Tag Archives: Children

How is ADHD Treated? Psychotherapy and Parent Strategies

Psychotherapy

Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

How can parents help?

Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of “time-outs” may be used when the child’s behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.

Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child’s strengths and abilities. They may also learn to structure situations in more positive ways. For example, they may restrict the number of playmates to one or two, so that their child does not become overstimulated. Or, if the child has trouble completing tasks, parents can help their child divide large tasks into smaller, more manageable steps. Also, parents may benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child’s behavior.

Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups typically meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Tips to Help Kids Stay Organized and Follow Directions

Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.

Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.

Use homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.

Be clear and consistent. Children with ADHD need consistent rules they can understand and follow.

Give praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.

 

 

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How is ADHD diagnosed?

Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children or seems constantly “unfocused” or “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.

No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood brain disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.

Between them, the referring pediatrician and specialist will determine if a child:

  • Is experiencing undetected seizures that could be associated with other medical conditions
  • Has a middle ear infection that is causing hearing problems
  • Has any undetected hearing or vision problems
  • Has any medical problems that affect thinking and behavior
  • Has any learning disabilities
  • Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
  • Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.

A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.

The specialist also will ask:

  • Are the behaviors excessive, and do they affect all aspects of the child’s life?
  • Do they happen more often in this child compared with the child’s peers?
  • Are the behaviors a continuous problem or a response to a temporary situation?
  • Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?

The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.

Finally, after gathering all this information, if the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

What Causes ADHD?

Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.

Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.4,5 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.

A study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.6

Researchers are also studying genetic variations that may or may not be inherited, such as duplications or deletions of a segment of DNA. These “copy number variations” (CNVs) can include many genes. Some CNVs occur more frequently among people with ADHD than in unaffected people, suggesting a possible role in the development of the disorder.7,8

Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.9,10 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, have a higher risk of developing ADHD.11

Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.

Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.12 In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.13 Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.14

In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children received aspartame.15

Food additives. There is currently no research showing that artificial food coloring causes ADHD. However, a small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. They may experience fewer ADHD symptoms on a diet without additives, but such diets are often difficult to maintain.12,16

Symptoms of ADHD in children

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Children who have symptoms of inattention may:

  • Be easily distracted, miss details, forget things, and frequently switch from one activity to another
  • Have difficulty focusing on one thing
  • Become bored with a task after only a few minutes, unless they are doing something enjoyable
  • Have difficulty focusing attention on organizing and completing a task or learning something new
  • Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
  • Not seem to listen when spoken to
  • Daydream, become easily confused, and move slowly
  • Have difficulty processing information as quickly and accurately as others
  • Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

  • Fidget and squirm in their seats
  • Talk nonstop
  • Dash around, touching or playing with anything and everything in sight
  • Have trouble sitting still during dinner, school, and story time
  • Be constantly in motion
  • Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

  • Be very impatient
  • Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
  • Have difficulty waiting for things they want or waiting their turns in games
  • Often interrupt conversations or others’ activities.

ADHD Can Be Mistaken for Other Problems

Parents and teachers can miss the fact that children with symptoms of inattention have ADHD because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, whereas children who have more symptoms of hyperactivity or impulsivity tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive symptoms just have disciplinary problems.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

ADHD: Yesterday, Today and Tomorrow

ADHD- Yesterday, Today and TomorrowAttention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in children and adolescents. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and very high levels of activity. Studies show that the number of children being diagnosed with ADHD is increasing, but it is unclear why.

Yesterday

  • ADHD was seen as a behavioral disturbance caused by environmental factors, such as inconsistent parenting.
  • Methods to study brain development in people with ADHD were not available.
  • ADHD was treated with immediate-release stimulant medications such as methylphenidate (e.g., Ritalin), which worked well but only lasted for a few hours. Children needed multiple doses during the day, disrupting their school schedules and daily activities.

Today

  • Using brain imaging technology like magnetic resonance imaging (MRI), scientists have observed that in some children, ADHD may be related to how the brain is wired or how it is structured. For other children with ADHD, brain development follows a normal but delayed pattern. In some regions, development is delayed by an average of three years compared to children without the disorder.
  • The delay appears to be in the frontal cortex, a part of the brain that supports the ability to suppress inappropriate actions and thoughts, focus attention, remember things moment to moment, work for reward, and plan ahead. In contrast, the motor cortex—the area that controls movement—tends to mature faster than normal in children with ADHD, an exception to the pattern of delay. This mismatch in brain development may account for the restlessness and fidgety symptoms commonly associated with ADHD.
  • Findings from the Preschoolers with ADHD Treatment Study (PATS) indicate that using a very low dose of methylphenidate (e.g., Ritalin) to treat children 3–5 years old diagnosed with severe ADHD can be effective. However, for some very young children, early behavioral interventions designed to reduce their ADHD symptoms may be effective alternatives or additions to medication treatment.
  • Preschoolers with fewer than three coexisting disorders were most likely to respond to methylphenidate treatment, whereas those with three or more coexisting disorders did not respond to the treatment.
  • Different types of psychotherapy are effective in treating ADHD. Behavioral therapy helps teach practical skills such as how to organize tasks and manage time to complete homework assignments. It also helps children work through difficult emotions. Therapists also teach children social skills such as how to wait their turn, share toys, ask for help, or respond to teasing.
  • Studies show that interventions that include intensive parent education programs can help decrease ADHD problem behavior because parents are better educated about the disorder and better prepared to manage their child’s symptoms. They are taught organizational skills and how to develop and keep a schedule for their child. They are also taught how to give immediate and positive feedback for behaviors they want to encourage, and how to ignore or immediately redirect behaviors they want to discourage.
  • The Multimodal Treatment Study of Children with ADHD (MTA study) is helping to inform long-term treatment decisions. For example, MTA researchers found that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs. As children with ADHD mature, treatment decisions should adapt to the demands of adolescence and take into account long-term academic and behavioral problems commonly associated with ADHD.
  • ADHD likely stems from interactions between genes and environmental or non-genetic factors. Several genes have been implicated in the risk for developing ADHD. One study showed that brain areas controlling attention were thinnest in children with ADHD who carried a particular version of a gene associated with brain development. However, these brain areas normalized in thickness during the teen years, coinciding with clinical improvement. Although this particular gene version increased risk for ADHD, it also predicted better clinical outcomes and higher IQ than two other versions of the same gene in youth with ADHD.

Tomorrow

  • Research continues in the search for innovative methods to treat ADHD and may someday offer more options for children who cannot take stimulant medications or who do not respond to them. For example, researchers are looking for ways to improve psychosocial treatments that combine behavioral and cognitive therapies.
  • Other research is focused on neurofeedback, an activity in which a person receives information about the frequency of his or her EEG brain waves while undergoing a task such as playing a video game. The person can then be trained to bring these frequencies into a range associated with healthy brain function, which theoretically can lead to improved behavior.
  • ADHD symptoms may decline for some children as they grow up. But others may face continuing problems. A recent study found that adults with untreated ADHD have higher than average rates of divorce, unemployment, substance abuse, and disability. Also, while many adults with ADHD receive treatment for other mental disorders or substance abuse, a smaller proportion receive treatment for their ADHD symptoms.
  • More studies are needed to assess the effects of ADHD over the lifespan and to find better ways to diagnose and treat ADHD in adults, with a special focus on improving functioning.

 

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ADHD Fact sheet from NIMH – NIMH publications are in the public domain and may be reproduced or copied without permission. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml#part_145450

ADHD Websites

ADD websites    Non-profits    Starter Information   Popular sites
1 ADHD Websites- Salvatore Vuono-fdp

“The most important things we can offer Children & Adults with ADHD are Love, Acceptance, Respect & Empathy… In the absence of these things, all of the Other things you do are unimportant” – Sam Goldstein

 

Center for Disease Control and Prevention ADHD section. Attractive, ADD-Friendly format- complete, but concise- offers basic information about ADHD and children, but provides links to help you find out more. (Mostly to CHADD or the National Resource Center)

 

 

NON-PROFIT ORGANIZATIONS

CHADD  CHADD stands for Children and Adults with ADHD. CHADD has a national headquarters and approximately 200 local chapters that hold monthly meetings and offers a professional directory (with paid listings.) They provide a wealth of free information on both their own site and link to The National Resource Center for ADHD for even more. Please note: CHADD now offers an Accessibility and Language option that includes text-to-audio in any language as well as many other features.  Look for it on the top right-hand corner. Pressing the link brings up Recite me, an amazing tool! Note: You can also email or talk to a resource specialist to get personalized help.

CHADD National puts on a large annual international conference and publishes the bi-monthly magazine Attention – (One of many membership benefits which include access to their many members-only articles – Individual or family, $5 a month or $53 yearly) Free monthly e-news. Find online support CHADD’s Parent Support group on Health Unlocked

ADDA – ADDA stands for the National ADD Association for Adults. They send out e-mails to keep you up-to-date and feature a Professional Directory. Collecting personal stories from readers and offering Virtual Peer Support.  Webinars are Free for Members ($50 a year or $5 a month) or $10 each.

Attention Deficit Disorder Association Southern Regions  Very active in Texas! Many volunteers help support their work and can offer information in areas they cannot serve with a support group. Good variety of articles both posted and linked.

 

STARTER INFORMATION

Children

Healthy Children’s ADHD section features a number of articles from 3 paragraphs to 3 pages long. Topics cover a number of general as well as more specific concerns for ages 3-18 – From the American Pediatrics Association

Kids Health -The #1 most-visited website for children’s health and development. – The Nemours Foundation sponsors a website for Parents, Kids and Teens – each has their own section. Covers any and all aspects of children’s health concerns. Available in Spanish and you may add audio to most articles if reading is a problem. Use the Search option- Just type in ADHD– or just start browsing for other concerns.

ADHD Resource Center from the American Academy of Child and Adolescent Psychiatrists – Includes Facts for Families with up-to-date information, video clips plus an eBook. Copy and paste link: https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/Home.aspx

 

Children and Adults

Help Guide.org is a site founded by the Rotary Club International. (Link works) They have a quite a good ADHD section,  but they also address MANY other concerns of modern life – Mental and Emotional Life, Family and Relationships, Healthy Living, Seniors, and Aging.

The Times Health Guide: Attention Deficit Hyperactivity Disorder. Good overview with additional articles and Q&A with Russell Barkley, Ph.D. – Start here!  ADHD Patient Voices3-minute podcasts with slide shows for 8 children, teen, and adult speakers.

POPULAR ADHD SITES

ADDitude.mag – A complete site sponsored by ADDitude Magazine, a national bi-monthly magazine for the ADHD community. Short, pertinent articles address a host of AD/HD concerns. Learn about family support options for Attention Deficit Disorder as well as many topics specific to adult issues. Just added a Networking section to their site – with Forums, Blogs, Videos and listings for nationwide ADHD events – Great targetted newsletter -Choose your concerns

ADD About.com – Keath Lowe moderates the site, keeps a Blog, sponsors a Forum and expands the site every day- Up to date and easy to read- Their Coping with ADHD section has a wonderful selection of on-point and useful information.

Totally ADD! for adults –  Some pretty good Information and a lot of just plain fun. Quick videos address a number of common concerns of adults with ADD. Blog and ADHD screening tools- Constantly adding more videos and now providing  FREE Webcasts– (recorded and available for view anytime)

Health Central.com / ADHD Central– Recently rewritten. Solid, relateable information with recommendations for other sites and ADHD advocates.

Web MD has a large section devoted to ADHD. Copy and paste: http://www.webmd.com/add-adhd/default.htm –  They offer a very well-organized and informative overview of the disorder. Articles are generally short and somewhat impersonal, but they’ve tried to cover it all. They even have Videos (prefaced with short ads- indeed many videos are advertisements themselves for supplemental treatments), keep up-to-date on ADHD news, and monitor an online community.

Healthy Place.com – Another good starting place- ADHD section addresses a number of common concerns and needs. Most are short, introductory articles, but they cover a  number of topics.

 

ADD freeSources

ADHD – ADD freeSources on Pinterest – Over 15,000 Pins featuring articles, images and other commentaries on ADHD and related topics.  Choose from 90 boards.  They offer tailor-made information for parents, adults with ADHD,  professionals as well as for children and teens.

ADD freeSources on Facebook – If Facebook is more your cup of tea, we post our favorite articles twice a day.

 

See Find ADD Support for more on-line support communities.

 

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Encouraging Self Advocacy in Teens

Tools to help students with ADHD discover their strengths and learn to ask for help to overcome their difficulties.
During their younger years, it is the parents responsibility to speak up for his or her child to get their needs met at school. However, as  therapist Louise Levine writes,

Doing everything for your children may make you feel like a successful parent but it may not let your child be a successful person.”

“Before children leave the protective shelter of home and zealous parenting, we need to help them practice basic techniques and instill competencies that will enable them to:

Feel comfortable conversing about their disability,…

Identify their warning signs,…

Advocate for themselves,…

(Have systems in place that)… will help them…manage their lives, and

Have a sense of humor about ADHD….and their own particular foibles.” (1)

For all children, the ability to view the future with hope is central to their future success. According to the Gallup Student Poll, hope, engagement and well-being are all factors that have been shown to drive students’ grades, achievement scores, retention, and future employment. (2) For students with ADHD, knowing that they have areas of competence and strengths that can help them overcome their difficulties gives them hope.

Realizing that many of your weaknesses are not personal but symptomatic of the disorder and exploring strategies to address specific problem areas provides a sense of power and competence they may not have felt before. Knowing that asking for help is often met positively builds social trust. Being skilled in requesting options to standard requirements at school can also help students to re-engage with learning. The ability to affect their environment and how people react to them increases self-esteem and, in turn, affects their sense of well-being.

For those with ADHD, knowing there are ways around your difficulties that don’t involve constant struggle is truly liberating.

We have found a few strength assessments and self-advocacy programs that can help your teen through this process.

Evaluate Strengths

FREE – VIA Strength Survey for Children (VIA stands for Values in Action) Measures 24 Character Strengths for Children – Well researched

FREE – Interest Profiler – Discover what your interests are and how they relate to the world of work. The Interest Profiler helps you decide what kinds of occupations and jobs you might want to explore based on your interests.

strengths explorer $ – The Strengths Explorer For Ages 10 – 14 – Package includes: Downloads for Youth workbook, a parent guide, a teachers guide, and one online access code. ($10 for code)

Self-advocacy for ADHD: Know Yourself On-line resources for identifying learning styles and personal strengths as well as exploring interests. Know why your personal style is important. Pursue self-evaluation as well as talking with friends,  parents, and teachers about what they perceive as your strong points.

 

EBook

BUILDING A BRIDGE From School To Adult Life – A Handbook for Students and Family Members to Help with Preparation for Life After High School (92 page Workbook – Includes strengths and interests survey as well as self-advocacy tips)

Stepping Forward: A Self-advocacy guide for middle and high school students – 68 pages

 

1) Kids with ADHD are Natural Born Leaders by Louise Levin, Marriage and Family therapist – SmartKidswithLD.org – http://www.smartkidswithld.org/getting-help/adhd/kids-adhd-natural-born-leaders/ (Link works) – Harvested March 19, 2015 (Copy and paste URL to link to article)

2) Gallup Student Poll – Hope, Engagement, and Wellbeing http://www.gallupstudentpoll.com/home.aspx – Harvested March 19, 2015

 

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ADD freeSources: ADHD Kids Page

Kids have questions too. Things to read, do and watch for the younger crowd.Things to read
Things to do
Things to Watch
More Reading
Pinterest Boards for Kids

What is ADHD? – An illustrated article for kids  by Peter Jaksa, PhD

Kids Like Me with ADD – Illustrated articles: School and Me, Friends and Me, Cool stuff about ADHD, and Medicine and Me and ADHD –  by Peter Jaksa, PhD

Things to do

Kids Health- ADHD section–   Search for ADHD – Choose your audience, Parents, Kid, or Teens –

Fin, Fur and Feather Bureau of Investigation – Set of internet-based games ideal for kids with ADHD. Each game is designed to teach useful skills and strategies while continually encouraging players to complete increasingly difficult tasks. To increase interest, the FFFBI Academy uses a humorous spy theme and frequent reinforcements for successful gameplay. Funded by the U.S. Department of Education.

Self Esteem Games – Designed to help you practice certain habits of thought, and they may be difficult at first. These games are offered here for educational, demonstration, and entertainment purposes only. Have fun trying them out!

VIA Youth Survey – Ages 10 to 17  – Explore your strengths. Measures 24 Character Strengths for Children

Things to Watch 

Flynn Pharma ADHD Explainer – For children ages 6 to 12. (3 1/2-minute video) Metaphors, such as a postman delivering letters as messages between brain cells, can help this age group better understand the condition.

From adhd1.net – Dr. C and Friends – Psychologist/puppeteer Dr. Candelwood –

The ADHD Song – Dr. C and Elwood – 1-minute

ADHD and “Avatar” – Not a fidgety kid in the theater! – 1-minute

Dr. Fox News- ADHD and Impairment – 1-minute poem from Dr. C

ADHD and Me” brings research interviews with children to (animated) life. The ADHD VOICES study investigated children’s experiences with ADHD; about how ADHD feels, problems understanding the diagnosis, different treatments, stigma and the kinds of support that can help. – This 18-minute video is ideal for talking to your children about ADHD and involving them in treatment discussions. Watch it in shorter clips on their YouTube channel.

HARRY POTTER has ADHD? (2-minute parody)

What are Learning Disabilities? – 4-minute animated explanation for 5 to 8-year-olds

The Learning Brain – 7-minute video on how the brain works. Ages 10 and up

More Reading 

Zebra Stripes for ADHD- an e-zine – Follow the adventures of Joey, the zebra without stripes, and learn how to live with ADHD –  How-to tips, the latest news from the ADD – ADHD world, and stories to understand the complex world of Attention Deficit and/or Hyperactivity Disorder. From  ADD Coach, Sara Jane Keyser. 

Kids Pages  for kids and teens on a number of mental health issues. Includes ‘A Kid in my Class has ADD,’ ‘When your Mom or Dad have ADD,’ and ‘I am different, but you may not know.’ For and about children from 6 to 16. Northern County Psychiatric Associates
Follow ADHD / ADD freeSources’ board For and about Kids with ADHD on Pinterest.

Follow ADHD / ADD freeSources’ board Fun for Kids on Pinterest.

Follow ADHD / ADD freeSources’ board School Strategies for ADHD on Pinterest.

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Why I Choose to Medicate my ADHD Child

 " I know that he feels better about himself and his life when he feels more productive and connected, and when things are less of a struggle."By Parent coach Diane Dempster

The pros and cons of medicating ADHD kids is a hot topic that weighs heavy on the minds of our clients and other parents. It’s been on my mind, lately, too. Here’s my perspective and my story.

My story:

I generally take a holistic approach when it comes to my family’s health.  We prefer to eat organic whenever possible, and I tend to choose more holistic remedies for managing illness.

In third grade, when my son was first diagnosed with ADHD, I was adamant that I would not medicate him. Even though I had been working in healthcare for many years, the idea of putting an 8 year old on a maintenance medication seemed extreme. I was convinced I would find an alternative, something other than what I assumed was a “brain-numbing” medication that I was convinced would turn my fun-loving daydreamer of a kid into a zombie.

Our Pediatrician was a saint. She was eternally patient with me, wanting to support my wishes. When I asked, she held firm on her perspective that medications have been proven to help most kids. Unless ruled out for some other clinical reason, she considered medication to be “best practice” for ADHD treatment.

At some point in the process, after hours of research and hair pulling, something she said to me stuck hard. “It’s clear that you want to do all you can for your son to help him be more successful. What if medication could work for him, but you weren’t willing to try it? Yes, there are potentially side effects, but typically they are not significant. He can always stop taking it if it doesn’t work, or the side effects are a problem.”

As a coach, we encourage our parents to use their values as a barometer for decision-making. Looking back, the values that were most important in helping me make my decision were: dedication to family, being responsible, striving for excellence, and being well educated.

I knew that I could always have my son stop taking the medication; but, if he never tried it, I wouldn’t really know if it would help him or not. Bottom line: I was committed to doing whatever I could to help my son. For me, that meant letting him try the medication and see what happened.

We were fortunate. The process of finding a medication “fit” was easy for us. The first medication we tried worked quite well, and its effects appeared instantly. He was like a new kid, literally, in a matter of hours. His side effects were mild and manageable. After that first week, I never looked back. It was clear to me that I had done the right thing for my son.

My son is now a teenager. Sometimes we end up in conversations about whether or not he has to take his pills, particularly when he’s not in school. He knows that they help, but sometimes he thinks that he would be better off not taking them. Ultimately he doesn’t like to feel “different.” That’s a big deal for most teens. I have compassion for how he feels. I also hold fast to the house rule that he take his medication (most of the time).

Here’s why I choose to medicate my ADHD son:

  • For my son: He has a neurobiological disorder of the brain, and medication definitely helps his brain to focus and to work more efficiently. If he had diabetes, I would never question whether or not to put him on insulin if he was an appropriate candidate.
  • For me: To be honest, it makes my life easier when he takes his medication. Being a parent of a special needs kid is more than challenging. It’s often overwhelming and highly stressful. Having a child that is a little more focused and a little less emotional takes some pressure off. It helps to support me in staying out of crisis mode, and in being more of the parent I know I want to be. It also helps me feel like I’m doing all I can to help him be successful. Yes, we can debate what it means to be successful, but that is a whole other blog.
  • For the other people in his life: Like it or not, society rewards people for “fitting in.” If you know me, you’ll know that I’m a huge fan of beating your own drum. I am also a realist. My parents always told me, “you attract more flies with honey.” I want my son to be attractive.

Ultimately everything comes back to my son. I know that he feels better about himself and his life when he feels more productive and connected, and when things are less of a struggle. He may not always remember this – after all, he is a kid with ADHD — so I get to be his mirror. When he is an adult, he’ll be able to make his own decisions. For now, while he is still under my direct care, I get the added bonus of knowing that I’ve made a powerful choice to support my ADHD kid!

 

Article originally appeared on ImpactADHD.com and is reproduced with permission of ImpactADHD™ Why I Choose to Medicate my Child by Diane Dempster

“Photo courtesy of ddpavumba/FreeDigitalPhoto.net” Modified on Canva

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Casting a Wider Net: Section 504 Revisions

Casting a Wider Net:  Section 504 Under the 2008 ADA Amendments Act (ADAAA)

©  Lisa M. LaVardera, Esq.

In 2008, Congress amended the Americans with Disabilities Act, significantly broadening the definition of disability, beginning in 2009.  That change impacted the definition of disability under Section 504, one of two statutes from which children  receive special education services in school, (the other being The Individuals with Disabilities Education Act, or IDEA.).  The major changes as they pertain to students with disabilities, including children with ADHD, 2e children, and other bright children who may not have qualified for special education services or accommodations are significant, and are summarized herein.

What’s Section 504 got to do with the ADA?

Both are civil rights laws that protect individuals with disabilities from being discriminated against in our public schools.   Section 504 was enacted in 1973 and applies to all programs and activities that receive federal money.  This includes public schools, colleges, and universities as well as certain employers, state and local government programs, and places of public accommodation, such as a public library, courthouse or Federal office building.  (It’s hard to find any school, including private school that does not receive some financial assistance from the government.)   The ADAAA includes a “conforming amendment” to Section 504 of the Rehabilitation Act; meaning that the newly expanded coverage under ADAAA also applies to Section 504.  Since both statutes are interpreted in parallel, the ADA impacts Section 504. While the wording of Section 504 did not change, because of the ADAAA, it’s interpretation has.  The main key to understanding Section 504 is that it is essentially a civil rights anti-discrimination statute, designed to level the playing field between a person with a disability and his non-disabled peers, when it comes to equal access to governmental sponsored activities, venues and rights.   It confers no federal funding upon the states, it is an unfunded mandate.

Today, the key difference between Section 504 and IDEA is that under 504, the level of restriction is the determining factor, not the severity of the impairment, or adverse educational impact.   Further, a substantial limitation in one major life activity need not be limiting in other major life activities in order to be considered a disability, and consideration must be made on a case-by-case basis, according to the “reasonable person” standard.  (If a reasonable person/ average person would consider that disability to be materially restricting.)

These changes are especially important if your child:

  1. Was previously evaluated under IDEA and was found ineligible.
  2. Was previously evaluated under Section 504 and was found ineligible.
  3. Already has a 504 plan.
  4. Is already receiving informal accommodations.
  5. Needs accommodations from the College Boards.
  6. Is applying to college.

 

Why The Change?:

Previously, the definition of disability was described in Section 504 of the Rehabilitation Act of 1973.  Under Section 504, a person was considered to be a person with a disability if he: (1) had a physical or mental impairment which substantially limited a major life activity and; 2) had a record of such impairment; or (3) was regarded as having such an impairment. Once a person met that standard, they could receive a “reasonable accommodation.” Over the years a few landmark employment law cases made it to the Supreme Court, which decisions tightened the requirements by which a person could be considered disabled for purposes of employment and disability law. Congress thought that those Supreme Court decisions contradicted their congressional intent of protecting people with disabilities, and so Congress revised the Americans with Disabilities Act (The ADAAA), to re- clarify and broaden the interpretation of disability and realign it with the original Congressional intent (which was whether the school, entity or facility met its obligations under the law, not whether the claimant met the definition of disability.)

What’s New?:

The Definition of Major Life Activity:

The definition of “major life activities” was expanded to include learning, reading, concentrating, thinking and even sleeping.  And the definition of “major bodily functions” was expanded to include neurological, digestive, reproductive and brain functions.

The Definition of Disability:

The definition of “disability” is to be broadly, rather than narrowly interpreted. And a limitation in one major life activity need not impact other major life activities.  Eg., a reading disability need not impact all subject areas to be considered a “disability.”

The Definition of Substantial Limitation:

The ADA as revised by Congress has now clarified “substantially limits” with a lower standard of “materially restricts.” While the wording of Section 504 did not change, because of the ADAAA, it’s interpretation has.  Today, the level of restriction is the determining factor, not the severity of the impairment.  Further, a substantial limitation in one major life activity need not be limiting in other major life activities in order to be considered a disability, and must be made on a case-by-case basis.  This change significantly broadened the definition of what constitutes a “disability.”

No Requirement of Educational Need:

Accordingly, the threshold for “educational need” is now more flexible under 504 than it is under IDEA.  Under 504, educational need or adverse educational impact is not the threshold for evaluation; the disability is. (Think disability plus some level of restriction in some area regarding learning, thinking, communicating, and so on, versus the requirement of “adverse educational impact” under IDEA.)  The threshold is not the same.

No Requirement to Fail:

As for twice exceptional children, or bright children who did not previously qualify for special education services; under the new interpretation under 504, a district may not use a child’s superior or adequate grades as a reason to refuse to evaluate him.  A 504 plan may still be appropriate even in cases where the disability does not impact learning. Nothing in the ADA or Section 504, or IDEA for that matter, limits eligibility to students who suffer academically.  Therefore a district may not refuse to evaluate a child whose disability has no educational impact if the child meets the new definition of disability under the ADAAA and thus 504.  Thus, schools can no longer tell parents that their child doesn’t qualify for an evaluation or a 504 plan solely because he is “doing okay without any intervention.” To say this is now a violation, says the U.S. Department of Education Office of Civil Rights (OCR). Other information about the disability must still be considered. The child may, after a full evaluation, still not qualify for a particular accommodation or service, but he must still be evaluated, if he has a physical or mental impairment that materially restricts one or more major life activities; has a record of such an impairment, or is regarded as having such an impairment, regardless of good grades.

 

Definition of Reasonable Accommodation:

A “reasonable accommodation” has no definition in educational law and no limit at the moment, other than undue hardship on the part of the district.  And, the accommodation requested does not need to be directly related to the specific disability. (That does not mean however, that the sky is the limit in requesting accommodations from the school district.  The accommodation request can still be denied if the school district feels it is unreasonable, and then it is up to the hearing officer, or judge to decide.)

No Consideration of Mitigating Measures:

Mitigating measures cannot be considered in determining substantial limitation (except for contacts and eyeglasses), and if mitigating measures create an additional impact, there must also be an accommodation for that issue caused by the mitigating measure. A student must be able to use a mitigating measure independently; if the school personnel has to do something, then the disability is not mitigated. When determining whether the disability materially restricts a major life function, school districts must do a “look back” evaluation to determine what the child is like when off medication or without the mitigating measure. That is a very difficult task, but good news for kids with ADHD who take medications to help them focus.  They must be evaluated based on what their behavior would be when un-medicated.

No Penalty for Self-Accommodations:

And perhaps the most important change: kids who have learned to “self-accommodate,”  adapt—or compensate, as we like to call it—now cannot be penalized for learning to manage the disability on their own. Learned adaptive skills are a mitigation that may not be taken into consideration when determining substantial limitation. A child with a reading disability who can still learn in other ways is still disabled for the purposes of the new interpretation under Section 504, perhaps even if he is an honor roll student.  This change significantly benefits children with ADHD, and other children who were bright enough, or had enough compensatory skills to slip under the classification radar.

What Conditions Are Covered?:

In addition to disorders of learning, reading, concentrating, thinking and sleeping, other biological conditions are now covered. Diseases in remission are now considered as if they were active.  (Yes, you can get a 504 plan for cancer in remission, if it materially restricts you in some way.)  Alcohol problems are covered, although drug addiction is not. Other biological conditions such as gastro disease, neurological, brain, and reproductive disorders also fall under 504 protection.  Medical needs, if they trigger 504 services are now a burden that the district must bear.  And service dogs are now covered and may be allowed in schools.

Children Who Are Bullied:

Another interesting wrinkle, children who are bullied may fall under the “regarded as” prong if they are bullied as a result of their perceived disability.  And, according to Congress in revising the ADA, that discrimination provides them protection under 504, whether the disability is “substantially limiting” or not. This is a very interesting new wrinkle. Conceivably, a child may be entitled to an accommodation for being bullied if he is discriminated against (bullied because he had a disability), whether or not his disability is materially restricting enough to otherwise qualify for Section 504 protections or accommodations.

Evaluations Under Section 504:

Evaluations under the new interpretation of Section 504 must be comprehensive and look at all areas of learning: thinking, concentration, communicating, and so on.  School Districts must meet 504’s evaluation and placement procedural requirements when developing the plan.  For children with medical conditions who previously had an IHP (health response plan), the IHP may no longer be sufficient to meet 504 procedural requirements and they may need to be upgraded to a 504 plan.

Clinicians who do private evaluations and recommend a 504 plan should be aware that their evaluations:  must clearly show how the disability materially restricts a major life activityhow it impacts learning; (thinking, concentrating, communicating, and so on); also address any deficits masked by mitigating or self-accommodation measures, (what the child looks like off medications); and list any accommodation required for any effect of a mitigating measure.  This is especially important for children who are high functioning and have no adverse educational impact.

What Is The New Standard of Education under Section 504?

That’s a really good question.  The standard of FAPE, (Free Appropriate Public Education) is not the same as under IDEA.  Section 504 regulations define appropriate education as “the provision of regular or special education and related aids and services that (i) are designed to meet individual educational needs of handicapped persons as adequately as the needs of non-handicapped persons are met and (ii) are based upon adherence to procedures that satisfy the requirements” of the additional regulations governing educational setting, evaluation and placement, and procedural safeguards.

Two notable cases, Lyons and Mark H., establish that the 504 “appropriate education” standard is enforceable, and that the standard it imposes on public schools is different from the IDEA appropriate education standard, maybe lower, maybe higher, depending on the circumstances of your particular school district.  For example, a wealthy district that offers multiple programs and activities for nondisabled children, would be held to a higher standard of education for children covered by 504, a standard well above what IDEA calls for.  Poorer school districts that offer a barely decent level of services and instruction to children without disabilities, might be able to get away with providing lesser services to their children with disabilities, which may fall far below the expectations of IDEA.   How this will play out especially in wealthier districts whose kids have more positive outcomes, remains to be seen.  At this point in time, remember there is no definitive limit to 504 services, as long as they provide an equal opportunity for FAPE as that enjoyed by the non-disabled peers.

Remember, under IDEA, the IEP compares the child to his own best capacities, (more person-centered) while Section 504, when looking at the impact of the disability, compares him to his same age peers across the nation.  But, the obligations of school districts and other entities are measured by how equally they provide access and services to the disabled versus non-disabled, and that is a local standard.  And, when assessing violations of the ADA and 504, the focus is on the school or entity, not the disability, or the person with the disability.  This is an entirely different paradigm than under IDEA.

All services, accommodations and modifications must level the playing field in order to be 504 compliant.  Not all actually do what they are intended to do.  A level playing field means an equal opportunity to succeed in school.  It does not mean maximization of your child’s potential.

By now all school districts must have updated their 504 evaluation criteria, procedural requirements, manuals, materials, parent letters, prior written notice letters, etc., and trained personnel not to make statements or policy that violates Section 504.  The Office of Civil Rights has said it will enforce Section 504 in a manner consistent with the ADA Amendments Act. Because school districts must create their own evaluation procedures under Section 504, this is particularly challenging.    Also, Section 504 does and has always included the provision of services, as well as accommodations and modifications.  There is nothing in the statute that limits 504 in that regard, but for some reason school districts forget that.  But, perhaps the most challenging issue facing school districts is understanding that even children who are doing adequately in school may still qualify for Section 504 accommodations and services, if they have a disability that materially restricts a major life activity.

What Should Parents Do?:

Clearly, these changes suggest that any child previously refused services under the old interpretation of Section 504 should promptly request an evaluation under the new interpretation of Section 504.  This is especially important for children who did not meet threshold criteria before or who may have had a discipline involvement (or both) and who are now otherwise protected under the “regarded as” prong of 504 (for example, already receiving informal accommodations).  It is also important for college-bound teens and those seeking accommodations on college boards to be promptly re-evaluated under Section 504. (However, the college board makes it’s own decisions under Section 504, independent of the school.)

Do not expect your school district to fully understand the ramifications of these changes.  Parents must be proactive and vigilant in protecting their children’s Section 504 rights, even if their school is not.

Ask, ask, ask for a new evaluation.  Be prepared with data and information about your child’s disability, and include examples of how your child functions without their medications or self-accommodations in ALL areas of learning, thinking, communicating, etc.  If your child has another type of disease or disability that is now covered, including gastro-intestinal, immunological, or cancer remission, remember to ask for a 504 plan for any issues arising out of that disease or it’s treatment.  Use your knowledge about your child to paint a picture for the committee.

Be specific about what services and/or accommodations you think they need to level the playing field in school.  Services are included under 504, do not be afraid to ask for “504 Services” by name.  Services that your child may have been denied under IDEA may be appropriate and more easily accessible under the new interpretation of Section 504.

Be a very attentive listener.  If you hear a comment from your school district that violates Section 504, as indicated above, report it to OCR, you can file an OCR complaint online.

Conclusion:

For many years the focus was on IDEA and the IEP and obtaining IEP services.  Children who had a 504 plan in school rarely got the same level of services or procedural protections as those given to children under IDEA.  In fact, the 504 plan was regarded as the “ugly stepchild” of special education.  Today, the ADA Amendments Act has created a paradigm shift in the way we look at children with disabilities, assess them and service them.  There seems to be no end in sight to the possibilities and potential ramifications of the new interpretation of Section 504.  But more importantly, it has opened a world of new possibilities for more students, and especially higher achieving students with disabilities to receive appropriate services and accommodations for disabilities that went un-noticed, un-validated, and un-serviced under IDEA.

 

Disclaimer: Please be advised that this information is not intended to take the place of legal advice.  For specific legal questions seek the advice of a licensed attorney.

©  Lisa M. LaVardera, Esq. – All rights reserved.  Articles may be reproduced or electronically distributed as long as attribution to Lisa M. LaVardera, Esq. is maintained.

Find the original article at: PTS Coaching –  Casting a Wider Net 

 

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