CA Dept. of Education

Home

Attention Deficit Hyperactivity Disorder Archive 2005

bc  

Shari Gent, M.S.,
Educational Specialist

Shari Gent, M.S. is an education specialist with eighteen years of teaching experience. She has taught a diversity of students including those with learning handicaps, mental retardation, and autism spectrum disorders in both urban and rural environments. Her special interest is working with children with attention deficit disorder and associated mental health conditions. Shari has appeared on National Public Radio with leading experts in the field of attention deficit disorder. In addition to her professional work, she is a chapter coordinator for Children and Adults with Attention Deficit Disorder (CHADD) and parents a teenager with AD/HD.

Submit A Question

Click a topic below to expand the full question and answer.

  • How early can ADHD be diagnosed?

Question:

Can ADHD actually go undiagnosed and really appear not an issue until puberty? How early can ADHD be diagnosed?

A concerned teacher


Answer:

Thank you for your interesting question.

Attention Deficit Hyperactivity Disorder (ADHD) is diagnosed by a psychologist, school psychologist, physician or psychiatrist based on criteria in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). The DSM-IV criteria specifically state:

  • “symptoms of inattention have persisted for at least 6 months”
  • “some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.”
  • “some impairment from symptoms is present in two or more settings (e.g., at school [or work] and at home).”

Many research studies of developmental course have been done. However, taking the criteria literally, clearly, some impairment has to be present before the age of seven years. In real life situations, a severe degree of impairment is sometimes not evident until later in life. Some children do not demonstrate significant impairment at school until organizational demands increase in middle school or high school. In the process of diagnosis, the professional may search for evidence in school records or in interviews of “some … symptoms” being present before the age of seven years. Adults who think they may have ADHD are often asked to provide evidence of early impairment based on interviews with people who knew them when they were young.

Many people worry about whether a diagnosis in early childhood is appropriate and express concern about the use of medications in young children. The DSM-IV mentions that excess motor activity is common when children are toddlers and states that “caution should be exercised in making this diagnosis in early years.” Some children, particularly those with more severe impairment, may be diagnosed in preschool but the decision about whether to administer medication is made by a physician and family. Like any other medical conditions the benefits and possible side effects of medication use must be weighed carefully.

Most children with ADHD are diagnosed when in elementary school. As far as the long-term course, the DSM-IV describes symptoms as typically becoming milder, not more severe through adolescence and adulthood. “In most individuals, symptoms attenuate during late adolescence and adulthood although a minority experience the full complement of symptoms of Attention-Deficit/Hyperactivity Disorder into mid-adulthood.”

In summary, children can be diagnosed with ADHD as preschoolers. Adolescents can also be diagnosed with ADHD during or post-puberty providing they demonstrated some symptoms before age seven.

 

Source:

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition . (1994) Washington, DC: American Psychiatric Association. Pages 82-84


  • What can I do about a parent who refuses to consider placing her son on medication?

Question:

I am a resource specialist at the intermediate grade levels. There is boy in my sixth grade class who seems to have ADHD but his mother refuses to hear it. He is an only child of a single mother and she feels his problems are just at school and that his teachers are causing the problem. There is no way that she will even consider placing her son on medication. This boy’s behavior makes it impossible for other kids in the class to learn, however. His behaviors are even more of a problem in the general class. He has constant temper outbursts when he’s frustrated. He bothers other kids by poking and kicking and interrupts the class all the time. We have tried suggesting placement in a special day class but his mother has refused this. What can I do?

Sylvia


Answer:

Dear Sylvia;

Thank you for your question. Your concern for your students is evident. I have experienced and worked in situations like the one that you describe many times. It’s often very hard to get everyone on the team on board at the same time.

First, some common sense suggestions –

Teachers spend more hours during the day with a child than nearly any other person. They are in a unique position to compare a child’s behavior and performance with that of other age peers. Parents, on the other hand, are in it for the long haul and spend more years involved with their child than any professional. Use this knowledge to your advantage. Even if this parent has difficulty admitting that her son has an attention and behavior problem now, if the problem is truly as serious as you suggest, she has heard from teachers in the past and will continue to hear from more of them in the future. Eventually, she may be willing to listen.

If the child has AD/HD, symptoms must be present in two or more environments. The child may experience natural consequences for his inattention in extra-curricular activities and his mother will hear from his coach, scout leader or other involved adults. Whether he acts out at home or not now, his behaviors will eventually visit the home in one form or another if he has AD/HD. Children whose AD/HD symptoms go untreated are more likely as teens to be involved in substance abuse and to have automobile accidents. Your student is teetering dangerously close to adolescence.

So, take heart and realize your limitations. If you can’t solve all of your student’s problems now, there will be other adults in the future to take your place.

Second, some practical suggestions to keep you going –

If you haven’t done this already, you might consider requesting assistance from a behavior specialist. A behavior specialist can take and interpret quantitative data that will assist in formulating a positive behavior plan. Even if your student does not take medication, using positive behavior management strategies can help turn his behavior around. If your I.E.P. team is not familiar with positive behavior plans or needs more information about their creation and implementation, refer to this website for an I.E. P. team handbook:

http://cecp.air.org/fba/problembehavior/main.htm

A additional resource is provided by the Office of Special Education Programs (OSEP), U.S. Department of Education. This website contains useful information about classroom management, school-wide behavior programs, and positive behavioral plans:

www.pbis.org

When designing a plan, be sure to set priorities. Don’t try to change everything at once. Instead, focus on the behavior that most prevents learning first.

To provide support for the general education teacher, consider sharing an excellent online article by Amy Mc Cart and Ann Turnbull entitled The Issues: Behavioral Concerns within Inclusive Classrooms and available at:

http://www.pbs.org/teachersource/prek2/issues/602issue.shtm

You may want to think about creating a classwide system both in your resource room and in the general classroom. Classwide systems avoid singling out the individual student as having a “problem” and make use of peer support for reinforcement. Two very practical resources for implementing a classwide behavior management system are the books:

The Tough Kid Tool Box by William R. Jensen, Ginger Rhode, and H. Keaton Reavis (Sopris West)

All About ADHD: The Complete Practical Guide for Classroom Teachers by Linda Pfiffner (Scholastic Professional Books)

Finally, consider referring your student for evaluation for 26.5 mental health services. Your county mental health agency will determine if your student and/or his family would benefit from support. If his mother is receptive, she may develop a more realistic picture of her son’s behavior through participation.


  • What non-medical controversial therapies are effective in treating ADHD?

Question:

What non-medical controversial therapies are effective in treating ADHD?


Answer:

This three-part series on alternative treatments for ADHD concludes with a discussion about the effectiveness of non-medical alternative and controversial treatments such as biofeedback, hypnotherapy, Interactive Metronome Training, Sensory Integration Training and Optometric Vision Training.

Therapies that claim to give children the tools to regulate their own behavior and functions have a special appeal to parents of out-of-control children. Dr. Joel Lubar, biopsychologist, is a leading proponent of the use of biofeedback to treat ADHD. Biofeedback is based on the assumption that children with ADHD have more unalert brain waves than their peers and that they can learn to regulate the type of brainwaves they produce through feedback via charts, graphs, or cartoons. In biofeedback, sensors are placed on the child’s skin to monitor changes in heart rate, muscle tension, and perspiration rate that are associated with specific patterns of brain wave emission. Biofeedback proponents hold the hope that this method can provide a treatment that has more permanent effects than medication or behavioral intervention. Research has indicated that the theory behind biofeedback is consistent with what is known about the nature of ADHD. However, the effectiveness of the treatment has yet to be subjected to the rigorous investigation required to prove efficacy. Although some studies have been done, they have not been controlled for the effects of other treatments accompanying biofeedback such as a close relationship with a therapist and training in academic skills. The American Academy of Pediatrics describes biofeedback as “having potential” but remaining a “unproven therapy.” Parents should be forewarned that biofeedback treatment is time-consuming, generally requiring up to forty sessions, and extremely expensive. Although hypnotherapy can effectively treat tics and sleep disorders that sometimes accompanies ADHD, core symptoms of ADHD were not improved.

Sensory Integration Training (SI), developed by Dr. Jean Ayers, is based on the theory that the brain of the child with ADHD is overloaded by too many sensory messages and is unable to integrate and make sense of these. SI is also used to treat developmental motor coordination problems that sometimes accompany ADHD. SI can be temporarily calming to children with ADHD but studies have not demonstrated effectiveness in improving attention.

Optometric Training, or behavioral optometry claims that faulty eye movements and visual perceptual problems contribute to dyslexia and other learning problems that often occur with ADHD. Skills such as tracking are taught through the use of eye exercises and colored or prismatic lenses. Unfortunately, the effectiveness of this approach to treat learning disabilities has not been proven. The American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology issued a joint policy statement in 1984 that no known scientific evidence “ supports the claims for improve the academic abilities of dyslexic or learning disabled children with treatment based on visual training, including muscle exercises, ocular pursuit or tracking exercises or glasses (with or without bifocals or prisms).” The American Academy of Pediatrics has expressed concern that treatment with Optometric Training can delay more effective treatment for learning disabilities.

Auditory integration training is based on the premise that a cause of ADHD is the difficulty attending to and making sense of information while listening. The most well-known of these trainings was developed by Alfred Tomatis, a French physician. Children participating in this training practice listening by being exposed to high frequency modifications of the human voice, classical music, and Gregorian chants through special headphones. One study has shown that boys with ADHD were better able to solve arithmetic problems while listening to music, however, no scientific studies have proven that the Tomatis method improves the symptoms of ADHD.

Interactive Metronome Training (IM) has demonstrated some promise. In this training, the child is taught to keep rhythmic beat with a computerized metronome in order to produce improved motor planning and timing skills. The treatment is based on the theory that motor coordination is related to behavioral inhibition, a theory for which there is no evidence. However, one carefully controlled scientific study has been conducted that supported the effectiveness of IM training for boys with ADHD. More than one study needs to be done to prove that the treatment is effective.

This article concludes the three-part series on alternative treatments for ADHD. Whenever a family is considering an alternative treatment, consultation with the treating physician is recommended. Much money and time can be wasted on unproven, expensive and ineffective treatments.

Sources:

Assessing Complementary and Controversial Interventions: CHADD Fact Sheet #6. available at www.chadd.org

Rickover, Robert. The Tomatis Method and the Alexander Technique. Essay available at www.alexandertechnique.com

Reiff, Michael I, editor. (2004) ADHD: A complete Authoritative Guide. American Academy of Pediatrics.


  • What effect does diet have on symptoms of AD/HD?

Question:

What effect does diet have on symptoms of AD/HD?


Answer:

Parents are often eager to find alternatives to medication for treating AD/HD. Being an informed consumer is essential for providing our children with safe and effective treatments. This three-part series on alternative treatments for AD/HD continues with a discussion of diet.

Adjustments to diet can be classified as elimination or supplementary approaches. The theory behind elimination diets is that substances eaten by children can cause changes in their behavior and mood. In fact, scientifically designed research has indicated that diet and nutrition affect brain development in early years. However, according to the American Academy of Pediatrics, “a young child must be significantly malnourished in proteins and calories before brain development is seriously affected, and this level of malnutrition is rare in the United States.”

The Feingold Diet, developed in the 1970’s by allergist Dr. Benjamin Feingold, is an example of an initially promising elimination diet. Dr. Feingold theorized that many children are sensitive to dietary salicylates and artificially added colors, flavors, and preservatives; eliminating these from the diet could improve learning and behavioral problems. Initial positive responses to the diet, unfortunately were based on anecdotal accounts rather than scientific investigation. Few families were able to stick to the Feingold Diet for extended periods of time. As the diet was studied further using scientific methods, results indicated that only about 10% of children with ADHD demonstrated any allergy to food dyes and a mere 2% on the Feingold Diet experienced improved behavior when these food dyes were eliminated. Consider the fact that ADHD occurs in about 7% of the population and that only 2% of this 7%, or slightly more than one tenth of one percent, benefited from elimination of food additives.

In recognition that this very small percentage exists, the American Academy of Pediatrics now recommends screening selected children for food sensitivities but does not recommend the Feingold Diet. More recent research has shown that children who could have behavioral changes due to food reactions are those with inhaled and food allergies coupled with a family history of migraines and food reactivity. In addition, these children usually have health and behavioral problems in addition to AD/HD, often including sleep and neurological difficulties. For these children, the treating physician generally implements the conventional course for food allergies. Foods such as milk, soy, wheat, corn, citrus, and peanuts are eliminated from the diet one at a time for two to four weeks. The process can continue until a potential food sensitivity is identified by documented improvement in the child’s symptoms.

Many parents and teachers report seeing a connection between the amount of sugar consumed and a high activity level in children. The American Academy of Pediatrics has reported one study that revealed a link between high sugar consumption and hyperactive behavior, and there was no evidence that one caused the other or that the behavioral problems were not due to parenting styles or other factors. For example, children often consume high levels of sugar during naturally stimulating activities such as birthday parties or sleepovers. The excitement of the events themselves may contribute to the high activity level. Many subsequent studies have failed to substantiate any connection whatsoever between sugar consumed and hyperactivity or AD/HD symptoms.

In the 1980’s, pediatrician and allergist Dr. William Cook, postulated that hyperactivity and learning problems were caused by chronic candida (yeast) infection. His theory was based on the premise that frequent use of antibiotics could kill the bacteria that normally prevent the spread of this yeast also associated with vaginal infections in women. He also speculated that yeast overgrowth produced toxins that cause AD/HD by weakening the immune system. Since that time, AD/HD has been shown to be a function of problems with brain neurotransmitters not known to be related to immune deficiency. Crook’s claim of a 75% success rate when children were placed on an elimination diet and given megadoses of vitamins was based on his personal observations rather than on scientific study. Today, megadoses of vitamins are known to be potentially dangerous to health and this approach to treating AD/HD is not recommended.

In addition to megadoses of vitamins, other dietary supplements have been claimed to improve symptoms of AD/HD. As mentioned , AD/HD is a brain disorder in which neurotransmitters are not functioning effectively. Nerve cell membranes are composed of phospholipids containing large amounts of polyunsaturated fatty acids (omega-3 and omega-6). Studies to examine the impact of Omega-3 and Omega-6 supplementation have been promising but not conclusive.

Glyconutritional supplements are another product currently being touted as effective for treating AD/HD. Glyconutritional supplements contain basic sccharides necessary for cell communication and formation of glycoproteins and glycolipids. The saccharides are glucose, galactose, mannose, N-acetylneuraminic acid, fucose, N-acetylgalactosamine, and xylose. Two small studies (Dykman and Dykman, 1998 and Dykman and McKinley, 1997) found some reduction in AD/HD symptoms after these supplements were used, but a third study failed to substantiate these claims.

In a review of the research on other supplements, CHADD (Children and Adults with Attention Deficit Disorders) concluded:

 

  • Definitive controlled studies have been done but have not proven the effectiveness of
    • essential fatty acid supplementation
    • glychonutritional supplementation
    • recommended daily allowance (RDA) vitamins
    • single vitamin megadosage
    • herbs.
  • Megadose multivitamins ( not RDA vitamins) “have been demonstrated to be probably ineffective of possibly dangers,” and “have not only failed to show benefit in controlled studies, but also carry a mild risk of hepatoxicity and peripheral neuropathy.”
  • Zinc, iron and magnesium deficiencies are not associated with symptoms of AD/HD.
  • Amino acid supplementation does not appear to be “a promising area fo further exploration.”
  • Hypericum, Gingko biloba, Calmplex, Defendol, or pycnogenol have not been found to be effective in treating AD/HD.


Next month: Biofeedback and other therapies

Sources:

Assessing Complementary and Controversial Interventions: CHADD Fact Sheet #6. available at www.chadd.org

Arnold, L.E.(2002) Attention Deficit/Hyperactivity Disorder: State of the Science and Best Practices. Kingston, NJ: Civic Research Institute.

Dykman,K.D., and Dykman, R.A. (1998). Effect of nutritional supplements on attentional-deficit hyperactivity disorder. Integrative Physiological and Behavioral Science, 33, 49-60.

Dykman, K.D. and McKinley, R. (1997). Effect of glyconutritionals on the severity of ADHD. Proceedings of the Fisher Institute for Medical Research, 1, 24-25.

Reiff, Michael I, editor. (2004) ADHD: A complete Authoritative Guide. American Academy of Pediatrics.


  • Are there any natural things I can try instead of stimulants?

Question:

My son is seven years old and has had a lot of problems with medications. Are there any natural things I can try instead of stimulants? I read about ginseng tea and listol. Do you have any suggestions?

Carmen


Answer:

Dear Carmen;

I am not a medical doctor and cannot suggest medications to you for your son, however, perhaps some review of the literature about possible natural remedies for ADHD would be helpful.

In short, the only treatments proven by research to be effective are behavior therapy and stimulant medications. Treatment effectiveness is proven by one of two methods: 1) scientific investigation and 2) case studies, anecdotal report, and testimonials. Unfortunately, unlike diseases such as diabetes, AD/HD cannot be identified by laboratory tests such as blood or urine sampling. Scientific investigation is the preferred method because these studies include standardized methods that decrease the chances of reaching faulty conclusions. Case studies have questionable generalization because only one individual is studied, while scientific research compares groups of people. Comparisons of groups are more likely to generalize to the larger population than a study of a single person. Testimonials and anecdotal evidence, while seemingly persuasive, lack objectivity; only one perspective is presented. Scientific investigations, on the other hand, are subject to review by scientists other than the researcher before being made public. More than one study needs to be completed before a particular finding is accepted as true. Scientific investigations also involve random assignment of participants to treatment or comparison treatment groups and whenever possible, evaluators and participants are blind as to what treatment they are receiving until the results are completed. In testimonials and anecdotal reports, however, persons receiving treatment usually know the treatment they are receiving and often have a personal stake in the outcome. For example, many testimonials and anecdotal reports are collected by the organizations selling a given substance. Often, only those that were purportedly successful are reported.

Treatments can be taken in addition to conventional therapies (complimentary treatments) or in place of scientifically proven therapies (alternative treatments). The best way for you, as a parent, to safeguard your child’s health is to carefully evaluate the treatments you are considering. Some so-called “natural” treatments are not without side effects and should not be given in combination with other medications. For example, gingko biloba when taken with aspirin, anticoagulants, or antidepressants, can increase their effects to a dangerous level. If you are considering an alternative or complementary treatment, be sure to inform your child’s physician. The National Institute of Health provides information about alternative treatments through the National Center for Complementary and Alternative Medicine (NCCAM). This office can be reached toll free at:

888-644-6226

Website: http://nccam.nih.gov/

In addition, as suggested by CHADD, consider asking the alternative health care provider the following questions:

    1. Have clinical trials (scientific investigations) been conducted regarding your approach?
    2. Can the public obtain information about your alternative approach from the National Center for Complementary and Alternative Medicine (NCCAM)?
    3. Is there a national organization of practitioners? Are there state licensing and accreditation requirements for practitioners of this treatment?
    4. Is your alternative treatment reimbursed by health insurance?

Regarding your specific question about Listol and Ginseng, the efficacy of both of these products to treat AD/HD has not been scientifically researched. According to one website selling Listol, the substance supplies minerals that are often missing in children with AD/HD. As evidence for Listol’s efficacy, the author cites a research study from Lancet completed in 1985. This citation is accompanied by a testimonial and the research study cited is twenty years old. Since that time, the field of neuropsychology has developed exponentially. We now know that AD/HD symptoms are related to problems with the neurotransmitters dopamine and norepinephrine. From the information presented, I would question whether Listol truly targets the primary medical condition associated with AD/HD.

One source, advertising American Ginseng as effective for treating AD/HD, cites “clinical trials” however, the researchers and date for these trials is not listed. In addition, we don’t know if the trial cited has be replicated. Generally, more than one study proving the effectiveness of a product needs to be completed for that product to be considered effective. If I were you, I would ask more questions before giving my child this substance and also check with his doctor.

Because there have been so many questions about alternative and complimentary treatments for AD/HD, I would like to extend this discussion to a three part series.

Next month: What effect can diet have on AD/HD symptoms?


  • ADHD and Bipolar Disorder.

Question:

I have a 7-year-old son diagnosed with ADHD/Bipolar.  After seeing several doctors, psychologists and finally a child psychiatrist, he was diagnosed with Bipolar and put on Lithium.  Evidently, extreme ADHD can often be mis-diagnosed when really  Bipolar.  This has been such a horrible experience.  We are now on our 3rd elementary school in 1 1/2 years.  They just give up until I pull him and demand another IEP meeting.  He is at least 2 years behind academically and  we are still struggling with behavior issues.   These teachers are just not equipped to handle these kind of kids.  I am very frustrated and wondering what advice you could give me in help improve our situation.  Thank you in advance.

Dixie


Answer:

Dear Dixie;

Thank you for your timely question. I am sorry to hear about you and your son’s experience with Bipolar Disorder (BPD), formerly known as manic-depressive illness. However, you are fortunate in having your child diagnosed and treated early. BPD in children is often difficult to diagnose because only the criteria for adult BPD has been formalized. Misdiagnosis or lack of diagnosis and treatment can lead to worsening of symptoms.

Childhood BPD is a serious and sometimes life-threatening condition. Until the last ten to fifteen years, experts did not believe that this disorder occurred in children. Conservative statistics now point to occurrence in about 1% of children. Research has also indicated a connection between AD/HD and juvenile BPD. Children with childhood onset BPD often have AD/HD (98%, Wozniak et al., 1995). Though children with AD/HD are more at risk for developing BPD than the general population, most studies show a significant but small risk (6-20%, Barkley, 1998). Specific statistics vary depending on the source but the existence of childhood BP and the relationship with AD/HD is generally recognized. Bipolar Disorder is hereditary as is AD/HD. Your experience with misdiagnosis is common. Severe AD/HD has many of the same symptoms as childhood BPD.

For those readers who have never heard of the condition, I have listed some of the symptoms of the disorder according to the Child and Adolescent Bipolar Foundation. However, I caution readers not to try to diagnose this illness yourself. Diagnosis of this disorder is a complicated process and should only be done by highly trained professionals, preferably a child psychiatrist who has seen a large number of these children.

  • an expansive or irritable mood
  • extreme sadness or lack of interest in play
  • rapidly changing moods lasting a few hours to a few days
  • explosive, lengthy, and often destructive rages
  • separation anxiety
  • defiance of authority
  • hyperactivity, agitation, and distractibility
  • sleeping little or, alternatively, sleeping too much
  • bed wetting and night terrors
  • strong and frequent cravings, often for carbohydrates and sweets
  • excessive involvement in multiple projects and activities
  • impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
  • dare-devil behaviors (such as jumping out of moving cars or off roofs)
  • inappropriate or precocious sexual behavior
  • delusions and hallucinations
  • grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

There are several types of BPD and you should check with your son’s clinician to familiarize yourself with your child’s type.

Addressing specific behavioral concerns faced by you, your son and his teachers is difficult as I have not met your son and you do not list specific concerns. However, as a parent, one of the most important things you can do is to educate yourself, your son and your son’s teachers about the disorder. The Child and Adolescent Bipolar Foundation website has a wealth of information that can assist you in putting together a packet of information to share with your child’s teacher. Included on the website is a handbook for educators and online courses for both parents and educators about educational rights and teaching strategies. Also available is a booklet for children, illustrated by children that describes how it feels to have a mood disorder. In addition to education, you will benefit from the support of other parents facing similar challenges. CABF sponsors online and in-person support groups across the country.

Child and Adolescent Bipolar Foundation (CABF)
http://www.bpkids.org/

Demystification of BPD to those working with your son is essential. The most important concept to communicate is the fact that BPD is a brain disorder. Unfortunately, our society still attaches a lot of stigma to mental illness and many people incorrectly believe that BPD is a character defect or a behavior problem that is potentially under the child’s control. Teachers need to understand that any possible rage attacks that occur are not directed personally at them but may be a symptom of this illness. CABF advocates for the use of the special education classification of Other Health Impaired (OHI) to obtain services because this classification emphasizes the biological nature of the illness. Some school districts may prefer to use the Emotionally Disturbed (ED) classification. Teachers may need to receive training in charting your son’s moods at school to provide feedback to his physician. In addition, you may need to prepare yourself for the possibility that your son may not be able to be educated in the general class setting for his entire school career. Particularly when his condition is not stabilized, he may need a more restrictive setting, such as a special day class or day treatment center.

School problems associated with BPD and medication include sleep disturbance, impaired concentration, memory problems, slow visual fine motor coordination, increase or suppression of appetite, blurring of vision and irritability. Many children with BPD are uncommonly bright but suffer from learning disabililties. Unfortunately, all of the medications used to treat BPD have significant side effects. Some medications can cause cognitive dulling, slurring of speech and physical discomfort such as excessive thirst and nausea. Your son’s educators need to be familiarized with these before making decisions about possible accommodations. Some possible medication-related accommodations are listed below. You will need to discuss the side effects of your child’s medication with his physician to determine which of these might apply to him.

  • access to a water bottle
  • opportunity to use the restroom when necessary
  • reduction in reading assignments due to blurred vision [bullet/indent/block}opportunity to nap at school if the medication causes drowsiness [bullet/indent/block}frequent behavioral and/or medication monitoring reports from the teacher

Sleep disturbance is common in BPD. Your child may sleep excessively during the depressive phase of his illness or seem to have little need for sleep when manic. Some accommodations you may need to consider:

  • allowing late arrival
  • shortening his school day

Children with BPD are vulnerable to stress and need a curriculum that will teach coping strategies. Some stress-relieving accommodations to consider are:

  • consistent routine
  • seating away from distractions
  • shortened assignments
  • prior notice for transitions
  • specific planning for unstructured times such as recess
  • scheduling of challenging tasks at a time of day when the student is best able to perform.

An extensive list of accommodations categorized by symptoms is available on the CABF website.

A list of resources is also available. Some of my favorites are:

Greene, Ross W. The Explosive Child. Harper Collins, 1998

Papolos, Demitri and Janice Papolos. The Bipolar Child. Broadway Books, 2002.

Steele, Danielle. His Bright Light: The Story of Nick Traina. Delacorte Press, 1998. Danielle Steele tells the story of her son’s life and ultimate death from bipolar disorder.

Waltz, Mitzi. Bipolar Disorders: A Guide to Helping Children and Adolescents. O’Reilly, 2002

For teachers:

What is Childhood Bipolar Disorder? A Resource for Educators An interactive CD created by CABF for teachers.

For Children

The Storm in My Brain. Illustrated by children with BPD, this book details how it feels to have bipolar disorder. The book is available free of charge at the CABF website.

Additional Websites

Juvenile Bipolar Research Foundation
http://www.jbrf.org/

Bipolar Child website
http://www.bipolarchild.com/

Positive Environments, Network of Trainers
http://www.pent.ca.gov/posenv.htm
A California Positive Behavior Initiative, sponsored by the California Department of Education, designed to provide information and resources throughout California for educators striving to achieve high educational outcomes through the use of proactive positive strategies for behavioral intervention.


  • Getting a teacher to implement a 504.

Question:

We have a 504 in place that states that the teachers ensure my son's homework assignments are written down and initial each day.  But the teacher says it is not her responsibility to chase him down and sign his planner.  What can I do?

Teresa


Answer:

Dear Teresa;

Thank you for your question.

If you have a written Section 504 plan, teachers are required to implement it. Should a teacher refuse, you have the right to file a complaint with your Section 504 coordinator. Go to the school district Section 504 coordinator rather than the school coordinator. However, bear in mind that it is in your son’s best interest for you and his teacher to work together to provide the best possible school experience for him. Avoid unpleasant confrontations whenever possible and attempt to communicate with the teacher regarding ways that your son can access his homework assignments. Some other options might be posting the assignments on the school internet website and creating a homework “hotline” on which the assignments are recorded. Be sure that all of your son’s teachers are included when the Section 504 plan is updated. Individual teachers may have their own ideas about ways to accommodate your son.

Whenever possible, encourage your son to take responsibility and become more independent. If your son is in high school, help him begin to advocate for himself by talking to teachers involved himself. He may need you to accompany him initially, but eventually should learn to do this on his own. Many parents and students make a packet together that describes their disability and give this to teachers at the beginning of the year along with the Section 504 plan. This helps teachers understand your son’s needs and enlists their cooperation before things get tough.

Other readers have asked similar questions about implementing Section 504. For more information about Section 504, please see the AAS previous question from “K”, starting with “Can a parent demand a 504 student…” The Diagnostic Center, Northern California also has an online training about Section 504 at:

http://www.dcn-cde.ca.gov/504/504_index.htm


  • ADHD after high school.

Question:

My son who was diagnosed with ADHD just finished his freshman year and failed at least two classes.  It seems that he cannot make the decision to study.  Is this a characteristic of the disorder?  He had a math tutor, but during the sessions, did not ask for specific help.  He scored over 1100 on SAT with formal preparation and does fairly well on tests/quizzes (without much studying of course).  Is there anything we can do or say to point him in the right direction (whether or not he should continue)?

FOLLOW-UP

Hi Shari,

My son appears to be doing better, although I still worry about how he manages his class load.  He has a knack for psyching himself into thinking that he’s doing well in all his courses; whereas the reality could be that he may do really well in one class and the others drop off the edge of the cliff.  We’re waiting to see how he does this semester.  I’ll keep you posted.

Concerned Mom


Answer:

Dear Concerned Mom;

I am so happy to hear that your son is doing better this year. Freshman year is tough for all college students, but especially challenging for students with AD/HD. You should be proud that your son made it to college. Consider the fact that only 45-50% of students with AD/HD do attend college. College students with AD/HD typically encounter problems with completing schoolwork. A common pitfall for these students is thinking that when they graduate high school they are magically cured of their AD/HD. However, between one half and two thirds of these kids will continue to struggle with significant symptoms as adults.

Because of their problems with procrastination, time management, and organization college students with AD/HD often have difficulty completing assignments. They also suffer from reading problems as the reading load increases in college and they continue to have difficulty concentrating. An increased demand for writing and notetaking is another common challenge. Frustration and anxiety about whether increased demands can be met and problems with personal relationships is a common source of mood instability for college students with AD/HD. Because they have a tendency to think they are already “cured”, and because responsibility for obtaining medication rests solely with themselves, many students stop taking their medication, or take it irregularly. Students with AD/HD often suffer from increased problems with sleep, lack of sleep and difficulty getting up in the morning.

Students who accept their disability and are willing to seek help or accommodations are most likely to succeed in college. Has your son registered with his school’s Student Disability Support Office? If so, and if he has documented his disability appropriately, he would be eligible for accommodations that might ease his pain under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act.

Common accommodations found useful by college students include:

  • Extended time on tests (documentation must specify exactly how much time is required) with short breaks between multi-section or multi-hour examinations.
  • Testing to take place in a distraction-free environment
  • Access to a coach or advisor to provide time management and work organization support and structure
  • Use of a computer with spell and grammar check not only for all written work but for essay examinations
  • Private dormitory room to minimize distractions
  • Use of assistive technology such as the Kurzweil reader to help maintain focus on reading material and to assist with notetaking
  • Option to photograph notes on the board or tape record lectures
  • Use of a notetaker to provide or supplement class notes

In elementary and secondary school, the burden for qualifying a student for accommodations falls on the school. In contrast, in college, the responsibility lies with the student. If your student is having difficulty negotiating the maze of college services, you might want to employ the services of a private coach. Although this option can be costly, a coach can fill the gap between depending on mom and dad and full independence. Some college disability centers support groups for students with AD/HD where your son could receive all important peer validation.

Below are some resources you and your son might want to consider:

Books

Bramer, J.S. (1996). Succeeding in College with Attention Deficit Disroders: Issues and Strategies for Students, Counselors and Educators. Plantation, FL: Specialty Press.

Mooney, J. and Cole, D. (2000) Learning Outside the Lines: Two Ivy League Studetns with Learning Disabilities and AD/HD Give You the Tools for Academic Success and Educational Revolution. New York: Simon and Schuster.

Nadeau, K. (1994). College Survival Guide for Studetns with ADD or LD. New York: Brunner/Mazel.

Quinn, Patricia. (2001). ADD and the College Student – Revised. Washington DC: Magination Press.

Organizations

Children and Adults with Attention Deficit Disorder (CHADD). Also the National Resource Center on AD/HD, a program of CHADD. Both are accessible atwww.chadd.org

Attention Deficit Disorder Association (ADDA). This is the national support group for adults with AD/HD. Information is available at www.add.org