Ask the Child Psychologist

Category: ADHD

Strategies to help child with ADHD succeed

In my previous blog post, I discussed ways a parent can access school accommodations for a student diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Now, I will discuss some strategies that can be a part of a Section 504 plan or an Individualized Education Plan (IEP).

These tools also can be utilized by classroom teachers without a formal plan. Be aware that each child is unique and the evaluation by a multi-disciplinary team or a psychologist should help identify the specific challenges resulting from having ADHD. Once we have a good understanding of a child's needs, we can come up with appropriate interventions to help.

Here are some common accommodations that can help students with ADHD:

• Preferential seating: The child can be placed in close proximity to the teacher to help maintain eye contract and keep the child on task. Often a verbal or physical cue can be created by the teacher and student to remind the child to stay focused.
• Extra set of books: For children who are chronically forgetful, the school can sometimes provide an extra set of books that stay at home.
• Allow breaks: Some children have a very difficult time staying in their seat and might do better if they get breaks to move around the back of the class or be allowed to have an object to hold (some examples include a Koosh Ball, Silly Putty, two pieces of Lego).
• A clear communication plan between the parents and teacher: Because many children with ADHD are forgetful and disorganized they may not be so reliable when asked if they have homework or whether they brought home necessary supplies. Many schools now have parent online access programs where homework and grades are posted. Other teachers have a Web page or a blog detailing work. In other cases, a system over e-mail or notes in a planner can be helpful.
• Plan to teach organization skills: Several kids with ADHD-related challenges will have very messy desks and lockers. In fact, when I am assessing for ADHD I will ask what the child's desk, backpack and locker look like. Some kids need a weekly time when a parent, teacher or even a peer helps reorganize the child's desk or locker. Papers can be purged and corrected papers filed in color coded folders.
• Modified assignments: In some cases where a child has extreme difficulty sustaining attention, assignments can be shortened. For example, a teacher may only require the child to do odd number problems. Another option would be to break up larger assignments into smaller ones. Usually, the teacher can be helpful here.
• Create a home daily report card: A few goals can be established such as staying at his/her desk and following directions. Depending on the child's age and ability, the teacher and child can rate how they did. The child can earn points on the card to earn rewards from a menu either given out at home or school. Rewards could include extra free time, chance to do a job, or free choice of a dessert when they get home.
• Self monitoring: The child can be trained to observe his behavior during segments of time and record this on a card. Sometimes a tape recording of nonintrusive beeps can run that cues the child to check on his behavior.

These ideas are far from exhaustive and just scratch the surface of the many ways we can help students with ADHD succeed in school. Maintaining a good working relationship and open communication with your child's school can help tremendously. Additionally, many great resource books are available with educational strategies and ideas.

Family conference on Nov. 8
Sandra Rief, M.A., will be highlighting this year's Anita Naftaly Jewish Family Circle Conference on Nov. 8 in Southfield, which is open to the public. Rief has written several extremely helpful books, including a best-selling ADHD book called, "How to Reach and Teach Children with ADD/ADHD". By utilizing resources and developing strategies we can make sure all children with ADHD can have every opportunity to succeed.

Category: ADHD

Parents can work with schools to make accommodations for ADHD

Kids with Attention Deficit Hyperactivity Disorder (ADHD) can face many challenges and many have to do with school and education. One of the many ways we try to help these students is through environmental accommodations.

Using environmental accommodations, teachers and parents make changes in some of the ways the student is taught. For example, some students with attention difficulties may do better sitting closer to the teacher and/or in the front of the class. This is called preferential seating. In other cases, a behavioral modification plan might be needed to encourage positive behavior.

In some situations, a parent can ask the teacher to help make some of these changes. In many cases where the ADHD is having an impact on the child's ability to learn, the parent can request an evaluation by the school to determine if the child would qualify for formal accommodations. The way this process usually begins is by a parent putting in a written request asking for an evaluation to be completed. In some cases, the school may initiate the process with the parents. If the primary diagnosis is ADHD, a written letter from the diagnosing physician is also helpful. This gets the ball rolling and will lead to an invitation for a parent meeting at school to discuss the request or to sign forms to begin the evaluation process. Once the school has agreed to complete the evaluation, it has 30 school days to complete its work (in other states they may have up to 60 days).

There are two main types of plans a parent and/or school can seek, either a Section 504 plan or an individualized education plan (IEP). Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits discrimination based on disability. ADHD is included as a disability if the impairment substantially limits a major life activity such as the child's education. An IEP is rooted in the Individuals with Disabilities Education Act (IDEA), which was written to ensure all children receive a "free and appropriate education" while meeting some of the unique needs of children.

To receive formal accommodations, the child has to be qualified by the school through documentation at the school. A request by a parent does not guarantee qualification nor can a school qualify a student without permission from the parents. Evaluations can vary from some observations and behavioral data to more formalized psychological testing to determine if there are learning problems. Once the process is underway, the school's team of professionals should work with you to determine what tests are necessary.

In general, I find most schools to be cooperative in working with the parents I see in seeking the accommodations for their child. The best approach is to maintain a positive working relationship. If a parent is experiencing difficulty with the process, he may choose to find an educational advocate who can help navigate the system and look out for what is in the child's best interests. Some great educational resources in this area include the Citizens Alliance to Uphold Special Education (CAUSE), which offers classes for parents on school advocacy and other great resources and bridges4kids.org. On the national level, Pete Wright, one of the nation's leading experts on educational advocacy, has a Web site, Wright's Law, that is full of very helpful information.

Once the child has qualified for services, a variety of accommodations can be explored to help the child. For kids with ADHD who are chronically disorganized, an extra set of books for home can be provided, modification on assignments, tests administered orally or in small groups, copies of teacher notes and study skills classes are just a few examples. In my next blog post, I will go into much more detail on possible school strategies and interventions for kids with ADHD and learning differences.

Family conference on Nov. 8
There is also a terrific speaker coming to town in November whose expertise is in providing practical strategies in helping kids in this area. Sandra Rief, M.A. will be highlighting this year's Anita Naftaly Jewish Family Circle Conference on Nov. 8 in Southfield, which is open to the public. Rief has written several extremely helpful books including a bestselling ADHD book called, How to Reach and Teach Children with ADD/ADHD. If you have a child who is challenged in school due to ADHD, I encourage you to consider attending the conference.

Category: ADHD

ADHD conference a boost for patients, parents

Michael Golds was a young man with many special talents and great potential that was only beginning to be realized. He was a master diver and a pilot. He had been accepted into a graduate program at the Florida Institute of Technology. However, for many years academics were a challenge - until he was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and began receiving treatment.

He enrolled in Project Bold at Oakland Community College in Farmington Hills, a specialized program that provides support to students with ADHD, and learned the strategies he needed to become a successful college student. He went on to earn a BA from Eastern Michigan University. While he was working at an airport in Florida, he was killed in a freak accident.

In his memory, his parents, Barbara and the late Dr. Jack Golds, created the Michael Golds Memorial AD/HD Conference, bringing together parents, educators and professionals to inspire those affected by ADHD and learn about the latest in ADHD assessment and treatment. The annual conference, which began in 1999, has grown to more than 350 participants. This year's conference is scheduled for Oct. 2 at the Orchard Ridge Campus of Oakland Community College. Over the years, so many of the parents I work with have attended and found the presentations and event to be very informative and worthwhile.

This year, the keynote speaker will be Dr. Michael Ginsburg. Dr. Ginsburg was raised in southeastern Michigan, went on to Stanford and the University of Michigan Medical School. He will share his inspiring story of how he faced his own challenges with ADHD and what he learned that can help others.

Following Dr. Ginsburg's talk, participants will be able to choose from a broad variety of breakout sessions addressing different issues that children, adolescents, adults with ADHD as well as and parents might face. Topics address areas such as defiant behavior, organizational skills, relationships, sleep, parenting, current and alternative treatments, medication, lesbian/gay/bisexual/transgender issues, learning difficulties and a panel discussion of learning specialists and students with ADHD. The lineup of speakers includes some of the top professionals in our community.

Beyond the various sessions is the opportunity for people to interact with one another and connect with parents facing similar issues. So often, I hear from parents how they feel so isolated or judged and others do not understand the challenges they are struggling with. For those who are directly or indirectly effect by ADHD, I hope you will consider joining me on Oct. 2.

For more information about the Michael Golds Memorial AD/HD Conference or to register, call 248-522-3645 or visit the conference Web site.

Category: ADHD

ADHD medication study prompts more debate about safety

Recently, a new study was published in the American Journal of Psychiatry associating stimulant medication with sudden, unexplained death in children and adolescents. The study made headlines in local and national media and raised the concern of parents whose children take these medications for the treatment of Attention Deficit Hyperactivity Disorder (ADHD).

The issue of prescribing medications to children and adolescents can elicit strong reactions from people. Some in the media do not help this issue by sensationalizing the various aspects of this tough decision or encouraging sound bite debate between people with strong opinions. Just last week on a major cable news network, I watched a physician and a reporter each given 30-second intervals to debate the merits of medicating children. For the children and adolescents who are considered for medication or already taking something, the decision is usually much more complex. Over the years, I have watched medications dramatically change many children for the better and I have seen children enter a challenging process of trial and error with multiple medications with little benefit. The question to medicate a child or adolescent should be a collaborative decision made between parents and the treating physician based on an appropriate assessment, medical history and sound research.

In the case of the American Journal of Psychiatry study, both the Federal Drug Administration (FDA) and the American Academy of Child and Adolescent Psychiatry (AACAP) have pointed out some of the limitations of the study, which were acknowledged by the authors in the publication. Concerns have been raised about the study including not demonstrating a causal relationship between the medications and sudden death as well as research flaws. The FDA and AACAP have concluded not to change any of their recommended evidenced based practices in the medical treatment of ADHD. So you are aware, current FDA recommendations when considering stimulant medication includes a thorough medical history for cardiovascular disease in the child and family and a physical exam with special focus on the cardiovascular system.

When studies like this one are announced, my strongest recommendation is to talk to the physician managing the medication. Openly discuss any concerns that are raised and ask your questions. Ask the doctor more about this study or other issues you might come across in the media. There is a ton of information and misinformation on the Internet. By talking with professioanls, you can gain a more thorough understanding of the medications and help reach decisions that are truly in the best interests of your child.

Category: ADHD

Use professionals for proper ADHD diagnosis

Attention Deficit Hyperactivity Disorder (ADHD) is one of the challenges that I often come across in my practice. This is no coincidence as ADHD is thought to be one of the most common childhood disorders, believed to be found in at least 3 percent-6 percent of school-aged children.

A child with ADHD is going to have a significant impairment in at least one of three core areas: sustained attention, impulse control and/or hyperactivity. I am often asked if ADHD is overdiagnosed. As a mental health professional, I'm more concerned that children are properly diagnosed.

To date, there is no single test to determine whether a child has ADHD. Instead, the child should be evaluated by a qualified professional who can use a variety of methods. A good assessment begins with a thorough interview with the parents, child and teacher(s). A family history of mental health should be taken. Parents and teachers should be asked to complete behavioral rating scales. Classroom observations can be helpful to get a sense of the child in his learning environment. A review of the child's school records is important. The child should have a physical with his pediatrician to make certain other medical reasons are not producing ADHD-like symptoms. Hearing, speech and vision are sometimes evaluated as well. Intelligence and achievement testing can help indentify learning problems that often accompany ADHD or can even cause symptoms that look like ADHD.

Often you can request your child's school to complete the intellectual and achievement testing at their cost. However, a school cannot make a diagnosis and its findings should be integrated by a qualified outside professional. The clinician should evaluate how the symptoms manifest for the child in home, academic and social settings. He or she is trying to see if there are alternative explanations for the symptoms or there may be a co-existing problem.

Professionals who can assess for ADHD include pediatricians, clinical psychologists, nurses, neuropsychologists, social workers, psychiatrists and neurologists. Whichever professional a parent chooses should be well trained in comprehensive ADHD assessment. Additionally, a good professional will give you a detailed explanation of the testing that is being conducted and give you specific feedback and recommendations when the evaluation is complete.

Many terrific resources exist online that can provide much more information as I'm just scratching the surface. One is the National Resource Center on ADHD that was created by a cooperative between a group called CHADD and the Centers for Disease Control and Prevention. CHADD is a national organization created by parents to support those affected by ADHD. It has many local chapters around our area.