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ADDed Attractions January 15, 1999
Just a few quick words before we get started with this month's newsletter.
Over the Christmas holidays I noticed that James was having problems even after taking his medication. As the holiday vacation progressed, it became clear, that the meds were having little if any affect on James and were providing absolutely no help for him from what I was witnessing.
I called the school and spoke to his teachers as soon as school resumed and found out that they had been experiencing problems both in the classroom and on the playground for quite sometime and for whatever reasons, they were just dealing with the issues on their own, or ignoring them rather than calling me to let me know there were problems.
Through observation and working together as a team, we came to a clear understanding that James' meds were no longer working well for him at their current level and so, I made an appointment with his dr. and we made the decision to increase his meds by 5mg in the morning only and we are back on track and James is doing well in class.
The point I guess I am trying to make here is that we CAN'T and shouldn't rely on the school or the teachers to notify us if there are problems at school. It's up to US, to monitor and make sure that our children are doing well in class and continuing to excel and make progress. Taking the stance that "No news is good news" is not wise in the case of our children and I encourage ALL parents to take an active role in their children's education. I make a habit of checking in with my children's teachers at least once, every quarter. I got in this habit because of my total lack of trust in the schools ability to take care of my children but over the years, I have found it to be a good habit to get into PERIOD, no matter what the reason.
** Dr. Dave's ADDvice **
NOTE: Please note that Dr. Dave Rabiner's site address has changed. Please change your bookmarks to reflect his new address www.helpforadd.com
My column this month deals with the type of treatment that children with ADHD receive on a typical basis. It appeared in a recent issue of ADHD RESEARCH UPDATE, the electronic newsletter I publish to help parents and professionals stay informed about new research on ADD/ADHD. I'd be happy to send you several sample issues of this newsletter to review. Just e-mail your request to firstname.lastname@example.org and type "samples" in the subject line.
VARIATIONS IN THE TREATMENT RECEIVED BY CHILDREN WITH ADHD
What type of treatment do children with ADHD typically receive in the US and how does this differ according to the type of provider consulted for treatment? These interesting and important questions were addressed in an article that appeared the September, 1998 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (pages 968-976).
The authors of this study began by identifying all children from within the population of second through fourth grade special education students in a particular school district who could be diagnosed as having ADHD. (As the authors point out, one cannot assume that results from this particular locale would also be found in other regions of the country, but their results are nonetheless instructive. It is also true, that the population of special education students with ADHD may not be representative of the general population of students with ADHD. Once again, however, I think the results from this sample are still quite instructive.)
After identifying the children who had ADHD, the authors interviewed the children's parents to learn about the treatment for ADHD that their child had received. Here is an overview of the major findings:
* 29% had received no care from any type of provider during the prior year;
Before moving on to highlight other aspects of the results, several points about the data above need to be made. First, it is striking that almost 1/3 of children with ADHD in this sample received absolutely no treatment of any kind during the prior year. Unfortunately, information about why no treatment was provided to these children is not presented. Second, it is striking that over 2/3 of children who were treated by a primary care provider had absolutely no contact with a mental health specialist during this period. This may reflect an important deficit in the care these children received, since primary care providers would be less likely to provide the kind of behavioral parent training and/or child behavior therapy that is often an important and necessary component of a child's treatment.
In regards to the general characteristics of the treatment that children received, here is a overview of what the authors found:
* For children treated solely by a primary care provider, the average total amount of contact with the provider during the past year was only 2.3 hours (it is hard to imagine that this could really be adequate). This compares to an average contact time of over 17 hours for those children treated by mental health specialists.
What this means, of course, is that many children were taking medication without the prescribing physician obtaining any direct feedback from the child's school about how well the child's symptoms were being managed. As a result, it is virtually certain that many children were taking medication who were not deriving any significant benefit from it any many were being maintained on a less than optimal dose. Results of a large scale intervention study that I hope to discuss in the near future (published results are not yet available) seem to clear indicate that carefully monitoring medication effectiveness makes a critically important difference in the success of this treatment.
* Only 2% of children treated by primary care providers received any type of psychosocial therapy, which include such empirically validated treatments behavioral parent training and child behavior therapy.
As noted above, there is no way to know the extent to which the findings from this small segment of the population is reflective of the type of care that children in this country with ADHD generally receive. I must say, however, that this is not inconsistent with what seems to be the case in communities that I have practiced in. Overall, the results are pretty discouraging in that they strongly suggest the following:
* Many children with ADHD are receiving no treatment at all;
Although there remains much to be learned about how to most effectively promote the long term success of children with ADHD, much of what has already been learned is apparently not being routinely incorporated into the care that children are receiving.
Please do not interpret these results as indicating that primary care physicians can not provide adequate care for children with ADHD. I have been fortunate to personally work with a number of outstanding pediatricians and family doctors who did an absolutely first rate job of this. What the data show, however, is that there are many times when this may not happen. Also, as discussed above, there were many children seen by mental health specialists who were also not making any regular contact with children's schools or providing any type of behavioral intervention as part of the child's treatment. This is why it is important for parents to be vigilant in making sure that their child is receiving the different components of effective treatment that he or she may require.
That's all for this month. Please get in touch if you would like to receive sample issues of ADHD RESEARCH UPDATE
David Rabiner, PhD
** REQUESTS FROM READERS **
**My 7 year old son was just recently diagnosed with ADHD and I'm looking for every available means of support. So please add me to your ICQ list to make avialable to others. I would love to be able to chat with other parents in the same situation so I wouldn't feel so alone in this. . My ICQ # is 12874702. Thanks. Solacer.
**A reader of your site needs legal help. His son, who is currently in college was illegally expelled from his high school 4 years ago. The school district that has and continues to commit numerous illegal acts is doing everything they can to hide their illegal actions to this day. It includes the continued hiding of documents, the destruction of medical evaluations, the refusal to allow the family access to his son's permanent files. If the school district provides these documents it would show that numerous people committed perjury, obstruction of justice, retaliation, hid key documents, made believe that my son did not try to commit suicide in the school when a note exists in our son's files that proves they did know, that were denied during discovery etc. He needs a lawyer, who wants to help in a case that has been going on for too long without justice. His lawyer and others have told him that there is no money in suing the school district and too costly to them to handle it. They say the school will just appeal it to death. I need a lawyer who will help me right the wrong and make a name for himself in Special Education Law in our area. We already have a State level investigation by the Dept. of Education that showed they broke seven different laws and the Attorney General for the State of New Jersey is currently investigating the destruction of our son's medical records by the doctor who evaluated our son (the school District's doctor openly admitted it in a letter to me). This is a case that will make headlines. If you can help, please write to Steve at TEACHER007@aol.com
**My name is Tracy Durant.....I have been struggling with A.D.D for many years My Son Kevin has been struggling with it also...Because he has it. He is 10 years old now. I have ICQ my number is 10365021......I just need to talk to others...I love my son very much but sometimes it gets to much to handle.......Please could i be on the list......Thank you Tracy Lasenba-Durant
**Stay In Lane **Proceed With Caution!** ** No Passing Ahead:**
Coaching The Rules Of The Road
In my last article, "Classroom Coaching: Bringing Skills On-Line," I introduced the metaphor of driving to help children understand how observing clues in their environment helps them to cope better with the different "roads" in their lives, i.e, school, family life, friends' homes, etc. The intent was to offer a format for concerned adults (parent, teacher, or counselor) to deliver group coaching assistance to children in need of improved social and emotional skills.
The present article will extend the driving metaphor to several other social "rules of the road" that are are often deficient to varying degrees in many children. Among these "rules" include the consideration of timing, respect for boundaries, tolerance for the mistakes of others, and importance of fitting in. Each one of these issues comprise a critical social/emotional skill that helps children achieve smoother functioning no matter what "road" they travel. During a series of articles, I will examine these and other skills from the vantage points of individual children (composites of various patients of mine) who came for help with many examples of "driving-related" problems in their lives. Each child will portray a typical profile of varied social-emotional skill deficits.
Samantha (Sam) is an 12 year old girl who unabashedly described herself as "needing attention and wanting to be in control." Yet, she was often confused and easily upset by the reactions of others to her behavior. Her parents described her as extremely outgoing and enthusiastic among peers but tending to be unaware of "social signs and signals." Her teachers shared a similar view of Sam's troubles, explaining how she would often raise her hand and immediately begin speaking in class or "barge" into a discussion among others. These and many other social skills problems had contributed to damaged self-esteem and regular conflict between Sam and her parents.
Parents and teachers regularly come into contact with passionate children like Sam. They love to participate and can't tolerate the thought of being left out of anything they desire. They relentlessly pursue connecting and contributing no matter what social fall-out it may cost.To their credit, they often have very valuable ideas to offer but overlook the importance of timing, boundaries, and reciprocity. Therefore, instead of receiving the approval they crave they often feel unfairly treated and frustrated.
It is especially challenging to coach skills in children like Sam because of their high degree of sensitivity and controlling nature. Delivering the coaching skills requires a lot of verbal diplomacy or the message gets pushed away as unfair criticism. For this reason, it is useful to abandon the direct "head-on" approach since this leads to collisions between adults and the Sams in their life. The following is a recommended coaching approach to children who fit Sam's profile:
"I can see how much you want others to notice you and all the neat ideas you have to offer. So much of the time you have something to contribute or ask for, and sometimes you end up feeling pushed aside for no good reason. You end up feeling frustrated, and probably blame the other person. But blame can get in the way of understanding what happened. Maybe there's a way of getting past the blame and looking at what is going wrong when you are on the road to get attention."
In this opening appeal, the coach joins with Sam to express understanding of her feelings and begin building the partnership. Sam must not feel criticized at this delicate juncture or she won't feel safe enough to keep an open mind and accept the coaching help. I emphasize to parents/teachers that the first level of coaching is to empathize with, not diminish, the child's experience. (Diminshing might take the form of saying "everybody has to deal with this" or "I had the same problem and learned to stop acting that way.") As a way of deflecting feelings of self-blame from hitting Sam's fragile self-esteem, the coach normalizes the problem and introduces the notion of auto-pilot program:
"All kids find themselves in tough spots at one time or another. People are not treating them the way they want to be treated. Sometimes it's easy to figure out. Maybe the kid really did something wrong, like hit someone or throw something at somebody. But other times a kid is meaning no harm but people still don't treat them well. In these cases it may seem to the kid that it's everyone else's fault for treating them badly. All they want is to be included, or to be heard, or to show something to others, and so on. In other words, they don't think they are doing anything wrong to deserve this kind of bad treatment from others.
"Let's throw out the idea of who's at fault because that just gets in the way of solving the problem. Instead, let's look at it as a matter of road conditions. Drivers have to be aware of road conditions in order to drive safely and observe the rights of other drivers. As the road swerves, they have to stay in lane. If the temperature drops, they have to look out for icy patches. When it's unsafe, they must not pass other cars. But what if a driver always drove the same way no matter what condition the road? It would be like having an auto-pilot program that controlled the car for them. Usually the auto-pilot automatically gets them where they want to go. But when road conditions change, they would be at greater risk of accidents and would anger other drivers. Ofcourse, they would not be trying to do these things but that would be the outcome."
This second level of discussion finds the coach distinguishing between intentions and outcome. Children with Sam's profile have difficulty accepting responsibility for their actions because they do not "try" to make others angry or rejecting. Alternately, their hope is for praise and acceptance, so the outcome is especially difficult to swallow . By identifying with the driver who relies on the "auto-pilot" program, the child accepts the notion that just because their "driving habits" steer them well in some places doesn't mean they will work smoothly in other places. The "auto-pilot" acts as as the "chalkboard" where the coach can talk about the automatic behaviors that get Sam into so much trouble with others. Parent Coaching Cards can also serve as the chalkboard, since they offer a place to review how the "auto-pilot" program may be "programmed." Next, the coach can speak more directly to the skills that need to be learned:
"When kids rely on their auto-pilot in dealing with others they usually forget to check road conditions. If a kid's programmed for maximum contribution and control, kind of like you, backfires occur, especially in school and at home. That's because there are other drivers who want their share of the road. But kids can learn how to check road conditions so that things go more smoothly with friends and adults. Here are some of the important "rules of the road" that kids can learn:
Timing is all about picking the right time to speak up so that what you have to say will be received in the best possible way. If you were really driving, it would mean that you choose the right time to pass another car. When the time is not right, you would not to risk trying to pass another car. Timing can be tricky to figure out when you're a kid. Here are some ways to improve your timing:
A. Consider what's going on around the person before you approach them. Are they in the middle of a conversation with someone else? Are they reading?
Boundaries are about the space that separates people from another. We all need some space of our own. If you were driving, it would have to do with keeping your car in the lane, and not swerving into the other driver's lane. For kids, it means not invading the space of others, but instead, respecting the boundaries of others. Here are some ways to improve your handling of boundaries:
A. Notice the distance that separates other people when they are talking to each other.
Reciprocity has to do with thinking about the feelings of others before you say or do something. If you were a driver, it would have to do with being courteous about using your turn signals or letting another driver get in front of you. For kids, it concerns sharing control over decision-making, inviting others to express ideas, and asking the right kinds of questions. Here are some ways of becoming more aware of reciprocity:
A. Ask yourself from time-to-time, "Is the other person in as much control over things as I am?" If they aren't, try talking a little less and asking them questions about what they want to do and their life.
These are some of the substantive coaching formats that parents, teachers, or counselors can offer to children like Sam. The intent is for them to develop greater attunement to the social environment so that they may elicit more favorable responses from friends and adults.
Dr. Steven Richfield
***** NEW SUPPORT GROUP INFORMATION ****
My name is Christie Beighley and I am a social worker at the local mental health center in Lexington, NC. A friend and I will be starting a Women's ADD Support Group on Thursday, Feb. 25th. We will be meeting at First Presbyterian Church in Lexington, NC at 7:30pm every other Thursday. The co-leader has her master's in counseling and also works here at the mental health center. I may be reached at (336) 248-4530 for directions and/or more information. Your assistance is most appreciated.
** ONLINE EVENTS**
ADD, ADHD, LD.....what does this all mean? Come take our quiz on ADD, submit a question in advance and then come back on January 26th (9 pm EST) our Live Event, Cutting Through the Noise. www.mediconsult.com/home/misc/live/hallowell/quiz/
Dr. Ned Hallowell will be available to answer questions that you have on the challenges of living with ADD and all that accompanies it. Please join us! www.mediconsult.com/home/misc/live/hallowell/questions/
Online Promotions Operation Specialist
phone: 506 383-8988
** NEW SITES **
I'm a dual certified teacher and self-employed in home tutor. I specialize in tutor students with behavioral problems, such as ADHD. Here is my site address for your information. tutor.hypermart.net/tutoring.html
My name is Lilly and I have Tourette Syndrome and ADD and OCD and other disabilities. My url is www.angelfire.com/in/tourettesyndrome/links.html Thank You for your time
OBSESSIVE - COMPULSIVE DISORDER
1. A chronic, abnormal focus on a single idea.
My son exhibited a considerable amount of these behaviors and I found that the valerian root, kava kava, St. John's wort helped tremendously. Vitamin/minerals added in the right dosages daily balanced over time. The E'ola herbal drops in conjunction with the above made life bearable.
I found that being firm but loving helped quite a bit and not letting new rituals start to be added to the existing ones.
There is light at the end of the tunnel and my son doesn't exhibit this disorder anymore, though the habit of trying to ritualize things occurs occasionally. I just tell him it's not needed and that 's the end of that discussion. I used to wonder how I survived the moment much less the day.
OCD individuals are protected under the Americans with Disabilities Act.
ADA Information Line
**ACCOMMODATIONS IN THE ADD WORLD**
In an ideal world, every teacher would instinctively reach every child.
In an ideal world, every student would learn without working too hard.
In an ideal world, parents could be certain that their child is getting a great education and everyone (parent, student and teacher) works together in harmonic bliss.
But guess what? Ours is not an ideal world. For many of us, it is an ADD world.
Unfortunately, not all teachers know how to teach to an ADD student. When asked, many parents are at a loss on how to help that teacher help their student. And let's face it, not all student learn the same way. One teaching style can't be perfect for all students all the time.
Those of you who know me or have read my book know that I am working to promote ADD-Friendly classrooms. I dislike the current system which requires parents to battle the teacher, the school, and the school district just to get special help for their failing or at least, struggling student. I believe this conflict is not healthy for the child, he often feels that he is to blame. Not only can't he pass school and always seems to be in trouble, but now the two sets of adults he cares most about (his parents and teachers) can't get along because of him.
However, ours is not an ideal world. Currently, many parents find themselves having to become the proverbial "squeaky wheel". Yet when asked for suggestion on the types of accommodations the student needs, the parent may be ill equipped to give ideas to the teacher or the student study team.
Although there are as many different approaches as there are ADD students, I would like to offer some suggested accommodations. Remember, however, that a structured, predictable environment goes a long way to minimizing the need for special accommodations.
Learning. Since ADD is a concentration issue, learning is often difficult because an ADD student can't focus long enough to understand what is being taught or read. Teachers and parents can help this student in several different ways.
1. Prior preparation. When my daughter, Caron, began having trouble with her algebra, she and I struggled to help her understand what was being taught. A friend of ours suggested that we work several lessons ahead, that way she would already be familiar with the material before the teacher taught it. This has turned her D into a B. She participates more in class and has an easier time listening without getting lost. If a teacher can let a parent know ahead of time what will be taught, the parent can have their student preread or prepare ahead, making learning easier for the student.
2. Highlight. Another way to help an ADD student or any student for that matter learn better is to allow them to highlight important information in their text book. Parents might consider asking the school if they can purchase the text for this purpose. ADD students have a difficult time sorting through all the words to determine what is important to know. Teacher can suggest what to highlight while teaching the lesson. As a teacher, I sometimes copy pages of the text on to overhead slides and highlight the important points and have them copy my model. This also aids the parent in knowing what to have the student study for a test.
3. Copy of outline/notes. Taking notes can be completely frustrating for an ADD student. Not only do they have a hard time concentrating long enough to get the information and remember the thought long enough to write it down, but also many ADD students are dyslexic or have other learning differences to boot. As an accommodation to compensate it is effective to give a copy of any notes to be copied by other students to the ADD student. This may seem like an unfair advantage, but ADD student are already at a disadvantage, this just levels the playing field and gives her the chance to be successful.
4. Reader/Tutor - One on one interaction is the best way to teach an attention deficit student. The more direct the learning situation, the less distractions, the more a student will learn. By having someone read to her, or teaching her one on one, the better the chance for her to both understand and retain the information.
5. Resource help - Because of the distractions in the classroom, ADD students often develop gaps in their understanding about what is being taught. Resource teachers can help fill this gap. However, a caution here, ADD is unlike other learning difficulties, these students are not learning impaired, they just miss some information. This is why so many of these students can't qualify for special education assistance.
Homework/Class work - One of the more frustrating aspects of ADD is that many of these pupils fail to do or complete assignments or take forever to do them. I remember going to my room to do my homework, with every good intention to do so, only to discover that two hours had passed and I had nothing done. Frustrated, I went upstairs and lied to my parents that my work was done. I was told it was laziness, but I now know it was an inability to focus on the work.
However, there are ways to help get work in. I will cover some ideas here, but you can find many more in my book published on my website at www.hyperactiveteacher.com
1. Syllabus - Why is it appropriate for college a course to provide syllabus for adults students with test dates and homework assignments made up to 4 months in advance; yet younger elementary, jr. high, or high school students are expected to remember to do the work assigned that day? A simple weekly syllabus allows the parent and student to know what is going to be assigned and allows them to plan ahead to get the work done. Also, the accountability of this approach makes it more difficult for the student to say he doesn't have any homework. I suggest all students get a syllabus, but if a teacher won't do that, maybe she will give the parent of an ADD student a copy of her lesson plans for the week.
Thank you for your newsletter and providing a wonderful forum to help educate families, teachers, etc. about ADD. My son, who is now 11, was 'diagnosed' with ADD when he was in second grade.
Our son goes to a school for gifted children, where quite a few students have learning differences. The teachers are very sensitive to each child's special needs and individual programs are developed continually. My son has been doing very well, except he is very slow doing work, often does not write down assignments, and needs help keeping his trapper (larger notebook with lots of folders for each subject) organized.
The school has a peer-mentoring program which was just started for our son. He has been teamed up with a 12th-grade boy who works with him every other day sharing ideas for organizing his work, checking his homework assignments, tutoring, etc. He set up a small (1 inch) notebook for our son for math with paper, folders, and special spaces for homework to do-homework done to hand in, etc. My son was thrilled (both with the system, but also with the process of working with the older student!).
Our son's mentor gets high school credit for working with our son, and works directly with the resource room's special teachers developing strategies to help the children.
A coaches job is not to teach, but rather to help the student be organized and is getting all the work written down and books to take home. Some school use resource help for this purpose, others have there yard duty take this role for certain students other use reliable and/or older peers.
3. Another effective accommodation is to reduce the workload, especially for repetitive assignments. This is especially effective for those student who are capable of learning quickly. Even though I could ace every test I took, I still failed in school. If learning is the goal and I was able to demonstrate my learning, why did my inability to finish homework cause me to fail? Teachers should consider reducing work loads and then expecting that the work assigned be well-done.
On-task Behavior - ADD student will be off-task. No ifs ands or buts about it. By definition ADD students CAN'T control concentration. Therefore, we must come up with ways to distract a student back on task.
1. Teacher Proximity is one of the most effective ways to remind a student to get back to work. Having the ADD student sitting in the front and near the teachers desk makes it possible to remind the student to get working without the other students knowing or being distracted.
Rick Pierce, The Hyperactive Teacher, offers his own free newsletter. To receive it email him at email@example.com He is the author of "How to Help an ADD Child Succeed in Life" which is available read and order from his website at www.hyperactiveteacher.com
**8 Lessons You'll NEVER Learn in School**
1. DON'T BLAME OTHERS. Most of what happens to people in life is their responsibility. There are choices and option. Don't look for scapegoats or reasons to rationalize your shortcomings. ……. Parents, background, race, religion, drugs, alcohol, socio-economic status, hair color, shoe size…. The list goes on and on.
2. GEEKS AND DWEEBS WILL RUN THE SHOW. These guys and girls may not win the popularity contests in school now, but, not to worry….. they will prevail. They may be signing your paycheck some day!
3. THE LADDER TO CUSHY JOBS WITH PERKS HAS LOTS OF RUNGS. If you think you'll start at 50 grand or more with a company car, cell phone and expense account, then you'll buy the ocean front property I'm selling in Arizona! For most, those first few years will follow a sequence of "titles"…….important ones like grunt, snuffy, gofers, and bean counter (no particular sequence denoting status!).
4. YOUR BIOLOGICAL CLOCK TICKS ON. So sorry, you're not immortal. You will get old. You will age. You will get wrinkles, need bifocals, gain weight, get tired more quickly, lose your hair etc., etc.! Remember to be particularly patient with old people and take good care of your body….it's got to last many decades.
5. REAL LIFE DOESN'T JIVE WITH TV AND MOVIES. Problems are NOT solved in 30 minutes, and reality is not Elaine, Jerry, Kramer and George.
6. THE "IT'S MY LIFE" PHILOSOPHY WILL BE HISTORY. Fifteen years from now you'll see that this type of thinking and believing the high school prom was your greatest most outstanding, stupendous life experience. Your life is not an island. Everything you do WILL impact someone else.
7. FORGET THE 35-40 HOUR WORK WEEK IF YOU PLAN ON COMPETING. If you're looking at a professional career with top salaries, bonuses, incentives, stock options, career tracks, and great retirement plans, then you need to do a couple of things. First, get an outstanding education, and secondly, plan to work the 60-70-80 hour week work plan.
8. FAME IS SHORT LIVED. Sports heroes, beauty queens, cool dudes and school stars are quickly forgotten. The old saying that everyone wants "15 minutes" of fame is so true. Real long-term life is in the form of leadership, academics, and character.
NATURAL AND ALTERNATIVE THERAPIES FOR ADHD: www.naturaladd.com
Copyright 1998 Brandi Valentine. All rights reserved. This Newsletter is copyrighted by the authors and/or publisher. ADDed Attractions may be used for non-commercial purposes only and may not be redistributed for commercial purposes without the express written consent of Brandi Valentine.
Appropriate credit should be given to this resource and it's authors if It is reproduced in any form. Brandi Valentine
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