OJP.RdgArticle.2011Open Journal of Psychiatry, 2011, 1, 79-87   OJPsych
doi:10.4236/jsemat.2011.13014 Published Online October 2011

CLICK here to read the complete Article

Given the findings of this study, it would seem advisable
forclinicians assessing individuals with ADHD to inquire directly
about whether they are able to complete tests involving reading
comprehension within the time usually allowed. If the student
reports frequent inability to complete such tests, the student
should be referred for a full psychoeducational evaluation,
including the NDRT or a comparable measure, to establish whether
accommodations including extended time for tests and examination
are appropriate and should be provided.

Related posts:

1. Edward (Ned) Hallowell, M.D. on ADHD
2. Managing ADHD at Home and at School
3. How to Have Better Teacher Meetings

The Proper Purpose of Assessments in the IEP process: It’s a lot more than reporting a score.

NYSBA Elder and Special Needs Law Journal, Vol. 22, No. 1, 2012 (in press).

This is a prepublication copy.
By Anthony Rifkin

We’ve all experienced not quite being able to remember something. It’s on the tip of our tongue, but … . Yet at the same time, you are sure you know it: the name, the word, the fact, etc.

We are lucky. Because there is a very good chance we’ll be able to retrieve that piece of information. (Technique: do something else, and it will probably pop out.) But what about those that can’t remember, and are challenged by a bottle-neck in that very same channel?! We are able to ‘stay on top of’ things because we can remember. But what happens to those that face such a challenge? Should it be assumed that ‘they don’t know’? Or, that they are less intelligent?

I use this as a simple example to show how and why testing must be so much more that scoring ‘yay’ or ‘nay’ on a set of test items. For as can be seen in the above case, what is the meaning of such a score, if it reflects only that ‘the right answer’ came out? Is it an honest ‘assessment’ of the individual? If it is us, then we can show what we are able to retrieve, and how we are able to perform. But with those that face challenges, the same score may only indicate that that retrieval or performance is not forthcoming. But that score tells us nothing about why. And if an individual requires a customized educational program that focuses on their needs, then an answer to why is needed.

For starters, it is also important to note how many such challenges may exist. There are broad categories, of course: problem solving, memory, attention, perception, language. But within each of these there are a multitude of possibilities. Secondly, it is important to remember what those scores actually reflect (e.g., the scores on intelligence or educational tests): they primarily reflect the norms for individuals the same age. In other words, just as we can perform well in relation to our peers (and can score well on these tests), those with challenges don’t. But again, that is all that the scores are indicating – these individuals don’t perform well in comparison to others, in general.

Yet we may have the responsibility to design a program for these individuals, which must not only address their reality, but also help them to deal with it, i.e., a program that addresses their challenges and can help them to learn and develop, as well as compensate for their challenges and participate in the world as fully as possible. As such, it is the challenges themselves that must be assessed.

This is a tricky business, but also not beyond our purview, as it can be done with those very same tests. We can even use those very same scores in doing this! But those scores become part of an interpretive and exploratory process. They become means to map out a terrain, showing the client’s high and low spots, strengths and weakness. But that is just a first step, as one must then try to discern why the terrain is shaped like that. And the terrain of an individual’s mental, emotional and social makeup is a very subtle thing. Plus one must account for their experiences up to that time as well.

As such, the task is, at the very least, daunting. And it can be easily understood why educational systems fall back upon normed scores to place and position individuals. But thankfully we can examine our client’s performances on those tests, item by item. And in that we can start to see what may underlie their performance, test further, and then eventually find what underlies that terrain. And this is an ongoing process. For the individual’s subsequent program can be structured to test that terrain too. But the initial key is to first perform a decent assessment. With that, we can start to open the door for them.

Luckily, the modes for doing this have been explored, and have been shared for some time now, with those very same tests that standardized scores are reported from. One of the primary approaches to this mode of testing is called the Process Approach[1].Via the Process Approach, one examines how the individual arrived at their answers on a test. In fact, on some of those same tests, alternative means are provided. For example, if one cannot retrieve a name, one may be able to recognize it, thus testing for the very blockage I mentioned earlier. Regrettably though, an individual’s issues are often not that simple. In fact, the combination of two or three challenges can provide quite a knot to be untied.

But that is why testing across the whole terrain becomes so important. This is the cornerstone of Neuropsychological testing, of which the Process Approach is a part. Obviously, on one hand, schooling in terms of brain functions can play an important part in the interpretive process. With head injuries and conditions leading to insults of the brain, one can see specific impairments in function and in the performances that result from localized damage. However, the parts of the brain are not organized in isolation of each other. Instead, the brain normally performs its functions via connections made between multiple areas of the brain, so that multiple processes can occur simultaneously. As such, when you hear something, there is an order and partitioning to processing what you hear. Multiple systems (e.g., cognitive, mnemonic, linguistic and perceptual) may be brought to bear on the processing of a single piece of information, and an additional full set of processes may in turn be brought to bear on one’s reaction to it, which can include a response (e.g., motoric or linguistic) and/or seeking further information (thus involving perceptual, attentional or linguistic processes).

If a brain insult occurs to one of the areas responsible for a part of one of these processes, then an isolated impairment may be seen, which will be seen when testing these individuals. In fact, they can be very similar to our ‘tip of the tongue’ example, with all else functioning normally (e.g., the rest of their language and thinking being in place) but with their just not seeming to be able to perform that one piece. It’s like it just ‘dropped out’. Or, depending on the injury, there may be multiple such pieces. Or worse, qualitatively different complexes. But still, there can be an identifiable, ‘localized’ sense to these.

However, with the neurological challenges that children face, the situation is different. The subtle contributions of development are so strong that isolatable functions and performances are less likely, especially in terms of how we know those functions in our fully-developed, ‘adult’ terms. Kids are still putting the pieces together. So even the role that a function may have (e.g., naming or remembering things) may be very different than it is for us. And that is so in their daily lives and the development which is the core focus of their lives. For example, it is not just that piece that is lost (e.g., when retrieving a piece of information), but the entire structure of their knowledge and ways of knowing, which they are actively building, that they need those ‘pieces of information’ for! By comparison, we have already ‘built’ our knowledge bases, so only need the information in the moment. And in the most general terms for the child, each of the sub-systems, (e.g., attentional, perceptual, linguistic, and motoric) play a part in development coordinated with the others. If one of them does not play its part, a broader set of issues may arise. These are like the complexes I mentioned for adults above, but their ramifications go even further. For they effect that ground that is being built for and by the child, through their development. As such, with kids, one is assessing a dynamic terrain, and having to judge occurrences yet to come.

But before we start feeling too phenomenally intimidated by all this, let’s drop back and look at a single test item, to see how we may tackle it. Part of what is so interesting about the standardized tests is how many systems may come into play within one test item. This is obviously the case, given the description I gave a few paragraphs back of how multiple systems must be coordinated for processing a single piece of information, much less our having to respond to it as well. As such, there is seldom an item that is a solely “verbal’ or solely “perceptual”. Like anything else, an item will be made of parts. A test with a set of such items may be similar. But caution must be taken here too, for new processes may be added on with later items, so that they are ‘harder’. For example, with an arithmetic problem, there’s a qualitative difference between addition of single digits versus addition of double digits, the addition of two numbers and the addition of 3 or more numbers, etc.. As such, our basic unit must be the single test item, with our noting exactly what the task demands are in each item.

But within a single such item one can see the whole of how an assessment can account for the above too. A single item, in this respect, is a microcosm of the larger whole, with the larger whole operating by the same principles. A single item is made of parts, so examine how those parts are dealt with, and you will be able to see how the whole operates.

Take a standard arithmetic word problem. If Mary has 6 tomatoes and sells 3 … . You’ve already solved it, without my even having completed the statement. Interesting, eh? You did it ‘in your head’, mentally. And you did it ‘automatically’ – I didn’t need to ‘tell you’ to do it. Six minus 3 equals … . And you used memorized ‘math facts’. Still a child counting on their fingers could solve it. But there is a strong linguistic component too. How did you (and the child) arrive at subtraction? A linguistic ‘convention’ indicated by ‘sells’ tells us this, plus the concepts behind ‘Mary has’, so that we’re looking for some alteration in that amount.

That is an example just a small piece of the mental terrain that is your life, that you don’t even think about. Yet the child must build a terrain like that which you now stand on. But our judgments of a child and their performance are not always so lenient. Even if transferred to paper, written down and solved, these are clearly mental manipulations. But what if a child can’t do it without writing it down? Are they unable to perform the ‘mental manipulation’? Hardly, especially if they did all the steps of translating and transferring the problem, performing the calculation, and arriving at the solution. No, rather, that child may be burdened by some other aspect of short term retention, of not being able to hold on to the information and perform the mental manipulation at the same time. Now we are starting to get at something.

However, whereas this ‘single item’ is probably not making you feel comfortable with this world of assessment yet, let me expand to show you where it fits. What if that single item, just the mental arithmetic problem alone, with its answer scored as ‘right’ or ‘wrong’, is all the information gotten from the testing?! Then all that underlies there is missed. For we that can ‘pop out’ with our answer, this is not a problem. But for a child that is struggling with some aspect of this, it is a problem. Luckily, in this case, it is likely that our child will be given a sheet of written problems to solve too. But if they do well with those, then it may be said “good with calculations, but not good with mental manipulations”. And even worse, that mental arithmetic score may be entered into an over all “verbal score” for the child (as they are ‘word’ problems), thus lowering that score too. Of course, any test worth its salt, and the testers who administer them, will note the significant difference of this test from others within that ‘verbal’ domain. But in the process of getting those scores reported, and meeting the demands for the classification and placement decisions for all students, are these differences really noted?

So we stop for a moment, and start with our single item again. If we at least have it as a snap shot of the student, that may give us an honest starting point, before all else is swept under the rug. While our single item is still no less intimidating, it at least gives us something – something real.

The trick for using it though, is in using it in combination with other test items – across tests – but doing so in terms of those ‘parts’ I illustrated. If two test items on different tests, share two parts, but differ on a third part, and the child’s performance is different on these two items, then … .This is why so many tests are administered during neuropsychological testing. Only in this way can you get a true picture of this child’s terrain, for their particular strengths and weaknesses. For example, that very subtle difficulty in ‘retaining and comparing information when problem solving mentally’ may show up elsewhere. Of course, with experience, you know what tests those may be, so you use them! As now you are looking at the terrain itself, testing it. The scores are secondary. Though you calculate them too, so that when writing about your findings, you can say, “the child fell below the norms on … “, but then with your comparison of items you can say, “… but here appears to be the reason why”. It is the combination of elements within particular tasks that you are now looking at … or more precisely, that you are looking at to see how the child responds. A similar task with just perceptual combinations may not give the child a problem. But that may be because the perceptual problem is ‘seen’, and can be solved by using mental manipulations of visually-present materials (such as puzzles). Or, because they got to perform the task motorically. So you look at tests that require the manipulation (juxtaposition and selection) of visually-presented materials without motor manipulation – quite a mouthful, but you know the tests, and what is done with them. Or maybe it’s the retention of linguistic information, which must then be manipulated, that is giving the child a hard time. So you look to see if they can handle other types of verbal materials that require inferences and prediction. Or is there something in the word/arithmetic problems themselves? Or is the problem in the character of number, and how the child relates to that?

In this way, all the single items are like atoms, bouncing off of each other. And the sets they come from, that may have similarities and differences within them as well, are like molecules. So you can see whether the atoms do or don’t bond. One watches their behaviors, and performs tests to see how they behave. And in this way one can come to know a child’s terrain – by closely examining it with these special tools, tools that one becomes familiar with, and with which one is able to see the nuances of an individual.

But finally, with a view of the child, one must then approach the dynamic of their development. As noted, a child’s purpose and place with all of this is very different from ours. They are testing and trying things. They are learning and coming to be. But as it is ‘us’ that is viewing ‘them’, so there is another point we should remember – we have values that we are bringing to this picture, much like the judgments I mentioned above. But is it the child we see, or our judgments? For we see a low score in mental arithmetic, or his need to use paper to solve the problem, but is that the end of the world? Our view says, ‘something is wrong’. But have we looked at its meaning for the child … and most importantly, for their development? For, what is the effect the pronouncement of ‘wrong’ itself? With that (and our normative scoring systems), we become as much of an ‘effect’ upon development as anything else!

I put this like this to suggest what our role is at this point, as we head toward setting out a program for the child – one that hopefully relates to their educational needs! So let’s say we find that there’s a mix, right there at the point where the linguistic aspect of the problems meets the arithmetic itself. And, that to overcome this impasse, the child has to write down the problem. We find that this enables them to make the transition. But (hypothetically), what if the other children aren’t allowed to do that, and there is a very stringent rule at the child’s school about this? Should our child be allowed to? Will he/she be given an unfair advantage thereby? Or do we look at our child as a developmental whole, who could well use that aid, to open and ease their way in the world.

Now obviously, I’m being a bit simplistic with this example. But it’s to make a point. To bring that point home, we are only talking about a single, easily imagined aid and solution, for a problem that does not appear that severe. And a solution that few would object to. But what if the linguistic gap is much larger? For example, our child has been found to have a real difficulty dealing with ‘abstractions’, exactly of the type found in word problems. I.e., our testing led us down a path that showed those aspects to be malfunctioning. Now what are our responsibilities, and how can they be met? What ‘compensations’ will be ‘allowed’? Will the child be allowed to use a calculator, even though he/she can perform the operations sufficiently without one. But what if this aids their linguistic challenge in this case, which can be tested and shown? Here we are starting to cross over a line, out of the land of our familiar, conventional knowledge and judgments. Here we are moving into that land above, the terrain of the brain systems themselves. And this is the child’s brain, the one they need to build their mental world with!

And this is still only scratching the surface. We may be helping to get the child by, but greater educational questions may need to be addressed as well. I.e., what ‘compensations’ may be needed if a part is not fully functioning, or potentially even “missing”. And, in terms of the IEP process, can the child receive an appropriate education if these challenges are not adequately identified and the necessary compensatory strategies not provided? Again, with the brain injured adult, that piece might be taken out, and a function lost. It is noted, and it is seen. Of course, such an occurrence, in and of itself, may be seemingly devastating, and means for compensating for the loss may be sought. But with the child, a distinct ‘piece’ is not as visible, because it has not as yet contributed its part to the child’s whole. And the child may present as being ‘of this character or that’, and may even seem fine. And, for example, in our world where ‘I’m not good at math’ is heard all the time, it may be easy to pass the problem by.

But we have identified a problem. We have looked further than the initial ‘word problem’ and the situation with arithmetic. And we are not satisfied with the global test score that may simply suggests that the child is a bit ‘slow’, if that is where this is leading. There is a reason why they are not performing well, and on a SET of very specific types of problems! So before the labels can be made to stick, what can be done?! If they have talents and strengths, those should be accentuated. How can they be given a better balance? As that is what we would feel, and hopefully seek for the brain injured above. So why not for our child too? Even if those stronger parts are not of an accelerated type, they must be supported and enabled to flourish, rather than the ‘whole’ simply receiving a label. This is where the ‘parts’ that have been identified by our initial test items can come into play. And work with those ‘parts’ should always continue. Even if it is never ‘complete’, ways may be found for the child to compensate, just as we would think about our brain-injured person who as ‘lost’ something. Yes, in the case of our child, it requires looking into the future, which is harder than noting something that was there and is suddenly gone. But we are looking at how they may grow, not weighed down by that part that they didn’t have, and by finding a way to live and work with it! And again, it is those ‘parts’ that we can ‘see’ in our tests!

In this way, an IEP should be sculpted to meet a child’s needs. And that should be an ongoing process over the years, tracking progress in the identified areas, and noting changes as they are needed. Of course, the challenges that may need to be faced, for and by any specific child, may be far more than portrayed above as well. The above picture was drawn to show a single thread. In actuality, a combination of linguistic, attentional, perceptual and motoric problems, can result in a rather complex terrain. But the challenge for us, as well as the child, is the same. Identify the problem, and deal with it. Scores and classifications mean nothing if they simply ‘place’ a child. That placement must be for the child’s identified needs. And their educational program, including placement and support services, must be for the same purpose. So the proper use of an assessment will be to tell us what those needs are. And it is only from that point that the work then begins. I.e., that which needs to be done to best facilitate and assure appropriate, measurable educational growth, leading to the achievement of the student’s independent functioning[2].

Endnotes

[1] Kaplan, Edith. A process approach to neuropsychological assessment. In Boll, Thomas (Ed); Bryant, Brenda K. (Ed), (1988). Clinical neuropsychology and brain function: Research, measurement, and practice, The Master lecture series, Vol. 7 (pp. 127-167). Washington, DC, US: American Psychological Association, 202 pp.

[2] Blau, A.F. Advocating for “Appropriate” Special Education Services: Focusing on the IEP. NYSBA Elder and Special Needs Law Journal Vol 21, No. 3, 20-24, 2011.

About the Author

Anthony Rifkin is a neuropsychologist and clinical consultant working with Dr. Blau & Associates, PLLC, with offices based in New York City. Dr. Blau & Associates focus on communication, education, and vocational program customization for individuals with complex physical and neurological challenges. The people served range from infants to the elderly, based on a philosophy that supports customized intervention for functional self sufficiency throughout the life span. Anthony earned his Ph.D. in Developmental Psychology at CUNY in 1986 and completed a Re-specialization in Neuropsychology at Teachers College, Columbia University in 1990.

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The Mysteries of ADD

published originally on the web for Psychology Today magazine. Tom Brown’s website www.DrThomasEBrown.com

The truth about attention deficit disorder
by Thomas E. Brown, Ph.D.

The Mysteries of ADD and High IQ

The five truths about attention deficit disorder.
Published on August 16, 2011 by Thomas E. Brown, Ph.D. in The Mysteries of ADD

We recently published a study of 117 high IQ children and adolescents with ADD. (Note: In this
article, the term ADD is used to refer to both ADD and ADHD). All of these very bright students
were struggling in school and often also in social relationships because of their ADD-related
problems. Results from that study uncovered a pattern of vulnerabilities in executive functions,
the management system of the brain, that caused these bright students to have chronic difficulty
in focusing on their work, in getting their work done adequately, in keeping in mind what they
had just heard or read, and in organizing and completing assignments. Some have been mystified

Students in this study, compared to others of the same age, were impaired not by lack of smarts,
but by chronic inability to deploy their smarts in effective work and in getting along with other
people. One of the measures used in our study was a rating scale that inquires about impairments
in various clusters that describe executive functions (EF). Everyone has problems with these
various functions sometimes; people with ADD have much more difficulty with these functions
than do most others of the same age.

Data from this study show that individuals can have very high IQ and still suffer significant
impairments in each of these executive functions that are essential for working effectively and
for getting along with other people.

3. How can someone be an honor student in elementary school and then struggle and fail
repeatedly in high school or college?

Most of the students in this study got high grades in elementary school. Many were in special
programs for talented and gifted students. Their school difficulties tended to begin when they
made the move from elementary school, where they were with one teacher and the same group
of classmates most of the day. Entry into middle school or junior high often brought increasing
difficulties in keeping track of assignments and in completing homework. We explain that
these students struggled when required to operate more independently without that one teacher
who can help to keep tasks and expectations organized for all subjects throughout the day. As
homework requirements escalated and parents were less able to monitor what was going on in all
the various classes, many of these very bright students began to flounder.

Some of the older students in the study had managed to function well even with the demands of
middle school and high school. Many of them had parents who were successful in maintaining
supportive scaffolding around their sons and daughters, helping them to prioritize, plan, monitor
and complete multiple assignments. Often the ADD impairments of these strongly supported
high IQ students did not show up until they went away to college or university. There, lost
without the strong daily support of their parents, many of these very bright students were unable
to cope with their schoolwork, had plummeting grades and were required to take a semester
off or transfer to another, less challenging college. Just being very smart is not enough to be
successful in college, university or employment; one also needs to be able to manage oneself,
to work productively and to get along reasonably well with peers, professors, supervisors, and
employers.

4. How can someone focus very well on playing a sport, video games, drawing, or making
music and not be able to focus enough on almost anything else?

The most mystifying aspect of ADD is that everyone who has this disorder is able to focus
very well on a few specific types of tasks, even though they have great difficulty in focusing
effectively on almost everything else. All of the students in this study reported that they had no
difficulty in exercising executive functions very well for a few specific activities. For some it
was participating in a sport or making art or music. For others, focus came easily for repairing
car engines, cooking, using the computer, or designing websites. When asked to explain why
they could focus on those few specific activities, but not on other tasks they recognized as
important, the students typically responded by saying: “If it’s something that really interests me,
I can focus. If it’s not really interesting to me, I just can’t focus, even when I know it’s important
and I really need to do it.”

One of our patients explained this: “ADD is like having erectile dysfunction of the mind. If the
task is something that really interests you, you’re up for it and can perform. If it’s not something
that turns you on, you can’t get it up and you’re not able to perform.” The capacity to focus and
mobilize executive functions for a task depends primarily on release of dopamine in specific
areas of the brain and that release of dopamine is not under voluntary control.

5. Does anyone ever get over having ADD as they get older?

Back when ADD was seen as simple hyperactivity, it was believed that anyone with ADD would

outgrow those problems by the time they were about 14 years old, if not before. That view made
sense because for several decades ADD was seen as just hyperactive behavior, not as a problem
with attention and EF. Often, though not always, hyperactive symptoms of ADD do go away as
one gets older. But longer term studies have shown that for about 70-80 percent of those with
ADD, their attentional symptoms tend to persist into adulthood, even if hyperactive problems
have remitted. We published an earlier study of 157 high IQ adults with ADD. The design of that
research was almost identical to this recent study of kids with ADD and the results were very
similar. For many, the EF impairments of ADD persist into adulthood.

Despite the persistence of ADD, many of those affected experience less impairment from ADD
symptoms as they get older. Three reasons may contribute to such improvement: for many with
ADD, junior high, high school and the first few years of university are the most difficult. This
is because these are the years when one is required to cope with the widest range of academic
tasks with the least opportunity to escape from the ones you’re not that good in. When one gets
further along in education or employment it is often possible to specialize in work that is more
interesting and which one can do reasonably well, without carrying so much of a burden of more
challenging tasks. Second, imaging studies have shown that the course of brain development in
adolescents with ADD is very similar to that of their age mates, except in a few specific regions
of brain that are essential for executive functions. Individuals with ADD tend to catch up in
development of these delayed regions of brain crucial for EF about 3 to 5 years behind their
peers. This may account for some students who do poorly in high school and early college, then
return to more advanced education a few years later and are very successful.

Thomas E. Brown, Ph.D., is associate director of the Yale Clinic for Attention and Related
Disorders, Department of Psychiatry, Yale University School of Medicine.

Thomas E. Brown, Ph.D.

Thomas E. Brown, Ph.D., is associate director of the Yale Clinic for Attention and Related Disorders, Department of Psychiatry, Yale University School of Medicine.

Books by Thomas E. Brown, Ph.D.

Attention Deficit Disorder: The Unfocused Mind in Children and Adults

by Dr. Thomas Brown Ph.D.

Yale University Press

buy now

ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults

by Thomas Brown

American Psychiatric Publishing, Inc.

buy now

Related posts:

1. High IQ Kids With ADHD – Thomas E. Brown, Ph.D.
2. Attention deficit hyperactivity disorder (ADHD) Patient Information
3. Post-Secondary Students with Attention Deficit/Hyperactivity Disorder: Legal Rights & Accommodations

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2. ADHD (TDAH) Adult Screener en Español
3. TDAH, Funciones Ejecutivas y Exito Escolar

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Learning disabilities and ADHD

Learning disabilities affect how you understand, remember, and respond to new information. They can cause problems in several areas, including speaking, reading, writing, and doing math.

Attention deficit hyperactivity disorder (ADHD) is not a learning disability, but it definitely can affect a person’s ability to learn. And if you have ADHD, there’s a pretty good chance that you may also have a learning disability.

Experts think a combination of factors causes learning disabilities and ADHD, including your genes and the environment around you. For example, lead in drinking water sometimes found in old homes can play a role.

Whatever the causes, having a learning disability or ADHD doesn’t mean you can’t do really well in life. In fact, lots of famous people with learning issues or ADHD — from cartoonist Walt Disney to clothing designer Tommy Hilfiger — went on to fantastic success. Keep reading to learn more about living with learning disabilities and ADHD.

• Learning disabilities
• Attention deficit hyperactivity disorder (ADHD)

Learning disabilities

Having a learning disability does not mean that you are slow or dumb. It means that your brain is “wired” a bit differently, so that you learn differently from most other kids.

Below are some common types of learning disabilities:

There’s no cure for a learning disability, and you may have to deal with it your whole life. But you can learn some great ways to tackle any challenges your disability may bring.

If you haven’t been diagnosed with a learning disability and think you have one, tell your teacher, parents, or guardian. They can start you on the path to the kinds of support you need. You may see a school psychologist or a learning specialist, who can give you tests to figure out what kind of disability you have. Then you may get help from teachers specially trained to guide your learning in ways that work best for you.

One way kids with learning disabilities get help at school is through an Individual Education Program (IEP) — a plan written just for you and your learning needs.

You can learn lots of ways to improve your learning skills, including memory tips from LD Online.

Attention deficit hyperactivity disorder (ADHD) top

ADHD is a medical condition that affects a person’s ability to pay attention, sit still, and follow directions. If you have ADHD, you may often lose stuff, lose concentration, and just plain lose control — none of which is much fun! But there are lots of tools and treatments for ADHD that can help you build a great future. Some extremely successful people have ADHD, including Ty Pennington, host of the TV show “Extreme Makeover: Home Edition.” Even Albert Einstein is thought to have had it! Some kids also find that their symptoms get better as they get older.

Symptoms of ADHD include:

• Being easily distracted
• Acting without thinking things through first
• Daydreaming a lot
• Having trouble finishing tasks like homework
• Feeling restless or fidgety
• Being very active
• Having trouble staying organized

Of course, everybody has these issues sometimes. If you have ADHD, though, you likely have them for longer and in more significant ways. And they probably cause some serious problems for you at school, at home, and with your friends.

A diagnosis of ADHD is made by a health care professional trained to recognize it. You could start with a visit to a pediatrician, who might recommend a specialist like a psychologist, psychiatrist, or neurologist. There’s no one test for ADHD, so diagnosis can involve talking with you, checking your school records, and doing a physical exam to rule out other possible causes for your symptoms.

Treatment for ADHD can be medication, some kind of therapy, or both.

Medications for ADHD include stimulants like Ritalin and Adderall. It may seem strange to treat being hyperactive with something that stimulates you, but these medicines have the opposite effect on kids with ADHD.

If you take medication for ADHD, learn its possible side effects and tell your parents or doctor if you get any. Also, if you know you have a heart condition, tell your doctor, since some ADHD medications can be a problem if you do.

Therapy for ADHD often is a kind called behavioral therapy. This type of treatment helps you work on how you behave. You might learn to give yourself praise or rewards for achieving a goal, like staying cool when you feel angry. Behavioral therapy also can provide the kinds of tips that help manage ADHD. For example, you might develop a system for staying organized, like putting your stuff in the same place every day or posting a list of chores.

Therapy also can be a great chance for you to talk about things that are upsetting you. A therapist can help you find healthy ways to handle your feelings. Sometimes just talking helps!

Schools provide services for kids with ADHD, so your parents should ask what’s available to you. The school will do an evaluation and may offer help like seating you where you’ll be less distracted. If you qualify, you will receive an Individualized Education Program (IEP), which is designed just for you.

A lot more boys in your school may have a diagnosis of ADHD than girls. But that doesn’t mean ADHD is a guy thing. Some girls have it but just don’t get diagnosed. Experts think girls more often have ADHD symptoms that a teacher might miss, like getting distracted. Boys with ADHD, on the other hand, more often are hyperactive, which is a lot harder to miss. If you think you have ADHD and no one has noticed, speak up to get the help you need.

Lots of things about having ADHD can be challenging — especially added on top of the usual stress a teen faces. But there are so many things you can do to feel better. Find ways to use your skills, relax, and connect with other people. You definitely have what it takes to learn how to deal with ADHD. The fact that you’re reading about it now means you’ve got the strength to put in the effort it takes to succeed!

Content last updated February 16, 2011

Office on Women’s Health in the Office of the Assistant Secretary for Health
at the U.S. Department of Health and Human Services.

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ADHD: A Disorder of Regulation

Books by Dr. Barkley:  CLICK HERE

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2. ADHD and Emotional Regulation Video by Dr. Russell A. Barkley
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Personal income tax is due in about 2 weeks!  Many people with ADHD – and without – have difficulty getting their financial records ready in time to make this deadline.  Be realistic.  If you see that you are unlikely to have your taxes ready to mail by April 15th (April 18th for 2011) , file for an extension now, to avoid penalties for late filing (you’ll still have to pay taxes and interest, so the sooner you file, the better).
It is possible to overcome major avoidance, which is what keeps many people from getting their taxes done on time. When you are working on tax prep, think of it as aproject.  It is then less overwhelming to manage this project by breaking it down into steps (tasks) and working on just one task at a time.  Entering each task on your calendar, as a Task-Appointment, makes it more likely you’ll get them done, as you’ve assigned specific times for working on each ‘baby step’ for your Tax Prep project.  It is easier to get your head, and energy, around doing a specific task then it is to think about accomplishing the entire project.

• ·         Task #1 – Begin by gathering the many financial papers you probably have in several different places, and put them in one location, even if you use the proverbial shoebox to hold everything!
• ·         Task #2 – Sort the various papers into categories (receipts, statements, tax reporting forms).
• ·         Task #3 – If you itemize, group your deductible receipts (medical, business, etc.).  Note:  Remember that you can request an annual statement from your local or mail order pharmacy that itemizes all medication expenses, so you don’t need to keep each receipt during the year.  Obtaining this statement can be a separate Task (visit the pharmacy, make the call or download the Pharmacy record).
• ·         Task #4 – Review your checkbooks, bank and credit card statements for possible deductible expenses.
• ·         Task #5 – Are any reporting forms missing?  (W2 or 1099’s, property or school taxes, mortgage interest, bank interest, stock dividends, etc.) You should have a list of what to look for from your accountant.  If not, several are available online or through the IRS website.  If any critical reporting forms are missing, set a Task to contact the originator for a copy.
• ·         Task #6 – Tally your categories and list the details, whether on paper or computer.
• ·         Task #7 – Fill in the tax forms or give your prep work to your accountant.  Note: Accountants may have different requirements as to what documentation they need to do your taxes, so check in advance.

Take your Tax Prep Project a baby step, or Task, at a time, and it will be easier to complete it without getting into a state of overwhelm or frustration.  Hopefully you can do this in time to file by April 15^th (April 18th in 2011 only),   but if not, by or before the extension deadline.

Don’t ignore it – taxes DON’T just go away J   If you don’t want next year to be as stressful, work with someone to set up a simple system for managing your financial papers.  It’s worth the investment, given the possible penalties and interest of late filings, the potential savings from having a clear record of all deductible items, and, perhaps most important, the reduced stress you’ll experience.

© Susan Lasky, Productivity/ADHD Coach and Professional Organizer, Organizing & Productivity Solutions

914-373-4787, Susan@SusanLasky.com, www.Organize-Coach.com

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Learn from Glen S. Hirsch, M.D., a nationally recognized expert in diagnosis and psychopharmacology, how a psychiatrist diagnoses this disorder, when and how the question of medication comes into play and, if appropriate, how the choice of a specific medication is made, how to titrate for maximum benefit and how to determine whether the medicine is working at maximum potential.
1. This is an audio recording only (We apologize for the poor recording quality.)

2.  Accompanying PDF of the presentation

Dr. Hirsch is the Medical Director of the NYU Child Study Center & Dept. of Child and Adolescent Psychiatry Assistant Professor of Child and Adolescent Psychiatry, Psychiatry and Pediatrics, NYU School of Medicine.

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Attention deficit hyperactivity disorder (ADHD)

Definition

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child’s age and development.

Alternative Names

ADD; ADHD; Childhood hyperkinesis

Causes

Imaging studies suggest that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenaline) differently from their peers.

ADHD may run in families, but it is not clear exactly what causes it. Whatever the cause may be, it seems to be set in motion early in life as the brain is developing.

Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be confused with, or appear with, ADHD. Every child suspected of having ADHD should have a careful evaluation to determine what is contributing to the behaviors that are causing concern.

ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 – 5% of school aged children. ADHD is diagnosed much more often in boys than in girls.

Most children with ADHD also have at least one other developmental or behavioral problem. They may also have another psychiatric problem, such as depression or bipolar disorder.

Symptoms

The symptoms of ADHD are divided into inattentiveness, and hyperactivity and impulsivity.

Some children with ADHD primarily have the inattentive type, some the hyperactive-impulsive type, and some the combined type. Those with the inattentive type are less disruptive and are more likely to miss being diagnosed with ADHD.

Inattention symptoms:

1. Fails to give close attention to details or makes careless mistakes in schoolwork
2. Has difficulty sustaining attention in tasks or play
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Has difficulty organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
8. Is easily distracted
9. Is often forgetful in daily activities

Hyperactivity symptoms:

1. Fidgets with hands or feet or squirms in seat
2. Leaves seat when remaining seated is expected
3. Runs about or climbs in inappropriate situations
4. Has difficulty playing quietly
5. Is often “on the go,” acts as if “driven by a motor,” talks excessively

Impulsivity symptoms:

1. Blurts out answers before questions have been completed
2. Has difficulty awaiting turn
3. Interrupts or intrudes on others (butts into conversations or games)

Exams and Tests

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.

The diagnosis is based on very specific symptoms, which must be present in more than one setting.

• Children should have at least 6 attention symptoms or 6 hyperactivity/impulsivity symptoms, with some symptoms present before age 7.
• The symptoms must be present for at least 6 months, seen in two or more settings, and not caused by another problem.
• The symptoms must be severe enough to cause significant difficulties in many settings, including home, school, and in relationships with peers.

In older children, ADHD is in partial remission when they still have symptoms but no longer meet the full definition of the disorder.

The child should have an evaluation by a doctor if ADHD is suspected. Evaluation may include:

• Parent and teacher questionnaires (for example, Connors, Burks)
• Psychological evaluation of the child AND family, including IQ testing and psychological testing
• Complete developmental, mental, nutritional, physical, and psychosocial examination

Treatment

The American Academy of Pediatrics has guidelines for treating ADHD:

• Set specific, appropriate target goals to guide therapy.
• Start medication and behavior therapy.
• When treatment has not met the target goals, re-evaluate the original diagnosis, the possible presence of other conditions, and how well the treatment plan has been implemented.
• Follow-up regularly with the doctor to check on goals, results, and any side effects of medications. During these check-ups, information should be gathered from parents, teachers, and the child.

MEDICATIONS

Children who receive both behavioral treatment and medication often do the best. There are now several different classes of ADHD medications that may be used alone or in combination. Psychostimulants (also known as stimulants) are the most commonly used ADHD drgus. Although these drugs are called stimulants, they actually have a calming effect on people with ADHD.

These drugs include:

• Amphetamine-dextroamphetamine (Adderall)
• Dexmethylphenidate (Focalin)
• Dextroamphetamine (Dexedrine, Dextrostat)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)

The Food and Drug Administration (FDA) has approved the nonstimulant drug atomoxetine (Strattera) for use in ADHD. It may be as effective as stimulants, and may be less likely to be misused.

Some ADHD medicines have been linked to rare sudden death in children with heart problems. Talk to your doctor about which drug is best for your child.

BEHAVIOR THERAPY

Both before and after a child is diagnosed, there is stress on the family. Families can experience blame, anger, and frustration. Talk therapy for both the child and family can help everyone overcome these feelings and move forward.

Parents should use a system of rewards and consequences to help guide their child’s behavior. It is important to learn to handle disruptive behaviors. Support groups can help you connect with others who have similar problems.

Other tips to help your child with ADHD include:

• Communicate regularly with the child’s teacher.
• Keep a consistent daily schedule, including regular times for homework, meals, and outdoor activities. Make changes to the schedule in advance and not at the last moment.
• Limit distractions in the child’s environment.
• Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients.
• Make sure the child gets enough sleep.
• Praise and reward good behavior.
• Provide clear and consistent rules for the child.

ADHD can be a frustrating problem. Alternative remedies have become popular, including herbs, supplements, and chiropractic manipulation. However, there is little or no solid evidence for many remedies marketed to parents.

Outlook (Prognosis)

ADHD is a long-term, chronic condition. If it is not treated appropriately, ADHD may lead to:

• Drug and alcohol abuse
• Failure in school
• Problems keeping a job
• Trouble with the law

About half of children with ADHD will continue to have troublesome symptoms of inattention or impulsivity as adults. However, adults are often more capable of controlling behavior and masking difficulties.

When to Contact a Medical Professional

Call your doctor if you or your child’s school personnel suspect ADHD. You should also tell your doctor about any:

• Difficulties at home, school, and in relationships with peers
• Medication side effects
• Signs of depression

Prevention

Although there is no proven way to prevent ADHD, early identification and treatment can prevent many of the problems associated with ADHD.

References

Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921.

National Institute of Mental Health (NIMH). Attention deficit hyperactivity disorder (ADHD). Accessed January 14, 2010.

Prince JB, Spencer TJ, Wilens TE, Biederman J. Pharmacotherapy of attention-deficit/hyperactivity disorder across the life span. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 49.

Review Date: 2/22/2010

Reviewed By: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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