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October 2012 Archives

ADHD School Planning in 300 Words or Less

By Dr. Mark Bertin on October 22, 2012 5:57 PM | 0 Comments
A 2011 study from the journal Pediatrics found that near 60 percent of children with ADHD have an associated writing disability. Beyond the effects of distractibility, rushing through assignments, impulsivity and all the rest of ADHD, these children have a neurologically-based deficit around writing. The ability to effectively gather their thoughts, organize them and get them onto the page is impaired directly, not only by their ADHD. Often overlooked and under-diagnosed, a writing disability impacts not only the specific tasks of producing coherent sentences, paragraphs and essays but also testing and note-taking. Without intervention the added time and stress around writing-related tasks affects overall school performance.
 
One of the most basic principles in supporting a child with ADHD is looking for other conditions that often tag along with it. These are termed "co-morbid conditions," and common ones include developmental delays (fine motor, language, etc.), various learning disabilities and specific mental health conditions such as anxiety. Nearly two-thirds of people with ADHD have at least one of these, and that statistic doesn't even count the far-reaching effects of executive function deficits inherent to daily living with ADHD.
 
School planning sometimes overlooks these possibilities, many of which are of particular importance in the classroom. Academic motivation depends on a sense of mastery and success and rarely develops when children feel at a loss or lack the tools they require to thrive. For students to enjoy and take ownership of their own academic career, underlying issues affecting school must be addressed first.
 
Here are suggestions (in fewer than three hundred words) to avoid common pitfalls while planning for the upcoming year:
 
  • Make sure evaluations have looked for specific learning disabilities, especially when children with ADHD have persistent academic problems.
  • Address difficulties with executive functioning at home and school. Children with ADHD require more structure and adult support to manage their work, and more direct instruction in organizational skills than peers. Because of their ADHD, they benefit from a scheduled routine instead of open-ended supports that say things like, "You can visit Ms. Jones if you feel you are falling behind." Their capacity to identify a problem ("I need help"), create a plan to address it and then stick to it over time is directly impaired by ADHD. Instead of open-ended solutions, schedule supports into their day: "Right after fourth period, you have a study session. Would you prefer to meet with Ms. Jones or Mr. Frank?" Similarly, most benefit from a consistent homework plan established at the start of the school year, before their workload increases.
  • Implement a structured, reward-based behavioral plan proactively. Don't wait for classroom tension to start before focusing on behavioral change.
  • Ask for placement with structured teachers who run classrooms that permit fewer distractions in the environment. Classroom set up (e.g., desks facing the teacher when she's teaching and not peers) and management (e.g., clear and consistent rules) matter greatly when children have ADHD.
  • Encourage schools to use evidence-based instructional methods for children with ADHD. Today, the most commonly used curricula rely on learning through exposure to academics without an emphasis on direct teaching of skills. Children with ADHD are less likely than peers to thrive without an emphasis on core skills, repetition and rote instruction.
 
Educational planning of this kind is one of the three foundations of ADHD care. Integrated with appropriate behavioral supports and judicious use of ADHD medications, children with ADHD can thrive at home and school through the upcoming year and beyond.

Election 2012: Children on the Ballot

By Dr. Mark Bertin on October 11, 2012 3:11 PM | 0 Comments
On your mark, get set, go. Off they race, the children of America, into our collective future. The end point of this particular race is a healthy, happy and productive adulthood. So here's the question: Are the odds equal that anyone who puts in the effort will reach that finish line?
 
Basic Training Starts Here
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The premise of a certain 2012 presidential platform (you decide which one) appears to be this: Life is an even playing field. As long as we try hard enough we all equally thrive. It's as if the secret to success is effort alone, and if you're not successful you're just not trying hard enough.
 
Research in child development contradicts this idea entirely. By the age of five, environmental experiences often handicap a child throughout a lifetime. Does effort matter? Absolutely, but countless factors affect the cognitive and emotional development of young children long before they make their own active choices about how to live.
 
The United States will never be the 'land of opportunity' for everyone without addressing this reality. Thankfully, many of these hurdles can be eliminated through interventions both compassionate and cost effective. To tackle these inequalities, some basic necessities of early childhood include: 
 
A safe and stable home environment 
 
The concept of 'toxic stress' may seem vague, but from a medical point of view excess stress has a significant impact on development. As outlined in a 2012 American Academy of Pediatrics statement, prolonged, excessive stress stacks the odds against children. Early adversity affects the entire body, from the brain through the immune system and even influences which of our genes express themselves. Too much stress can cause lifelong impairments in both physical and mental health and, as the authors state, "many adult diseases are, in fact, developmental disorders that begin early in life."
 
Making sure children are well fed and have health care is a start. Being undernourished or chronically ill affects an adult's capacities in daily life profoundly, children even more so. Additionally, programs that educate at-risk parents about supporting their children's development are impactful. Down the road, people who have received appropriate services while young are more likely to be reasonably settled when they have children -- and then their kids are better off. Adults who grew up in stable environments are more likely to be doing well in general, and less likely to require ongoing medical attention, mental health care or financial support from the government.
 
Education
 
The average low-income child has heard thirty million fewer words than peers by the age of three years, and this pre-school vocabulary score predicts language ability at age nine. Falling behind in these skills puts youth at high risk for school failure. School failure itself places children further in jeopardy of unemployment, underemployment, poor health choices and other difficulties.
 
Further compounding their disadvantage, these children exhibit a 'knowledge deficit,' which stems from decreased exposure to general information about the world. Limited content knowledge affects reading comprehension and related abilities, as understanding text relies on the reader's own background knowledge. One study showed poor readers who were baseball fans tested better for comprehension on a baseball passage than more skilled readers with little interest in the topic. While the more advanced readers could read the words, they didn't have the context to sort out jargon like 'a 6-4-3 double play.' Reading comprehension correlates with academic achievement, and also success after schooling ends; home and school based programs can help address the gap.
 
The types of schools we create matter greatly as well. A strong education starts with reasonably sized classrooms run by well-trained teachers. Children with mental health concerns, ADHD, autism or learning disabilities typically need services to keep up academically; these interventions are often unavailable or underfunded in low-income neighborhoods. Quality schools, developmental services, and mental health care head off long-term problems for not only individuals, but for the community as well. Without intervention, these same children are less likely to become healthy and independent adults.
 
The opportunity to learn through play
 
Free play is a foundation for later cognitive, communication and social skills. It also encourages emotional resilience and creativity. While you might think all children get an equal chance to play, many don't. Poverty interferes with play at home, at school and after school. Educating parents about the importance of free play and creating both community and school-based environments that facilitate it promote long-term development.
 
Team in Training
 
Failing to emphasize these early childhood services fails society as a whole. It perpetuates problems such as early school dropout, teen pregnancy, substance abuse and many other issues exacerbated by unstable childhoods. Investing in children at an early age even saves money over the years; without early intervention, we pay almost exponentially when adults struggle later. A RAND study, for example, suggested a minimum near two-to-one return for every dollar spent on early childhood services, and potentially as high as seventeen-to-one.
 
Eliminating early childhood programs turns a blind eye to the stark reality that life is not, in fact, a level playing field. Children need healthy nutrition and health care to grow. They need to be raised in nurturing, mentally engaging environments that encourage activities like imaginative play and reading. They require appropriate schools and stimulating after school experiences. Without intervention, these same kids often end up having children similarly at risk and the cycle continues.
 
When society abandons children before age five, we leave them adrift for a lifetime. Only through a concrete and prolonged investment in early childhood do we truly create an opportunity for all individuals to thrive. As the American Academy of Pediatrics states, "a vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development." Any plan that cuts or eliminates early childhood services fails not only our children but also our communal desire for a successful and stable society.
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