADHD style kids.

For them, the boredom is almost intolerable and they literally can’t stand it.  Inside their head is a different voice.  You may hear something like,  “No!!!!!!!!  Not another worksheet!!!  I didn’t finish the other one!  Now there’s one more to finish.  No way…I’m not doing it!”

Both groups find the worksheets boring and unpleasant, but the ADD style kids are jumping out of their skin.  The boredom is overwhelming.  When they are punished for it by having to stay in during recess or to take it home and do it for homework, this only compounds their sense2 of frustration and leads to an undercurrent of anger.

Understanding ADD/ADHD as someone who has difficulty coping with boredom is a somewhat different spin on the syndrome, but one that I think makes sense.  I know that when I explain it to parents in these terms, the difficulty managing boredom is something they get immediately and see with their child.

Is there an answer to this?  It’s never easy and issues are always complex, but if your child is getting too many of these worksheets, it is good to speak up.  Try and track how many the child gets over the course of the week.  If it is getting out of hand and there are too many of them, by all means raise the concern with the child’s teacher(s).  If that isn’t satisfying, you may need to talk about it with the principal.

Takeaway Point

No one likes boring tasks.  Some can tolerate boring tasks better than others.  You have to know which type your child is, to try and take an appropriate action.

 

A Helping of ADHD Mixed With a Dash of Anger

by | Jul 13, 2012 |

A central principle discussed in the soon to be released “School Struggles,” is the notion of the “Soup Pot Theory” of everything.  

As I note in School Struggles:

“I subscribe to the soup pot theory of practically everything.  What this means is that I rarely see things as one way or another, but as a mixture of variables that interact to create challenges for children.  There is a myriad of different issues for most children of concern.”

Young Jack, age 13 illustrates this point.  For years Jack has been on an ADHD medication, as a physician along the way determined that Jack was ADHD.  Medication was the extent of treatment or intervention done with Jack  since he was six and a half.

As the parents reviewed their stories and concerns about Jack, I certainly hear that Jack struggles with being impulsive and showing questionable judgment, common characteristics of ADHD.  However, when I hear more about the family dynamics and how his parents’ divorce has affected Jack, there is a new wrinkle to consider.  Maybe there are other facets to the story that the ongoing view of ADHD has not revealed.

When I meet Jack my sense of him is that there is anger in the mix that nobody seems to know  about or have mentioned.  From what I can tell, Jack’s anger has been like a simmering pilot light, there but largely ignored. 

Jack’s anger needs airing.

The takeaway point is that you may need to go beyond the label.  While labels may be comforting to you on one level, they don’t often describe the many variables interacting with a child. 

With Jack there has been too much of an emphasis on medicating and not enough of an emphasis on understanding.

A Helping of ADHD Mixed With a Dash of Anger: Understanding the Soup Pot

by | Jul 12, 2012 |

 Another principle discussed in the soon to be released “School Struggles,” is the notion of the “Soup Pot Theory” of everything.  With the Soup-Pot theory kids are less seen as “this” or “that” (e.g., ADHD or LD), but as a mixture of variables interacting to create challenges in children.

Young Jack, age 13 illustrates this clearly.  For years, Jack has been on an ADHD medication, as a physician along the way determined (based on a 20 minute interview with parents and child) that Jack was “ADHD.” 

As the parents review their stories and concerns with me about Jack, I certainly hear that Jack struggles with being impulsive and showing questionable judgment, characteristics of ADHD.  However, when I hear more about the family dynamics and how his parents’ divorce has affected Jack, there is a new wrinkle to consider.  Additionally, when Jack is evaluated I find that he has difficulty understanding certain language-based questions which affects his comprehension and capacity to process information.  School would be hard for him as a result.

Additionally, when getting to know Jack more, my sense of him is that there is anger in the soup pot, but that nobody seems to have recognized it.  Jack's anger has been like a simmering pilot light, present but largely ignored. 

So instead of seeing Jack as “ADHD,” it seems that Jack has a helping of ADHD, with a sprinkling of difficulty processing information, mixed around in a stew of angry feelings.

The takeaway point is that labels, while they may be comforting to you on one level, don’t often describe the many variables interacting with a child. 

With Jack, there has been too much of an emphasis on medicating and not enough of an emphasis on understanding.

The ADHD Soup Pot = A Dash of Inattention Sprinkled With a Helping of Reading Difficulty & a Pinch of Social Struggling

by | Oct 3, 2011 |

What comes to mind when you read the following about a 10 year old?

• Trouble focusing
• Doesn’t stay on task
• Easily distracted
• Can’t retain material

Of course, you would be thinking ADHD.

My problem with stopping there (as many professionals do – ok, the M.D.’s) is that it is rarely the end of the story.

What would you say about the same child if his answer to the question as to how “winter and summer were alike” answered, “I don’t know…this one’s hard…you turn up the heat in the winter and in the summer it’s already hot.”

I’d be thinking, something like, “With school struggling, it’s rarely to never straightforward and it’s almost always a soup pot of different variables and this kid is going to need a lot of help with reading comprehension – he’s confused.”

In addition, this same child when asked how he was getting along with other kids in school answered, “I’m not, ” and then proceeded to tell me ways that he felt others were making fun of him.  From what he told me, he’s going to need a lot of confidence building.

While I believe that this child will be helped by stimulant medication, it’s rarely just one solution that is the answer.  There are other areas often overlooked with the simple labeling process. 

It’s rarely a simple brew.
 

ADHD, LD & Writing: A Perfect Storm

by | Aug 26, 2011 | ,

To stimulate me out of the late summer doldrums, I looked to this news of the day feature that came across my e-mail inbox:

“Writing problems common in kids with ADHD,” said the news header. As the start of the article noted, ‘Kids with attention-deficit hyperactivity disorder are more likely to have writing problems such as poor spelling and grammar than their peers, suggests a new study.”    (reut.rs/oLagaR)

Very often the only treatment that I hear being suggested to address these issues is for the child to receive occupational therapy. While OT’s do very nice work with kids, writing is a complex process, with the occupational therapy  only scratching the surface, working primarily at the fine-motor level of functioning.

There is much more underlying the writing problems than fine-motor difficulty. Children with ADHD and related learning disabilities almost always have trouble with active working memory.   Often, there are related issues with usage of language.

Open-ended writing (e.g., write about your weekend), the favored approach to writing in most classrooms, places a great “load” on active working memory. Think about how much you have to hold in your mind when doing a simple writing activity such as “write about your weekend.”

The answer that I have seen work best with struggling children is to teach them in highly structured ways, one baby step mastered at a time. These approaches are very similar to the way reading is taught with the Orton-Gillingham methods work with reading and are in direct contrast to the popular approaches of open-ended writing.

 (For a good example of structured approaches to writing, see Landmark College’s writing program, From Talking to Writing: Strategies for Scaffolding Expository Expression, bit.ly/nKots7.)

The Pathology of Exuberance

by | Jul 29, 2011 |

George is a five and a half year old boy. He’s one of those types who’s quite bright, but hasn’t yet learned how to contain his exuberance or spontaneity. For example when George is in his pre-kindergarten class, he has a lot of trouble holding back whenever the teacher has a question.  George can’t contain his exuberance and enthusiasm. (Since George was the type of child who religiously watched shows on Animal Planet, he was a storehouse of knowledge that he couldn’t wait to share.)

 At home, his older siblings look at him like he is a little bit off. When they watch TV together or play on the Wii, George frequently starts jumping up and down during exciting parts, excitedly flapping his arms. It’s almost like every cell of his body becomes energized by what he watches. These behaviors bother his siblings.
 
George comes in to see me for an evaluation. 
 
I am charmed by George. He is fun, spontaneous, knowledgeable and exuberant. When I have George put blocks into different patterns, he exclaims, “Wow, Dr. Rich. I like doing these! This is fun!”
 
I know everyone is going to look at George like he is ADHD when George gets to kindergarten
 
You may not remember this era, but there was a time when kids like George weren’t considered “disordered.” 
 
They were just exuberant. 
 
Sure their exuberance might get on some people’s nerves and may be a bit hard to contain, but that’s the cost of doing business with children. There will always be Georges in the pack.
 
For now, George is not disordered in my book.  George is five and a half years old and loads of fun.
 
There will be time enough in life for George to “curb his enthusiasm.”
 

 

SHOULD CHILD BE ON MEDICATION WHILE BEING EVALUATED?

by | Jan 15, 2011 |

The followings question came to me regarding the pros and cons of having a child on medication while being tested:

“Please address whether a child should be on medication while assessing a child with executive function issues. Some of the specialists we refer to around the country say to lower the medication when testing so you see the real child. Others say give the meds so you can see the potential. What do you think?”

This question comes up a lot for me. Before bringing their child in for an assessment, parents will often ask, “Should I keep him/her on medication for the testing.”

Like most things in this business, there isn’t a clear-cut answer. (That’s why my hair turns progressively gray with each passing day.)

To me the question is answered by another question, “What’s your purpose of doing the assessment?”

For example, let’s say your child has had a year of tutoring (while on medication) and you want to know how the child is progressing. In that scenario I think having him on medication during the assessment makes sense.

In a different example, if your purpose is to get a second opinion as to whether the child still needs to be on medication, then it probably makes sense for the psychologist to see the child off of his medication, so he can get a better feel for the child. You child could also need medication for a number of other reasons, you may find yourself looking to an online pharmacy to assistance with permission from your doctor.

(Mind you, with this question I am only making reference to stimulant type medication here (e.g., Adderall, Concerta, etc.), as stimulants are very short-acting and are in and out of the system very quickly.)

Bottom line, get clear on your purpose for doing the assessment and this will help to resolve the question of medicating or not during the evaluation.

ADHD KRYPTONITE: THE LUNCHROOM & the PLAYGROUND

by | Dec 18, 2010 |

  Scene 1:  The Lunch Room – Jack’s Brain

“Gee, it’s so wild and noisy in here.  Everybody’s throwing stuff.  Haha.  Jake is so good at putting food in his nose.  Maybe I’ll try that too.”

“Why is that lunch lady getting mad at me?  Jake was putting food in his nose first.  How come she didn’t see it?  Jake never gets yelled at.  Now she wants me to sit off by myself until we go outside.  It’s not fair.  I was just having fun – just like Jake.”

Scene 2:  The Playground – Jack’s Brain

“Cool…we’re outside…great to be out….I’m so sick of being inside…oh man…I can’t wait to go over to the slide area and swing down…oh, man…There’s a line…oh, there’s Jake, maybe I can jump in front of him…wait there’s a cool stick that I can throw over the fence…wow, that went pretty far…better than yesterday’s stick.”

“Oh, no, that lunch lady is coming over to me again and she’s got that look."

“I didn’t mean to throw the stick,” I tell her.

“Phew.  She lets me go this time. Back to the swing…cool there’s Jake.  We can jump down together….oh, man it’s line up time already…how come the line teacher is yelling at me? I didn’t push on line, did I?  Everyone else is doing it too.”

Scene 3:  The Classroom- Jack’s Brain

“Oh, man.  The teacher is filling out that “daily report card” thing…that stinks… I got another frowny face on the report card for lunch and playground.  I’m going to get yelled at and punished again when I get home.”

“I didn’t do anything…How come Jake never gets in trouble?”

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