ADHD – LD6

 

While I personally find autism the most challenging and confusing disorder to deal with (perhaps because it is not “one” disorder?), Attention Deficit Disorder-ADD or Attention Deficit Hyperactivity Disorder-ADHD is certainly the most common of all childhood developmental disorders and also has generated the greatest amount of controversy as far as standards of diagnosis, treatment and parenting are concerned.

Undoubtedly, something that affects up to 5-10% of all children will call for a great deal of attention. ADD or ADHD (I generally prefer the second term but there are some kids who are attention deficit but not markedly hyperactive), should be detected as early as possible. What is often considered naughtiness is most often ADHD. In severe instances, the child will be thought of as “uncontrollable”, “terribly disobedient”, and perhaps also “unmanageable”. Hearing any of these terms (or their many cognates) should indicate the need for a professional evaluation.

In older children, once in school teachers will notice the short attention span and perhaps also the fidgetiness that goes with it and may call for an evaluation. Children with ADHD are often as intelligent as their peers or more so but will lag behind in the developmental testing due to the cumulative effecs of the short attention span. It is not uncommon to find dyslexia and or dyspraxia also showing up in a detailed evaluation but more commonly ADHD occurs alone. ADHD is now thought to be a catch-all designation that includes at least 5 or 6 different types of disorders, but you can find out more about that in your own research.

Common signs that we look for include:

• Consistently not completeing tasks.
• Not listening or paying attention.
• Keeps losing things.
• Swithches from one activity (or play) to another, more frequently than his/her peers.
• Easlly distractable.
• Refuses to do things considered “boring” (including homework).
• Acts without thinking, very impulsive.
• Needs constant supervision.
• Seems to have “too much” energy.
• Climbs, jumps, runs, more often than peers.
• May be short tempered.
• Seems to fidget a lot, has difficulty sitting still.
• Child can be inflexible, argumentative, and stubborn.

The professionals of course will have a much more detailed list and lots of questions to ask about stuff like developmental milestones, but if any of the above seem to apply to your child, do have a child psychologist do a complete evaluation.

So, if you do have a child with ADHD what’s next? depending on the age and the actual developmental level as well as the child’s own personality and what types of symptoms are present, the professionals will give you detailed instrucions. It is also very important that you do get into a support group with those who are also having to learn how to effectively deal with ADHD.

Controversies are many, so here I’m just going to tell you what I think and leave you to research the various issues and decide for yourself.

In my experience medications are almost always avoidable, but here the proviso is what sort of a parent or caregiver you are. If you are the type who finds all this difficult to accept and would rather not be bothered, then perhaps you should ask the psychaitrists to help both you and your child with some pills. Mostly a type of stimulant is used that strangely seems to calm ADHD kids down. But, I do believe that with a little care and the right support, your child probably can avoid needing to be medicated.

You need to start a journal. Note down behaviors, good and bad as they occur as well as stuff like sleep timings, diet – quantity as well as type, and how the child is coping with studies, feedback from teachers, achievements and especially the developmental milestones.

ADHD is treatable. 

Stay in close tough with the counselors, teachers and other professionals who are going to be dealing with your child’s ADHD, share ideas, ask questions and make suggestions. Find a team/school that both you and your child are comfortable with and work together to sort things out. We have found that in addition to counseling, occupational therapy, sensory integration and yoga have all proved helpful. Treatment is usually successful when done with a will to succeed. Your child may always have the tendencies, but will slowly learn how to keep them under control, how to concentrate better, and how to be better organised about life and the various tasks that go into making one more successful.

We pay a lot of attention to diet, but there are many who feel that it’s not that big of a deal. Generally, in our experience, cutting carbs and increasing mixed fats and proteins usually helps almost immediately to modulate hyperactivity and more slowly also has an effect on increasing attention spans. But, this may be anecdotal… We have also found that some children are “set-off” by particular foods or spices. If you do your journal properly, you will find your child’s pattern – if there is one!

We have found that identifying each child’s interests is an important first step. It’s much easier to work on the attention span using the child’s own interests as a springboard. Boredom is one of the biggest enemies, so trying a ‘standard formula’ rarely works across the board.

Keep plugging away. Both you and your child should realise that having ADHD does not make one less valuable as a person. The real point is that each and every child should have the best possible shot at realising their own unique potential – and that’s the Challenge!

P.S. There’s lots of half-baked stuff out there. Use your common sense, resarch thoroughly, discuss issues threadbare before jumping on to the latest bandwagon. A little thoughtful hesitation never hurts!

SLLOOOWWWW LEARNING, LD-5

Some educationists speak of slow learners as those not specifically diagnosed with a learning difficulty but yet who are below their grade level in studies. Others use this term to mean children with lower than normal IQs but who would not be considered retarded.

Both of these definitions are wrong. There are a very wide variety of causes for slow learning, not all of which are understood. Often it has absolutely nothing to do with IQ at all. In fact those with lower than normal IQs should not be called “slow learners” for not only will they be slow but in absolute terms they will never become age normative – that’s not slowness. Those who are just a bit slower will eventually catch up and will even sometimes go on to become exceptional.

In my experience, slow learners may have any combination of identifiable dysfunctionalities like ADD, hyperactivity, dyslexia, dysgraphia or dyspraxia, and sometimes none. But these disadvantages will be partial in effect and not severe enough to be uncompensatable. Very often, we have found that slow learners also have problems with visual-motor coordination. There therefore may be issues in delayed development of visual motor ability and there may be accompanying dyspraxia. While slow learners will lag behind their classmates, they will somewhat manage to keep up. Typically they will do better orally than in written testing and simple things like completing classwork or homework in time may be a constant headache for both parent and teacher- but this is to be expected if your child is slow!

Therapy in self organisation is very important. Building up the child’s self-confidence is also very important. Identify the child’s strengths and use these to bolster their confidence. Teachers should work harder at encouraging and stifle the urge to criticise and particularly should be careful about comparing one child’s performance or work with another’s. At the same time demand and expect performance. Do not let the child be satisfied with less than their best effort. You may find at one stage that there will be a sudden improvement in handwriting neatness and speed or perhaps in an ability to do sums, and this is a strong sign that the right parts of the brain are being stimulated to catch up and they mostly will then do so quite quickly.

Orally work with the child one-on-one whenever possible doing mental sums, or any kind of mental gymnastics, including solving puzzles, conundrums, and having fun with expressions and word plays will prove to be very helpful. At the same time make the child work on basics like arithmetic and handwriting on a daily basis.

Again encourage improvement without being too critical but don’t let the child dodge doing the basic amount of work. Daily work on keeping their workspace organised as well as getting them to maintain a daily routine in all things is very important. You will see change happen and sometimes it will happen quite dramatically. Till then a consistent effort will be needed to prepare your child to adequately compensate for whatever part of the mind is temporarily hanging back.

As we have discussed earlier, diet is very important. Get a professional evaluation done as soon as possible and then annually, and do discuss your child’s progress and difficulties with teachers and with your pediatrician. Religiously keep a journal. If the school is not handling your child properly be prepared to shift elsewhere. Do not compromise on the proper learning environment, for once your child feels put down you may never see anything but defeat.

Finally, find a support group. Slow learning is only recently being recognised as something different, so the closest fit will be a support group for ADD/ADHD kids some of whom may also be dyslexic or have other problems.

Tackling any learning disability or developmental delay is a bit like setting out on a marathon or trying to climb a tall mountain. It won’t be over quickly. Slowly and steadily and with determination and encouragement from fellow travelers, you will succeed in the end. Remember that your child is unique. No formulaic approach may work, but with your love and your commitment, your child will be best able to reach all of their own unique potential as a uniquely valuable human being – and make you proud of how much they have and will achieve.

LD4 – Autism

Autism, despite its name, is not just one type of disorder. The better term is Autism Spectrum Disorder (ASD henceforth) and that includes a number of distinct developmental deficits and perhaps also from a variety of etiologies (causes) too. DSM IV does distinguis between ‘classical’ autism and PDD NOS (pervasive developmental disorders – not otherwise specified) which does include most of what I’m here calling the autism spectrum.

ASD actually results in a failure to relate. The affected child may not make good eye contact, may find close physical contact disturbing, and will not easily speak even to express basic needs. In other words, the ASD child may not even recognise “the other” as similar to but distinct from “the self”.

Observant care givers will be able to identify the more severe forms of ASD quite early as the deficits in achieving developmental milestones and interaction may be discernible even from the 9th month onwards, but sometimes it takes much longer to detect.

Common signs include:

• not turning when the parent says the baby’s name;
• not turning to look when the parent points and says, “Look at…” and not pointing themselves to show parents an interesting object or event,
• lack of responsiveness.
• repetitive motion, rocking back and forth.
• failure to speak, babbling.
• lack of ‘pretend’ play.
• repetitive, mechanical, play.
• smiling late; and
• failure to make eye contact with people.

(The above signs may not all occur together and may not all be discoverable at the same ages)

The lack of interaction can have a devastating psychological effect on the parents. While all developmental deficits are challenging to parents, the parents of kids with ASD perhaps have the hardest time. But, if the challenge is taken up, even severely affected kids will show improvement and sometimes the improvements will be remarkable.

The challenge is really not ever to give up. The parent (or caregiver) must insist on a relational response and then must insist on the right response. It can be a lifelong struggle, but ultimately very rewarding.

Once ASD is suspected, the child psychologist or paediatrician will be able to confirm the diagnosis. Therapy involves intensive one-on-one occupational therapy, with sensory integration, and directed play involving the child. Behavioral approaches as well as cognitive ones have proved to be helpful but it is most important that the parents learn what they have to achieve at home and work to effectively reinforce whatever the therapists are doing. Some parents actually take the lead in providing therapy and we have seen this approach produce excellent results. The more the parental involvement, (in my experience) the better the child responds!

In our experience even severely affected children can show remarkable improvement, so don’t get discouraged and don’t give up hope.

While all the parents of children with developmental deficits will be under some extra pressure, especially the parents of autistic kids can find the pressure and tension very taxing. So, it is particularly important that they get support for themselves and being a part of a group with the parents of other ASD affected children can be a great help.

Asperger’s Syndrome is somewhat related to ASD and sometimes even considered to be a part of the ASD spectrum. In Asperger’s, the language deficits may not be present. These kids will have normal or even good language skills but will still be lacking relationally.

All ASDs are treatable. Sometimes, remarkable improvement is seen. With dedication and will, a lot can be done! Get help, and then stick to the task at hand. Take it one day at a time, be patient, set yourselves tough but achievable goals, and you may be surprised at what you and your child can achieve together.

Insight into your child’s personality, what he (ASD is about five times commoner in males) likes and dislikes, getting your lives into a routine, and keeping a detailed journal that covers nutrition, moods, therapies, and anything else that comes to mind – will all prove to be very valuable aids to doing the best that you can for your child.

The American Association of Pediatricians has just published two papers on Autism. For further information, this is an excellent place to start.
AND Please, please, PLEASE look at all the wonderful and up-to-date information contained in the “Yale’s Autism Seminar“!!!!