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Attention Deficit Hyperactivity Disorder Archive 2007

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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.

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  • Managing ADHD in a 4 year old boy.

Question:

I have a 4 year and 8 month old son who has been recently diagnosed, but with ADHD. The diagnosis is not conclusive because he is so young. Medications are making him more hyperactive. Somedays he is too good and some days he is very active. I get calls from the school that he runs out of classroom. He is not harmful to anyone but he is always on the go.

What can I do to change his behavior ? So far I have explained to him a lot that it is dangerous to run out of the classroom but it does not seem to make a difference. Any suggestions ??

Sincerely,
Sonal


My 4 year old son was recently diagnosed by a physician with a mild case of AD/HD – he’s currently in Pre-School at a Center with 30+ kids and every week I receive a call from the school about my son’s disruptive behavior. I understand that he has a hard time focusing and is easily distracted so I want to find a school in my area that has a smaller class size and can accommodate ADHD students. I’ve searched and all a lot of places in my area and class sizes are 30+ kids with 3 teachers at the most – I don’t like that ratio.

The doctors have suggested I give my son Ritalin but I refuse to give him any medications until my husband and I have done all we can to help him. I want to reduce this class size, keep him on a normal routine and help him transition with changes. I’ve never known anyone with AD/HD so the only information I have about it is from doctors or the Internet. If I need to change my routine as a parent to help accommodate my son then I will but I refuse to give him Ritalin. From what I’ve read on the Internet a lot of the parents who are giving their kids this Ritalin are still having the same issues with their child and they see no changes. As a new parent and a young parent – can you tell me where I can go to find a school or resources in my area that help kids with ADHD? Do you think a smaller class will help my son at all? PLEASE HELP.

Thanks! 
Alo


Answer:

Hello, Sonal and Alo;

Recently I have received several questions about preschoolers with AD/HD. Coincidently, new findings about best practices with preschoolers with AD/HD have been published within the last year so I thought I would take the opportunity to share this information with you while addressing your questions.

In 2001, the National Institute of Mental Health (NIMH) initiated a study to evaluate the effectiveness of behavioral and medical treatments for preschool AD/HD children. The study, completed in 2004, took place at six university medical clinics nationwide. The children are being followed for five years following the study. Findings indicate that behavioral therapy coupled with parent education was effective in improving the behavior of one third of the 303 three to five year olds who participated. Results also indicated that low doses of methyphenidate (Ritalin) were safe and effective in treating those children who did not respond to behavioral intervention and parent education training.

Results of the study indicate that medication should be a last resort for preschool children, reserved only for moderate and severe cases of AD/HD because, in this age group, side effects seemed to be stronger and the medication was not as effective as with older children. According to the NIMH, medication slowed the children’s growth rate: the children grew about half an inch less in height and weighed about three pounds less than expected throughout the duration of the study. No research has been done tracking the long-term growth rate of preschoolers who take methylphenidate. Other side effects observed were problems sleeping, loss of appetite, and repetitive skin picking behaviors. Despite current concerns about the possibility of an increase in blood pressure, this side effect was not present.

In addition, to the effects of medication, another study funded by NIMH looked at psycho-social and behavioral alternatives. Over the course of 70 months, researchers at Lehigh University’s Project Achieve looked at the progress of 135 preschool students with AD/HD. Dr. George DuPaul, one of the researchers, is known for his studies about the academic implications of AD/HD. According to Dr. DuPaul, “Medication may address the symptoms, but it does not necessarily improve children’s academic and social skills. “

Dr. Du Paul’s non-medical approach was effective in producing a 17% decrease in aggression and a 21% improvement in social skills at home. At school, teachers reported a 28% improvement in those categories. ( Lehigh University News, 8-16-07) These results are considered “significant” by NIMH. Participants were randomly assigned to one of two groups: multicomponent intervention (MCI) or parent education only (PE). Both approaches were equally effective. (NIMH Science Update, 8-15-07)

What was the non-medical magic that produced these results? To start with, I think it’s important to differentiate between poor parenting that may cause problems for children and enhanced parenting that can contribute to resilience and growth for those children with inherent, neurobiologically-based behavioral challenges. The interventions employed in the research studies were targeted at the second group. Parents of children with AD/HD need to remember that they are not the cause of their children’s behavioral difficulties, but they can be key players in improving the outcome for their child.

In addition, it would be very difficult, Sonal, for you to prevent your child from running out of the classroom unless you were actually at the school. Preschool children benefit from behavioral strategies that are concrete and readily available at the time the behavior occurs.

There are no easy answers. Understanding and parenting the child with AD/HD is a challenging job. Some general suggestions include:

  • Choose a preschool or daycare that is highly structured. Consistent routines are critical for children with AD/HD.
  • Provide a choice of activities throughout the day. Choice tends to diffuse conflict.
  • Give your child advance notice when it’s time to change activities. Timers can be helpful.
  • Use drama and other role-playing activities to teach social skills.
  • Catch your child “being good.” Give him or her plenty of praise for appropriate behavior.
  • Prevent escalation of an inappropriate behavior by using calm reminders when the behavior begins to surface.
  • Be sure to safety-proof all areas of the home and school. Children with AD/HD are accident-prone.
  • Establish communication with your public school district early. Early intervention may be available.
  • Communicate frequently with your childcare provider or preschool about your child’s needs. Whenever possible, provide consistent expectations and routines between home and school.

Many commercial programs are available that can help parents and school personnel develop specialized behavior management skills to support preschool children with AD/HD. These programs generally take place over at least several weeks and many of them require homework. The Project Achieve study used a “pre-packaged” parent education program called “Community Parent Education” ( Cunningham et al.) The support organization Children and Adults with Attention Deficit Disorder (CHADD) recommends several approaches for parent training. The CHADD organization offers the Parent to Parent education program that is extremely informative. For information about Parent to Parent in your area, visit the CHADD website. Another program mentioned in Attention! Magazine isParent Child Interaction Training (PCIT), a short term program for any preschool child experiencing behavioral challenges. People have reported success in supporting behavior at home with the “1-2-3 Magic” program by Thomas Phelan. This behavior management program is widely offered, sometimes through school districts and also published as a book.

Finally, I would strongly suggest that you obtain a copy of the CHADD Educator’s Manual (Zeigler-Dendy, Durheim, & Teeter Ellison) and share this with your child’s preschool. Chapter 6 is devoted to interventions for preschool children. One of our jobs as parents is to help educators become more aware of the challenges our children face.

Resources

Books

Phelan, T.W. 1-2-3 Magic, Third Edition1-2-3 Magic for Teachers. Available at: www.parentmagic.com

Zeigler-Dendy, C., Durheim, M, & Ellison, AT (2006). CHADD Educator’s Manual. Landover, MD: CHADD. Available at: www.chadd.org

Parent Education

Cunningham, C.E, Bremner, R.& Secord M. (1998) Community Parent Education Program. Ontario, Canada: Hamilton Heath Sciences Corp.

Parent Child Interaction Therapy (PCIT). University of Florida, Gainesville, FL. Information available at: http://pcit.phhp.ufl.edu/

Parent to Parent: A Family Training on AD/HD. Information available at: www.chadd.org When you get to the homepage, click on “Especially for: Parents.” You will be able to follow the links to find a teacher near you.

Triple P-Positive Parenting Program. Small changes, big differences, the University of Queensland, Australia. Information available at: :http://www1.triplep.net/

Articles

Lehigh University. Preschool ADHD: The Next Critical Public Health Concern.UR New Stories: 2295

Kern, L. DuPaul, J. Volpe, R.J., Sokol, N.G., Lutz, G, Arbolino, L, Pipan, M, VanBrakle, J.D. Multisetting Assessment-Based Intervention for Young Children at Risk for Attention Deficit Hyperactivity Disorder. Initial Effects on Academic and Behavioral Functioning. The School Psychology Review36. no.2. 237-55. June, 2007

National Institute of Mental Health. Preschoolers with ADHD Improve with Low Doses of Medication. Press Release. October 16, 2006. Available atwww.nimh.nih.gov

Neergaard, Lauren. Simpler, Nondrug Way to Treat Children with ADHD. Marin Independent Journal. Tuesday, September 4, 2007.

Wolraich, M. AD/HD: Can the Disorder be Diagnosed Before Children Enter Elementary School? Attention!. August, 2007


  • Is "Interactive Metronome" worth a shot?

Question:

I have a five year-old child with ADD or AD/HD characteristics. We have been working to help him through various solutions for at least two years. I do not feel encouraged about putting him on medication for many reasons, including his young age. I feel he is “high functioning”. My question to you is do you think “Interactive Metronome” is worth a shot? It is obviously costly, so I am trying to do plenty of research. I tried occupational therapy and other than a slight “calming” effect, I have not seen great improvement.

Many thanks. I appreciate your input.

Mary


Answer:

Dear Mary,

The Interactive Metronome (IM) is a computerized version of the metronome traditionally used to help musicians maintain a steady rhythm. The program, developed in the early 1990’s claims to be a neurological assessment and treatment tool that improves conditions such as:

  • Autism Spectrum Disorders
  • Sensory Integration Difficulties
  • Parkinson’s Disease
  • Motor sequencing and processing
  • Limb amputation
  • Multiple Sclerosis
  • AD/HD

Regarding AD/HD, the theory is that impulse control, motor control, ability to follow multi-step directions, and concentration are linked to motor planning and sequencing abilities. IM providers claim the rhythm and timing, influenced by the processes of motor planning and sequencing, are core neurologically-based skills that can be improved through practice because of brain plasticity.

The client is provided with headphones and hand and foot sensors. After hearing an auditory stimulus through a set of headphones, the client repeats the rhythm by appropriately tapping the hands and feet. Feedback about the immediacy of reproduction is provided through the headsets as the client taps. Visual feedback is also available. The training program includes a mininmum of fifteen one hour sessions with a certified IM instructor. Instructors can be occupational therapists, speech therapists, psychologists, or other trained providers. As you mentioned in your e-mail, the treatment is quite costly.

Interactive Metronome 
Photo from: www.handrightingink.com

Regarding efficacy, to date, two scientifically controlled studies have been completed supporting the success of IM as a treatment for individuals with AD/HD. In contrast, stimulant medication has been used to treat AD/HD for fifty years with over 200 well-designed studies demonstrating success with individuals who have AD/HD. The Interactive Metronome is generally viewed as a “promising” but unproven intervention for children with AD/HD (National Resource Center on AD/HD, WWK#6). This means that some well-designed research has been done that shows the intervention can be beneficial for children with AD/HD, but not enough to prove that this is a reliably effective therapy. Of course the choice to treat with medication is a decision best made by a parent with input from a medical professional.

Your concern about the use of medication in a young child is understandable. Medication for children under the age of six years is generally not recommended (Dendy, et al). The National Institute for Mental Health (NIMH) is currently sponsoring the Preschool AD/HD Treatment Study (PATS). Preliminary evidence indicates that appropriate first treatment for this age group is intensive behavior management coupled with parent training. For those children with moderate to severe AD/HD who do not respond, initial reports indicate that medication can be safe and effective.

I wish you the best in your search for treatment for your young son. In your search for treatment, you might want to consider the following resources:

 

Dendy. C. Editor. (2006) CHADD Educator’s Manual. Lynchburg, VA: Progress Printing

Phelan, T.W. (2004)1-2-3 MagicThird Edition and 1-2-3 Magic for Teachers. Parent Magic, Inc.

Interactive Metronome web references:

www.interactivemetronome.com

www.handrightingink.com

www.addsolutions.com

http://specialkidstoday.com/resources/articles/thebeat.htm


  • I keep getting calls at work about his behavior. Does this sound like AD/HD?

Question:

I have a 5-year-old son who is extremely bright however has some behavior issues at home as well as at school. He is a fast learner but has a short memory. For example, if I ask him to go wash his hands he will go into the bathroom and then immediately come out and say "What did you tell me to do?" At school, he just won't settle down when it is time to sit and follow the teachers instructions. He's very figity. However, I know he's learning because he is already reading and has a photgraphic memory. For example, the first time he saw the word “family” he spelled it once and then when I covered it up he spelled it correctly.

I keep getting calls at work about his behavior. What can I do? Does this sound like AD/HD?

Laura


Answer:

Dear Laura,

The symptoms you describe very well could represent AD/HD yet they could also be characteristics of many other conditions. If I were your son’s parent, I would request a full evaluation to look at any number of conditions that could be causing his difficulties, including, but not limited to learning disability, giftedness, depression, anxiety, and AD/HD.

This assessment can be completed by your school district. In California, parents may request an assessment and the district has an obligation to create an assessment plan within fifteen days of the request. I stress the words in writing. A simple verbal request will not do the trick.

The conditions mentioned above can be diagnosed by a school psychologist. After the assessment is completed, parents also have the right to request an independent assessment if they disagree with the assessment results. Neurologists, pediatricians, psychiatrists, and clinical psychologists are able to provide differential diagnosis for AD/HD. Of these, child psychiatrists have the most in depth background in other mental health conditions that sometimes mimic AD/HD.

Because your son is so young, a specific diagnosis may not be apparent at this time. Cognitive test scores do not stabilize until about age eight and children mature at different rates socially and emotionally. You may have to wait but you should document incidents that occur in case additional assessment needs to take place in the future.

If your son is found to have exceptional needs, even if these are not severe enough to qualify him for special education, he may be eligible for a behavior support plan that would specify interventions to take place for behavior problems. Having the school intervene to support appropriate behavior would provide relief from the potentially stressful experience of receiving calls about your son at work.

With the advent of IDEA 2004, California schools are in the process of transition. IDEA 2004 gave school districts to right to implement a new service delivery model designed to prevent serious academic and behavioral problems. As part of your assessment process, you should check to see if your son’s school is implementing the Response to Intervention (RTI) model. Steps for support will differ under this model than under the conventional approach. Your son may or may not be eligible for “Tier 2” interventions. These are interventions such as “social skills group” that take place in small groups rather than with an entire class. Eligibility is driven by documentation of past history including multiple office referrals, teacher request for assistance, and parent referral.

Additional information about assessment for AD/HD is available at:

Additional information about behavioral support is available at:


  • Test results may vary greatly with students with ADHD.

Question:

A psychologist concluded that ADHD was strongly supported due in part by scores on the following academic assessments:

WJR-III 5/5/04
 
Broad Reading SS: 70
Broad Math SS: 86
Broad Writing SS: 70
   
WIAT-II 12/1/04
 
Reading Composite SS: 61
Math Composite SS: 79
Written Language Composite SS: 71

I am concerned that the psychologist is drawing conclusions between two different tests, while similar, may be assessing different things, in addition to norms not being the same.

Do the statistical correlations between these two assessments demonstrate a sound comparison of skill level?

I understand that test results may vary greatly with students with ADHD. Were the above scores a demonstration of this characteristic?

Maureen


Answer:

Dear Maureen,

I am concerned that your letter may not include all of the information that the psychologist used to make the diagnosis. However, academic test scores alone definitely are not adequate to diagnose a student with ADHD.

Both the formal tests that you cited are “norm referenced” academic assessments. They are designed to measure academic achievement - defined as those skills and information that a student acquires in an academic setting in relationship to a student’s peers nationwide. Neither of these assessments purport to measure ability, aptitude, or cognitive processing. The manual for the WJ-III Tests of Achievement (WJ-III ACH) indicates that “An examiner can use the WJ-III ACH to determine and describe the present status of an individual’s academic strengths and weaknesses. Additionally, test results help determine how certain factors are affecting related aspects of development. For example, a weakness in phoneme/grapheme knowledge may interfere with overall development in reading and spelling.” Diagnosing mental disorders is not listed as a use for the WJ-III ACH.

The Wechsler Individual Achievement Test, Second Edition (WIAT-II) has a similar purpose. The manual for the WIAT-II states, “The WIAT-II is a comprehensive, individually administered test for assessing the achievement of children, adolescents, and college students… The WIAT-II measures aspects of the learning process that take place in the traditional academic setting in the areas of reading, writing, mathematics and oral language.”

In contrast, ADHD is classified as a “disruptive behavior disorder” in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). ADHD is described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development.” All of the criteria described are observable behaviors. Nothing in the criteria for ADHD indicates that the level of academic achievement, advanced, delayed or normal, is involved in the disorder.

Children who have ADHD often demonstrate characteristics that may be evident in their academic work. For example, one of the criteria in the DSM-IV suggests that child with ADHD, Inattentive type “often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities.” These careless errors may be evident in a student’s responses on either the WJ-III or the WIAT-II, but neither of these assessments provides a means to measure any degree of carelessness in order to diagnose ADHD.

The WIAT-II Examiner’s Manual reports that the assessment was administered to a sample of individuals diagnosed with ADHD and the results were compared with a control group. All means were in the expected range for individuals with ADHD. Although the means were within the average range, lower scores were reported on the Written Expression and Spelling subtests than in other areas.

The WJ-III has a cognitive component called the Tests of Cognitive Abilities (WJ-III COG). Some of the subtests in this battery may be useful for diagnosing ADHD but none is sufficient unto itself. The WJ-III Technical Manual cites research done to indicate that certain WJ-III COG subtests may correlate from slightly to moderately to other measures of attention. However, your question does not mention any WJ-III COG subtests. Whether WIAT-II scores correlate with WJ-III ACH scores is not relevant to the potential diagnosis of ADHD.

In summary, please refer to the link to “Previous Questions” at the Ask a Specialist website, for a complete description of what to look for in an assessment for ADHD. The response describes the guidelines for ADHD assessment published by American Academy of Pediatrics. These guidelines are a good place to start to evaluate if the assessment your child is receiving is thorough and appropriate.

 

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (2000) Washington, DC: American Psychiatric Association.

Mather, N. and Woodcock, R. (2001) Examiner’s Manual. Woodcock-Johnson III Tests of Achievement. Itasca, IL: Riverside Publishing

McGrew, K and Woodcock, R. (2001) Technical Manual. Woodcock-Johnson III. Itasca, IL: Riverside Publishing

WIAT-II Examiner’s Manual . San Antonia, TX: The Psychological Corporation (2002)

 


  • Is ADHD more prevalent among African-Americans?

Question:

I teach children who come from families with a primarily African-American background. They seem to demonstrate many more ADHD like behaviors than children of other ethnic groups with which I have experience. Is ADHD more prevalent among African-Americans?

A teacher at a recent ADHD workshop


Answer:

Thank you for your excellent question. Few research studies have been conducted comparing the incidence of ADHD in various US ethnic groups. Those that have been done indicate a similar incidence of ADHD among African-Americans, Hispanic-Americans and European-Americans in the United States (Office of the U.S. Surgeon General). One exception that I found was Dr. Russell Barkley who cites research indicating that prevalence may be higher among Puerto Ricans and children of military personnel. This research does not indicate that the incidence is higher among African-Americans than among the rest of the population.

Most sources I checked agreed that African American youth are two and a half times less likely than European-American children to receive a diagnosis of ADHD. According to the CHADD Educators’ Manual, one study also found lower use of medication in non-white youth. Just five percent of African-Americans and two percent of Hispanics in contrast with eight percent of Caucasians used medication to treat ADHD.

In contrast to their under-representation in ADHD diagnoses, African-American males are diagnosed with emotional and behavioral disorders at a higher rate than white males. One interpretation of these statistics is that students who might actually have ADHD are being placed in the category of “emotionally disturbed”. African-American children are also over-represented in arrests, detentions, and incarcerations. (Office of the U.S. Surgeon General). In general, children who do not receive treatment for ADHD are at high risk for developing criminal behavior. (Barkley) The general concern is that African-American children are not receiving optimal care for the conditions that they may have, not that ADHD occurs more frequently in that population.

There are several reasons why it might seem that there is a high rate of ADHD in your students. As discussed above, some of your students who have ADHD may not have been diagnosed with the condition. Secondly, although you do not mention your own ethnicity, it is possible that your communication style differs from that of your students.

Whenever professionals work with an ethnic group different from their own, we must be culturally sensitive. This requires education and effort on our part. Enid Lee, a leader in equity education addresses this question: “How do you tap into students’ cultures if you don’t know about these cultures and if they differ from yours? You might think that my first suggestion would be to learn as much as you can about the students’ cultures. This is important, but even more crucial is knowledge and assessment about your own culture.”

Various sources list specific communication styles of specific groups. A source for this type of information, Multicultural Students with Special Language Needs is listed in the Resources. However, I would like to share some of the tips given by Ms. Lee:

  • If we ourselves are members of the dominant culture we need to be aware of our tendency to think in “deficit” terms in relation to our own culture. As a first step, we need to check ourselves and ask “Is it really deficit? Or is it just different from what we consider normal?”
  • Ask ourselves, “Where can I look for that culture?” in order to learn more.
  • Most of us experience other cultures through the food and multicultural festivals. If we start there, we must look beneath these expressions of culture to ask “What is the meaning of these activities in the lives of the students and their families? What can they tell me about the prior experiences of this ethnic group? What does it indicate about my students’ interests and their goals?”
  • We can learn about our students’ culture through respectful interactions with their families and communities through getting to know these families and attending events in the community open to the general public.
  • We can continue to learn about the cultures through the literature and art of our students.
  • As we educate ourselves about our students’ cultures, Ms. Lee suggests the following guidelines:
  • Guard against the “deficit” lense. We risk perpetuating racism and limiting learning if we are not mindful of the ways in which the cultures of people of color are racialized and minimized.
  • Watch out for categorizing whole groups of people in a single word. Cultures change over time and vary over location. Ms. Lee suggests that we will be more accurate if we qualify our observations using terms such as “with this group of Native Americans, Latinos, etc. I have noticed this cultural pattern.”
  • Be open to learning from our students. They are a goldmine.
  • Honor our students’ families and communities as their first teacher.
  • Periodically renew our commitment to learn about the values and victories of our students and ways to incorporate these into our teaching.
  • Allow the joy of learning about our students’ and our own culture to shine on.

References:

Barkley, Russell.(2006) Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Third Edition. New York, New York: The Guilford Press

Delpit, Lisa. (1995) Other People’s Children: Cultural Conflict in the Classroom. New York, New York: The New Press.

Lee, Enid. Enid Lee Reader. Online at www.enidlee.com see “Questions to Enid Lee” and “Educating Children of African Ancestry in The United States of America, Canada, and The United Kingdom- A Select Bibliography”

Roseberry-McKibbin, C. (2002) Multicultural Students with Special Language Needs, Second Edition. Oceanside, CA: Academic Communication Associates.

Zeigler Dendy, C., Durheim, M., and Ellsion, A. (2006) CHADD Educator’s Manual on Attention-Deficit/Hyperactivity Disorder (AD/HD). Landover, MD: CHADD

Research regarding prevalence of ADHD cited here from the CHADD Educator’s Manual:

Office of the U.S. Surgeon General. (2001) Mental Health: Culture, Race. And Ethnicity, A Supplement to Mental Health: A Report of the Surgeon General.Washington, DC (author)

Rowland, A.S., Umbach, D.M, Stallone, l, Naftel, A.J. Bohlig, E.M. & Sandler, D.P. (2002) “Prevalence of Medication Treatment for Attention Deficit-Hyperactivity Disorder Among Elementary School in Children in Johnston County, North Carolina.” American Journal of Public Health, 92, 231-234.


  • ADHDs affect on "executive function."

Question:

My son has ADHD and is taking Ritalin. He is having problems with remembering his spelling words. He also has problems with writing the b,d & p he writes it the opposite way. He is 7 years old and attends a normal school. I had to make him repeat grade 1 because he was not coping with the work. He also has problems with math. In 2006 he progressed to grade 2.

Please help.

MALANIE


Answer:

Dear Malanie,

I am sorry to hear that your son is struggling in school. Although ADHD is not recognized as a learning disability in the California Education Code, it is a neurological condition that frequently affects learning, particularly in the area of “executive function.”

Depending on the level of severity of ADHD, medication may or may not “normalize” the child’s functioning. The Multi-Modal Treatment study, a well-known research study by the National Institute of Mental Health (NIMH) found that given the best clinically supervised medical and behavioral intervention, about 68% of students with ADHD were normalized. Most children with ADHD do not receive state-of-the-art treatment. This means that we can expect that at least 32% of our students with ADHD require additional support to function in the general education classroom.

To explain the concept of executive function, Dr. Thomas Brown of Yale University compares the brain to a symphony orchestra, where the musicians in the orchestra represent innate talents and abilities. The “musicians” or talents are present in the brain of the person with ADHD as in the typical brain. However, the typical brain has a conductor to coordinate the musicians so that the music is played clearly and on time. The conductor respresents executive function. The brain of the person with ADHD is lacking the critical direction to function in a coordinated manner.

There are many models of executive function. Dr. Brown has identified six components of executive function. Here is a brief explanation of each of these and how they affect school performance:

Executive Function

Definition

Implications for school performance

Activation

Organizing, prioritizing, and initiating tasks and activities

Trouble starting schoolwork. Procrastination on school tasks and homework.

Focus

Directing, sustaining and shifting attention

Easily distracted by noises or sights in the environment. Also distracted from completing tasks by internal thoughts.

Effort

Regulating alertness, sustaining effort, processing speed

Often have difficulty with sleep. May complete assignments more slowly than other students. Have difficulty sticking with work after starting.

Emotion

Managing frustration, anxiety and other emotions.

Easily frustrated when encounter difficulties in schoolwork.

Memory

Primarily short-term and working memory

Have difficulty holding things in mind while doing something else. In school, this particularly affects the areas of mathematics and written language.

Action

Monitoring and regulating actions once these have been initiated.

Difficulty monitoring their progress on long-term projects. Socially, often fail to notice their effect on others.

As you can see, children with ADHD often have significant difficulty with memory, which is a big factor in learning arithmetic facts and spelling words. The most prevalent learning disabilities for children with ADHD are written language and mathematics.

Since ADHD is not recognized as being a disability by the Education Code, many teachers do not realize the extent to which it can impede learning. Your child may be eligible for either special education, under the category of Other Health Impaired, or for accommodations in the general classroom under Section 504 of the Civil Rights Act. You might consider requesting an assessment to determine whether your son is eligible for either of these.

As a preliminary to requesting an assessment by the school district, consider sharing information with school personnel about how ADHD can affect learning. Two articles that I have found to be informative and accessible are:

Chris Zeigler-Dendy. “Five Components of Executive Function and How They Impact School Performance”, Attention! Magazine, February 2002, pps. 26-30.

Rosmary Tannock and Rhonda Martinussen. “Reconceptualizing ADHD”, Educational Leadership, Vo. 59. #3. November, 2001.

The websites listed below will also be helpful for informing teachers:

Dr. Thomas Brown
http://www.drthomasebrown.com/brown_model/index.html

Chris Ziegler-Dendy
http://www.chrisdendy.com/executive.htm

Children and Adults with Attention Deficit Disorder (CHADD)
www.chadd.org


  • Why is ADHD seen so much more frequently in the United States than in other countries?

Question:

Why is Attention Deficit Disorder seen so much more frequently in the United States than in other countries? Is the incidence increasing or is it just being diagnosed more?

Fifth grade teacher


Answer:

Many educators and parents have wondered if the incidence of AD/HD is increasing. Our perception often suggests that this is the case. However, research about the incidence of AD/HD among children has been inconclusive, with studies suggesting a range of incidence from 1% to 18%. This is because there is not a standardized research protocol for reporting the incidence of AD/HD. Thus, determining whether the incidence is increasing is difficult.

Well-known researcher, Dr. Russell Barkley, has detailed the differences that can occur in reporting due to the type of criteria used in any given report. Variations in the prevalence of AD/HD can occur due to differences in the ways in which samples are chosen, the criteria used to define AD/HD, and the age range and gender composition of the sample. For example, lower rates of AD/HD are reported when the full DSM-IV criteria and parent reports are used and higher rates are reported when teacher only reports are used. The DSM-IV or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, is the book used by mental health professionals to diagnose mental health disorders.

One of the more reliable studies was conducted in 2005 by the U.S. Center for Disease Control (CDC). This survey looked at the number of children reported by their parents in 2003 to have or ever have been diagnosed with AD/HD. The CDC found that the prevalence of AD/HD was about 7.8% nationally but varied quite a bit across socio-economic groups and geographic location. The lowest incidence of 5% was reported in Colorado and the highest, of 11% was reported in Alabama. California, at 5.34 % had one of the lowest reported incidence. This same report indicates that only about half of those children ages 4-17 years diagnosed with AD/HD actually took medication for AD/HD. The highest prevalence for medication treatment was in children aged 9 to 12 years.

In contrast, the incidence of adults taking medication for AD/HD has been increasing. A 2005 study by Medco Health Solutions found that the number of adults taking prescription drugs for AD/HD more than doubled from the years 2000 to 2004. One of the reasons for this increase may be than many people who began taking medication for AD/HD as children are now young adults. Even with the increase, only about 1% of the adult population takes medication to treat AD/HD.

Prevalence of reported AD/HD symptoms increased with age and was highest for males aged 16 years and females aged 11 years and lowest for preschool children. The highest rates were noted among English-speaking, non-Hispanic, and insured children. In addition, the rates were most prevalent in families in which the most highly educated adult had a high school diploma and lower in those families in which the most educated adult had more or less education than a high school diploma. Families with incomes below the poverty line were also more likely to report a child with AD/HD.

Studies of the incidence of AD/HD worldwide present a similar conundrum. The design of the studies are not the same, therefore, the results are not reliably comparable. However, the most reliable authorities describe a similar incidence world-wide. For example:

  • 3.8% among Dutch children, by parent report
  • 5.3% among Chinese children ages 6-11 years, using teacher ratings
  • 14.9% among primary school children in the United Arab Emirates, using teacher ratings
  • 19.8% among Ukranian children based on parent ratings of DSM-IV symptoms

Hope this helps to provide some perspective for you on the mystery of AD/HD.

Resources:

Centers for Disease Control and Prevention (2005) Prevalence of Diagnosis and Midication Treatment for Attention-Deficit/ Hyperactivity Disorder – United States, 2003. Morbidity and Mortality Weekly Report. September 2, 2005; vol.54, No. 34: pp. 842-847.

Barkley, Russell (2004) Attention-Deficit. Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity. American Psychological Association

Barkley, Russell (2006) Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Third Edition. New York, New York: Guilford Press

Hitti, M and Smith, M. ADHD Drups: Adult Use Doubled in 4 Years. MedicineNet.com. http://www.medicinenet.com/script/main/hp.asp

National Resource Center on AD/HD. http://www.help4adhd.org/en/about/statistics

St. Sauver,J. Mayo Clinic Proceedings, September 2004; vol 79: pp 1124-1131


  • Accommodations for the SAT.

Question:

My son wants to take the SAT this year. He is a senior at a small school for students with learning disabilities. His disabilities are Attention Deficit Disorder and Dysgraphia. The school does not offer any SAT prep classes and I am concerned he would just not be able to handle the test or the time required to  focus while taking the test. I understand the accommodations that are available. We need for him to be familiar with the test and the time involved. The school is also unable to suggest anyone who can tutor him. It is a Non- Public School funded through our District, who also does not have any suggestions for test prep for their NPS students.

Where can we go for assistance to help him prepare for this test which he will take in a few months? We live in the Claremont, CA. area. He is an excellent reader and speller, limited math skills and very limited ability to use a pen (dysgraphia), great difficulty studying, doing homework is a nightmare F on report cards for work,  he takes the classroom tests and earns A's.  F in homework  A's on test equals C and D on report cards.

Any information you can share with us would be much appreciated.

Thank you,

Chris


Answer:

Dear Chris,

You mention that you are familiar with the possible accommodations for the SAT’s. For readers who may not be so up to date, SAT accommodations are grouped in four areas. Examples include:

Presentation

  • Large print (14 pt; 20 pt)
  • Fewer items on each page
  • Reader
  • Colored paper
  • Use of a highlighter
  • Sign/orally present instructions
  • Visual magnification (magnifier or magnifying machine)
  • Auditory amplification
  • Audiocassette
  • Colored overlays
  • Braille
  • Braille graphs
  • Braille device for written responses
  • Plastic covered pages of the test booklet

Responding

  • Verbal; dictated to scribe
  • Tape recorder
  • Computer without spell check/grammar/cut & paste features
  • Record answers in test booklet
  • Large block answer sheet

Timing/Scheduling

  • Frequent breaks
  • Extended time
  • Multiple day (may/may not include extra time)
  • Specified time of day

Setting

  • Small group setting
  • Private room
  • Screens to block out distractions
  • Special lighting
  • Special acoustics
  • Adaptive/special furniture/tools
  • Alternative test site (with proctor present)
  • Preferential seating

Extensive information about eligibility for accommodations and the procedure to apply is available at the College Board website. In order for your student to qualify, he will need to show that he has received accommodations for testing in school. Since your student has dysgraphia, you may also be considering computer accommodations for the essay on the SAT Reasoning Test. Dysgraphia is one of the three impairments that are eligible for computer accommodations. The others are physical disabilities and severe learning disabilities. Poor handwriting does not automatically qualify a student for computer accommodations. Dysgraphia will only be considered when due to a documented fine motor impairment, so be sure that your son’s dysgraphia is well-documented. Refer to:http://www.collegeboard.com/ssd/student/index.html

The College Board website also contains resources for preparing for the test including a SAT calendar with daily sample questions, a study guide with sample questions, and an online course that students can take at their own pace.

Schools are not required to provide instruction on SAT test-taking strategies. Most parents, including those of typical students, hire professionals privately for instruction in taking the SAT. A popular resource is Kaplan Test Prep and Admissions. Kaplan offers both small group and one-to-one tutoring to teach test-taking strategies for the SAT. With individual attention, you and your son would be able to tailor instruction to his needs. Information about Kaplan Test Prep, including private tutoring and locations is available at: www.kaptest.com

If you decide to hire privately, consider a professional ADHD coach with experience in preparing high school students for the SAT. Just as the physician manages the biological aspects of ADHD, and the psychotherapist can help with social and emotional difficulties, the ADHD coach provides support with practical daily life problems.

The ADHD coach helps students with organizational and time management issues that may impact their performance on the SAT. College students who are away from home for the first time, often encounter difficulty in managing everyday life activities such as completing chores like laundry and keeping track of appointments and events. Most ADHD students rely on parents to structure these activities during high school. When that support is removed, some students experience difficulties. One advantage of using a coach now to help with SAT test-taking strategies is that your son may establish a relationship that could continue into college. The International Coach Federation (ICF) has a Coach Referral Service as well as information on finding the right coach and is found online at:www.coachfederation.org

The Educational Consultant is another type of professional often hired by families to help with college decisions. The Independent Educational Consultant Association (IECA) is a professional organization that provides consultants nationally. The Educational Consultant works with the family to teach the student self-advocacy skills that the student must use independently in college and is knowledgeable about schools and admissions processes. Educational Consultants can be contacted at: http://iecaonline.com/parents_learn.html

Additional Resources:

Bozak, S. Choosing an Educational Consultant. Attention! Magazine, October, 2001. 23-24.

Goldberg, R.L. The Transition to College for Students with LD and AD/HD: The Educational Consultant’s Role. IECA Insights, June-July 2004, 6-8.

Novash, P. Obtaining Extended Time on College Entrance Exams. Attention! Magazine. August, 2006, 36-39.

Quinn, P., Ratey, N. & Maitland, T. (2000) Coaching College Students with AD/HD. Silver Spring, MD: Advantage Books.

Young, J., & Giwerc, D. Just What is Coaching?. Attention! Magazine, December, 2003, 36-45.

For your son:

Mooney, J. (2000) Learning Outside the Lines: Two Ivy League Students with Learning Disabilities and ADHD Give You the Tools. New York: Simon and Schuster.