ADD Resource Center » Education

Organization, Time Management and Planning Deficits in Children with ADHD

Harold Meyer — Fri, 06 Jan 2012 17:28:50 +0000

Understanding & Intervening in Organization, Time Management and Planning Deficits in Children with ADHD

An audio presentation by Richard Gallagher, Ph.D

CHADD Mtg: Learning and Attention: A Pediatrician’s Perspective on Attention and Learning Issues

Harold Meyer — Wed, 04 Jan 2012 18:01:47 +0000

CHADD of New York is proud to present:

Jan 9, 2012 – Learning and Attention: A Pediatrician’s Perspective on ADHD, Attention, and Learning Issues

Each student diagnosed with ADHD or learning problems has a unique profile of strengths, challenges, and specific needs. Increasingly, neuroscientists and clinical researchers are learning more about the significance of these differences.

Parents, students, and educators who understand how to recognize variations in learning are in the best position to implement effective strategies and optimize academic performance. In this presentation, Paul B. Yellin, MD, FAAP will share emerging knowledge in the field, and discuss how to utilize new findings for the diagnosis and care of every student.

Target audience:

Parents of children and young adults with learning difficulties, such as ADHD, reading difficulties, math difficulties, etc.; Educators from grades Pre-K through College; Young Adults and College/Post-Graduate students with experience managing attention and related difficulties.

Paul B. Yellin, MD, FAAP, is the Director of The Yellin Center for Mind, Brain, and Education, a learning assessment, student support, and professional development organization based in New York City. Dr. Yellin is a board-certified pediatrician with more than 25 years of experience in improving the well-being and development of children. He is an Associate Professor of Pediatrics at New York University School of Medicine.

January 9th, 2012
5:55PM
Doors close shortly thereafter
65 East 89th Street (Parish Office-St Thomas More)
Between Madison and Park
New York, NY

CHADD Hotline:212/721.0007

Reservations are not required. Please leave the kids at home.

Caring for Children with ADHD: A Resource Toolkit for Clinicians

Harold Meyer — Thu, 22 Dec 2011 12:11:04 +0000

ADHD – NICHQ Toolkit

National Initiative for Children’s Healthcare Quality

To download the entire toolkit as a zip file, click here.

To download individual documents from the Toolkit, use the links below.

01 - Introduction

ADHD Assessment Tools

Harold Meyer — Thu, 22 Dec 2011 11:50:55 +0000

These ADHD assessment tools be used for educational purposes only. They are not substitutes for informed psychological advice or training. Do not use this information to diagnose or treat a mental health problem without consulting a qualified health or mental health care provider.

DSM-IV-TR: Attention-Deficit/Hyperactivity Disorder (ADHD) (from Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition Text Revision (DSM-IV-TR))

ICD-10: F90 Hyperkinetic Disorders (from The International Statistical Classification of Diseases and Related Health Problems, tenth revision)

National Initiative for Children’s Healthcare Quality (NICHQ): includes a variety of ADHD- related tools such as rating scales, successful protocols, order sets and forms, and guidelines for implementing key changes. Downloading tools such as the Vanderbilt Assessment Scale for ADHD requires free registration.

ADHD Rating Scale IV — Home Version

ADHD Rating Scale IV — School Version

Child Attention Profile (CAP)

Home Situations Questionnaire [PDF]

School Situations Questionnaire [PDF]

Parents’ Rating Scale for the Attention Deficit Hyperactivity Disorder (requires free registration)

Werry-Weiss-Peters Activity Rating Scale [PDF]

McCann BS, Scheele L, Ward N, Roy-Byrne P.
Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults.
J Neuropsychiatry Clin Neurosci. 2000 Spring;12(2):240-5. [Full Text PDF]

Wender Utah Rating Scale (for adults) [DOC]

Adult ADHD/ADD Quiz

The SNAP-IV Teacher and Parent Rating Scale
[Instructions for above]

Adult ADHD Self-Report Scale (ASRS-v1.1) Screener [PDF]

Adult ADHD Self-Report Scale (ASRS-v1.1) [PDF]

Childhood ADHD Symptoms Scale Self-Report [PDF]

Attention-Deficit Scales for Adults (ADSA) [must be purchased]

Conners’ Continuous Performance Test II for Windows (CPT II V.5) [must be purchased]

Gordon Diagnostic System (GDS) [must be purchased]

Test of Everyday Attention for Children (TEA-Ch) [must be purchased]

Test of Variables of Attention (TOVA) [must be purchased]

Conners’ Rating Scales–Revised (CRS–R) [must be purchased]

Brown Attention-Deficit Disorder Scales [must be purchased]

Brown Attention-Deficit Disorder Scales for Children [must be purchased]

Attention-Deficit/Hyperactivity Disorder Test (ADHDT) [must be purchased]

ADHD Symptom Checklist-4 (ADHD-SC4) [must be purchased]

Spadafore ADHD Rating Scale (S-ADHD-RS) [must be purchased]

ADHD Symptoms Rating Scale (ADHD-SRS) [must be purchased]

Copeland Symptom Checklist for Attention Deficit Disorders – Child and Adolescent Version
[must be purchased]

Copeland Symptom Checklist for Attention Deficit Disorders – Adult Version [must be purchased]

CARE – College ADHD Response Evaluation [must be purchased]

ADD-H: Comprehensive Teacher’s Rating Scale: Parent Form (ACTeRS) [must be purchased]

ADD-H: Comprehensive Teacher’s Rating Scale-2nd Edition (ACTeRS) [must be purchased]

—-

Go to: The ADD Resource Center Home Page.

How to Select a Professional to Work with You and/or Your Child

kerch — Mon, 05 Dec 2011 16:12:07 +0000

If you or your child has, or suspect you have, Attention Deficit/Hyperactivity Disorder (ADD or ADHD), you will most likely consult with a specialist or professional at some time, whether for diagnosis, evaluation, treatment, or remediation.

You may decide to have a formal evaluation for ADD/ADHD that may also include testing for learning disabilities and/or neurological issues.
You might seek an independent educational evaluation as to whether or not your child’s school is addressing his or her needs in the most constructive manner.
You may decide your child would benefit from an after-school tutor, or your college-aged child might need help with organization and time management.
You might be considering medication and decide to see a psychiatrist or other medical professional.
You might deside counseling is needed, whether it is with a psychotherapist, psychologist, therapist, social worker or marriage counselor.
You may be interested in the practical skills and accountability that would come from working with a coach.

The Importance of a “Good Fit”

You want to look for a “good fit” between you/your child and the professional—this can make a significant difference in the outcome of the treatment. However, selecting the most appropriate professional is a time-consuming and difficult task.

Based on the experiences of many of our clients, both as adults and as parents, and the suggestions of many professionals, we’ve put together certain questions you can ask, and strategies you can follow, to make this task easier and more successful. These suggestions should help, but here is the most important advice we can give you:

You are the ultimate expert on your child, and yourself. You know your child far better than anyone else does. Your opinions should be taken seriously by any professional you select to work with your child.

Don’t let yourself get caught up by an “expert” who is condescending or intimidating. Listen to your ”gut reaction. ” You are your child’s advocate. You are also your own. If you feel there is no chemistry between you and the professional, reconsider any long-term relationship. (Also be aware that the professional is not there to be your friend, to “yes” you, or to coddle you. You want honesty and directness, and sometimes you’d rather not hear what needs to be said.)

Be an informed consumer. Interview several experts to get a taste of different approaches to treatment; consider which approach might be best for your child; which approach best suits your personality. At the same time, avoid the trap of continually searching for the “ideal” professional.

While you must be responsible for making all major decisions affecting your child, do encourage the child to participate in the decision-making process, wherever appropriate. We all tend to be more invested in the outcome of events when we participate in the planning, and your child is no exception.

Keep in mind that adults with ADD/ADHD are not the best self-reporters. It is often helpful to have a spouse or someone who knows you well at the intake. After all, you want the professional to get as clear a picture of the situation as possible. Leave your ego (the part that wants to show the world only your best aspects, or minimize your child’s problems) at home.

Keep in mind that all children (particularly adolescents, although even 6 year olds) will occasionally resist regular meetings with a long-term treatment specialist (such as a tutor or therapist). However, any ongoing complaints or active non-compliance needs to be examined carefully and discussed openly with your child, listening to his or her comments and feelings. Encourage your child to “buy in” to the process. When there are problems, it may be advisable to meet with the professional to discuss this issue.

Sometimes, an individual’s needs will change over time and one therapist, whose work has been helpful in the past, will become ineffective. Plan to reassess any long-term arrangement at regular intervals, and stay flexible and responsive to your child’s/your own changing requirements.

It is difficult, as a parent, not to be drawn to the professional who provides the most positive prognosis. Try to meet with enough professionals to form a realistic picture, even if it’s not the one you would like to hear. Don’t shop around for the most optimistic diagnosis—look for the best relationship and a realistic approach to diagnosis and treatment.

Locate Suitable Professionals

Some of the professionals you may be looking for, over a period of time, may include diagnostic (pediatric neurologist, child psychiatrist, psychologist, educational evaluator, etc.) and treatment (psychologist, social worker, speech/language therapist, occupational therapist, tutor, psycho- pharmacologist, pediatrician, etc.).

Contact different sources for recommendations as to suitable professionals:

In NYC: CHADD of New York City (212) 721-0007
Resources for Children with Special Needs (212) 677-4650
Advocates for Children (212) 947.3089
The ADD Resource Center: (646) 205-8080
Outside of NYC: Contact CHADD National for a local chapter near you: chadd.org
Your MD
Your child’s school
Friends and acquaintances with similar issues
Resources for Children with Special Needs (212) 677-4650
Advocates for Children (212) 947.3089
It is recommended that you interview at least three professionals.

Initial Phone Contact

Make this contact short and sweet.
Indicate you are seeking a consultation.
Give name, address, sex and age of your child.
Offer the name of referring source (how you located this professional).
State problem as you see it; as others (schools, etc. see it). If you suspect your child may have ADD/ADHD, say so.
If your child has been previously diagnosed, state who did the diagnosis and when. If your child has not been previously diagnosed by a qualified professional, state this fact.
If your child is already on ADD/ADHD medication, give the name and amount, results as you see it.
Ask about this professional’s training and background in his/her area of expertise. If appropriate, inquire as to affiliations with hospitals, clinics, etc.
Confirm that it is the person you are speaking with, rather than an associate, who would be seeing the child.
Ask your questions, and set up the initial meeting, only with the person who will be seeing the child.
Ask specifically about his/her experience working with children with ADD/ADHD and their families.
Note: This can be discussed during the actual interview, but you might be able to save time and eliminate inappropriate candidates by well-chosen telephone questions.
Clarify the role you would like this professional to play in providing assistance to your family.
Have questions prepared that will help you determine whether you feel this professional would be a good match for your child.
Inquire about fees, fee scale, insurance payments, etc.
If interested in pursuing an initial interview/consultation, check whether there is a fee.
Find out how the professional prefers the initial session; with only the parents, with the child, or as a family group, etc. Note: Question carefully any treatment professional who doesn’t want to see the child prior to agreeing to treatment. This is less important with an educational evaluator, neuropsychological tester or psychopharmacologist, where expertise is the only critical criteria for selection.

Make the Initial Appointment

Inquire exactly what will be reviewed at the initial session.
Ask if you should send copies of any documents you have prior to the interview.
lf the professional you’re speaking with will be seen regularly over a period of time (psychologist, speech and language or occupational therapist, reading specialist, etc.) and time is extremely limited so you can only schedule regular sessions for specific hours, you should check now to see if the person you would be seeing is there at an acceptable time.
You should meet with the professional first, without the child. Only after you’ve determined there is a potentially good relationship, but before you’ve made any commitments, should you have the professional meet with the child. (This applies more for therapeutic services.)
If you’re making the second appointment (for the therapist or evaluator to meet the child), leave time to speak with the professional after he/she meets your child. Do not go in first, as this sets the relationship up in the eyes of the child as primarily between the parent and therapist. If you have a young child, find out if there is some provision for watching the child for part of the session so you can speak privately. Can you bring someone along for that purpose?

The Appointment

Both parents, if possible, should attend.
Briefly review with the professional all that was said on the phone.
Bring copies of all records pertaining to your child. (Although the professional may not wish to read these documents during the session.)
Discuss in what ways, and with which approach/technique the professional could help your child.
Specifically determine whether your child’s issues are within that person’s realm of expertise.
Be prepared to give a child and family background (the nature and extent of this depending upon the type of professional service being sought). Note: The intake interview, where this information is usually discussed in detail, should be scheduled only after you’ve decided this is the professional you want to use.
Discuss the professional’s experience with ADD/ADHD.
Ask the professional to offer his/her view on the cause(s) of ADD/ADHD—this gives you some idea of how involved the person is with the topic; whether they know of current neurological studies, etc.
Ask the percentage of current patients with ADD/ ADHD.
Ask if the professional is familiar with CHADD or is a member.
Inquire how quickly he/she will return phone calls.
Check on references. Ask if you can speak with the parent of a client.
If more than one professional is involved in your child’s treatment, ask this professional if he/she is:
Willing to work closely with other professionals who are also working with the child and family, including school staff.
Will he/she write reports if needed (fee?), attend meetings, have phone discussions, etc.?
Discuss the specific contact, if any, the professional will have with your child’s teacher
If the professional is an MD, find out how he/she will work with your child’s psychologist, if any; and if the person you’re interviewing is a psychologist or social worker, ask how they work with the medical doctor.
One person should be clearly designated the coordinator. This is usually one or both parents, but it can be anyone on the child’s team.
Review prospective starting date and available hours.
Check on charges for cancellations.

Summarize the Interview, in case of any misunderstandings, then:

Ask the professional if, given what he/she has been told about the child and what they’ve seen, do they think this is a good match for his/her services, or could they recommend another professional who might be even more appropriate for this child?
If the person indicates a desire to work with you and your child, ask them to be specific as to why they think they can help in your particular situation.
Ask if there are any special issues he/she would like to discuss that might influence your choice of professional.
Request a day or as long as you need to think about it, make your decision and get back to them.

After the Interview

Write a brief note to the various professionals you interviewed, thanking them for their time and insights, and for those not selected, a short comment to the effect that you’ve decided to work with someone you feel is more suitable for your child (and/or your pocketbook).
For the professional you do select, it is a good idea to get a written confirmation of the particulars of treatment(frequency and length of sessions with child, with family, types of tests, costs, etc.)

Following are questions specific to a particular need, be it diagnosis, evaluation, treatment or remediation:

Questions if you are seeking a Diagnosis (Medical, Psychological, Educational, etc.):

Ask for an outline of the methodology to be used to insure an accurate diagnosis. What criteria will be used? Will other professionals be included?
What tests will be utilized? Will a school or home visit be necessary? How much time will it take? What additional costs can be anticipated?
What treatment plan is likely to be recommended if the diagnosis is positive?
Will the person making the diagnosis be the same person who will do ongoing treatment? Note: This is not necessarily the case. Some professionals specialize in diagnostics; others in treatment.
Find our whether the evaluation will include a written report, specific recommendations (for the school, tutor, parents, etc.).
Ask whether the tester is willing to meet with the school and explain test results, and whether he/she will be available in the future for any questions you still may have.
Questions if the Professional is going to provide Therapy for your child (primarily Psychological); also applies to working with a Coach:
What is the type of therapy used (“treatment modality”) Le.: individual, group, family, tri-modal?
Review what the therapy “should” accomplish, from your perspective and from that of the professional.
Ask how often the sessions will take place.
Discuss if the professional sees this as totally open-ended or if he/she can assign a time frame to length of treatment.
Ask how he/she (and you) will know the treatment is working. What criteria will be used to measure success? How much time is needed before this judgment can be made?
Find out how you would be kept appraised of your child’s progress (Le., occasional phone calls, once a month meetings, etc.)
Find out how the professional views the confidentiality of his/her meetings with your child—will they alert you to critical issues or consider it patient confidentiality?
Inquire how frequently the treatment professional would like the child followed up by a psychopharmacologist.

Questions regarding Medication (primarily for the Psychopharmacologist):

Discuss the pros and cons of medication and how monitoring is accomplished if medication is indicated.
Ask what medications he/she is familiar with and has successfully used with ADD/ ADHD children; how long he/she has been prescribing each; personal preferences and reasons for them.
Ask how each medication works and what are its side effects and contraindications.
Ask how the medication is administered and adjusted.
Ask the psychopharmacologist how he/she (and you) will know the medication is working? How will he/she/you know if is isn’t working? How long will it take to make this judgment?
Ask how often the doctor needs to see the child and what will occur at these visits.

Questions about Testing (primarily for the Psychological/Educational Evaluator):

Ask what tests will be administered to your child, at what location and by whom -Request specific names and forms.
Ask why these tests are included in the test battery. What does each test show? How will each relate to your child’s specific diagnosis?
Ask how many test sessions will be needed.
Check that the evaluation includes a written report and specific recommendations (for the school, tutor, parents, etc.) Ask how long it will take for the test report to be ready. Specify if you have a time deadline.
Ask how test results will be explained to you; how will further questions be answered?
Ask whether the consultant is willing to meet with the school and explain test results, and whether he/she will be available in the future for any questions you still may have.
State who should receive copies of the test report.
Check on additional fees for reports, etc., if any.

Questions to ask the Educational Consultant/Advocate:

Ask about the advocate’s experience with public, private and special education schools.
Ask about his/her philosophy of appropriate educational placement for ADD/ADHD children.
Ask about his/her knowledge of due-process rights for ADD/ADHD children in your school district.
What is the person’s usual course of action with ADD/ADHD children? How much time is usually needed (and what outlay of money) to achieve the results you desire? Is there a retainer fee or an hourly rate?
What is the typical cost of the service? Clarify your financial obligations for known items (i.e., school visit) and future possibilities (school board hearing).
Ask how much parental participation is required? What will you be expected to do? What will the consultant/advocate do for you?
Be clear as to what meetings he/she will attend, and with whom? Are there any meetings the advocate would want to instigate?

Questions for the Tutor/Educational Therapist:

Ask about the tutor’s professional background (teaching experience, training, professional affiliations).
Ask specifically about the tutor’s experience with working with children with ADD/ ADHD and the age range of those children.
Ask about his/her philosophy of teaching children with ADD/ADHD. Does he/she have any negative feelings about medication as part of the treatment plan?
Ask if the tutor is familiar with your child’s school and/or has ever worked with children from the school.
Describe any academic difficulty your child is having. How might she/he approach this problem?
Does the tutor work primarily on skills development, compensatory learning strategies or homework help?
Is the tutor willing to maintain regular contact with the school if parent and school request it. Is there an additional fee for school visits?
Ask how much parental involvement in the tutoring process is expected. Will the child be expected to complete homework from tutoring as well as assignments from school?
Ask if the tutor will administer his/her own battery of tests before beginning instruction or will those administered by the educational evaluator be sufficient to begin.
Ask how progress will be monitored.
Ask about additional fees for written reports, missed sessions, etc.
If you have additional tips or suggestions, please send them to us at the address below.

With special thanks to the following:

Arlene Landes, CSW	Susan Luger, MSEd, CSW
Harold Meyer, DaD	Susan Lasky, MoM
Eileen Marzola, EdD	Virginia Sterling, Academic Language Therapist

For information on CH.A.D.D. (Children and Adults with Attention-Deficit/Hyperactivity Disorder), visit to chadd.org

TDAH, Funciones Ejecutivas y Exito Escolar

kerch — Mon, 21 Nov 2011 13:35:23 +0000

TDAH, FUNCIONES EJECUTIVAS Y EXITO ESCOLAR

Chris A. Zeigler Dendy, Maestra en Ciencias

Hace cinco años, la mayoría de los padres y maestros de estudiantes con TDA no sospechaba siquiera que el éxito académico de un niño está supeditado al desarrollo sólido de sus funciones ejecutivas. Hoy en día, sin embargo, muchos padres informados y educadores han caído en la cuenta de que los déficits en las capacidades cognitivas conocidas como funciones ejecutivas (FE) evolucionan más despacio en los niños que padecen de TDA. En 2007, algunos investigadores hicieron un descubrimiento sorprendente: los cerebros de quienes padecen de TDA maduran tres años más despacio que los de sus pares. Este descubrimiento sirve para explicar el atraso en el desarrollo de las funciones ejecutivas de estos niños.

Impacto del TDA y los Déficits en las Funciones Ejecutivas en el Proceso de Aprendizaje y Comportamiento. Hablando de manera práctica, se puede decir que las dificultades con el “centro directivo del cerebro” (brain’s CEO) ocasionan varios problemas: desorganización, dificultad para iniciar y terminar trabajos, dificultad para recordar tareas, dificultad para memorizar datos, escribir ensayos o reportes, resolver problemas matemáticos complejos, recordar material de lectura, completar proyectos de largo plazo, estar a tiempo, controlar las emociones y, planear para el futuro.

Antes de entender el papel de las funciones ejecutivas, tanto padres como maestros se frustraban cuando los estudiantes, aún los intelectualmente dotados, se encontraban al borde del fracaso escolar. Desafortunadamente, para aquellos no suficientemente informados, los déficits en las funciones ejecutivas se consideraban con frecuencia rasgos de “desidia o falta de motivación”. Cuando un estudiante tenía dificultades para empezar o terminar un ensayo o ejercicio de matemáticas, se asumía fácilmente que el estudiante elegía no terminar el trabajo.

Definición de las Funciones Ejecutivas. A pesar de que los científicos no han llegado a un consenso sobre los elementos exactos que componen las funciones ejecutivas, dos investigadores especializados en TDA, los doctores Russell Barkley y Tom Brown, nos han proporcionado descripciones interesantes de las mismas. El doctor Barkley define las funciones ejecutivas como “aquellas acciones sobre nosotros mismos, o dirigidas a nosotros mismos, que nos permiten alcanzar el auto-control, desarrollar comportamientos orientados a metas, y maximizar resultados futuros”. Mediante el uso de la metáfora, el doctor Brown nos proporciona una útil descripción visual al comparar las funciones ejecutivas con el papel de un conductor de orquesta. El conductor organiza varios instrumentos para que se toquen ya sea de forma individual o colectiva, integra la música haciendo y omitiendo ciertas acciones, y controla su ritmo e intensidad. El doctor Gerard Gioia y sus colegas también han contribuido a nuestros conocimientos sobre las funciones ejecutivas con el desarrollo de BRIEF (Behavior Rating Scale of Executive Functions) (escala de comportamiento de las funciones ejecutivas).

Investigación en Funciones Ejecutivas. Los reportes de investigadores varían ampliamente sobre la frecuencia de déficits de este tipo en estudiantes con TDA. No obstante, el Dr. Russell Barkley, reconocido experto en TDA, señaló que entre 89 y 98 por ciento de los niños con TDA presentan déficits en sus capacidades ejecutivas. El Dr. Barkley piensa que los resultados de las escalas que miden las capacidades ejecutivas son indicadores más acertados del funcionamiento en el mundo real que los bajos resultados de tasas de prevalencia de déficits que se reportan en tests tradicionales que miden habilidades ejecutivas.

De acuerdo con el Dr. Barkley, los estudiantes con TDA presentan aproximadamente un treinta por ciento de retraso en el desarrollo de habilidades sociales y organizacionales. Básicamente, esto significa que los niños con estas características aparentan menor madurez y responsabilidad que sus pares. Por ejemplo, con frecuencia las habilidades ejecutivas de un niño de doce años se parecen más a las de un niño de ocho años de edad. Para garantizar el éxito académico en estos estudiantes, los padres y maestros deben proporcionar mayor supervisión y seguimiento que lo acostumbrado para la edad correspondiente. Me gusta referirme a esto como “supervisión acorde al desarrollo”.

Impacto en el Mundo Real. A pesar de que nuestro hijo Alex superó con éxito los años de educación temprana, finalmente se topó con “el muro de piedra del TDA” (ADHD brick wall) cuando llegó a la educación media. Tardíamente caí en la cuenta de que en la secundaria la necesidad de las habilidades ejecutivas aumenta exponencialmente (trabajar de forma independiente, organización personal, empezar proyectos, recordar múltiples tareas). Aun como maestra y psicóloga escolar que fui, por muchos años no reconocí que un coeficiente intelectual alto no se traduce necesariamente en buenas calificaciones. No fue sino hasta que el Dr. Barkley identificó el papel central que tienen las funciones ejecutivas en el desempeño escolar, que finalmente entendí porqué la escuela era tan difícil para mi hijo. Los maestros solían decirnos: “Alex es brillante; tendría mejores calificaciones si se esforzara más”. La realidad es que los niños realmente tratan de hacer un mejor esfuerzo, sin embargo, no pueden tener buenas calificaciones sin los apoyos académicos y tratamiento apropiados. La conclusión – la causa principal por la que Alex tuvo dificultades en el ámbito académico fue padecer de déficits en sus funciones ejecutivas, no el TDA.

Componentes de las Funciones Ejecutivas.

Tomando como referencia lo que han escrito Barkely, Brown y Gioia, a continuación señalo ocho componentes generales de las funciones ejecutivas que afectan el desempeño escolar:

1. Memoria de trabajo y la capacidad de recordar (retener datos en la mente a la vez que se manipula información; recordar hechos almacenados en la memoria de largo plazo; incluye una noción deficiente del tiempo)

2. Activación, motivación y esfuerzo (empezar algo; poner atención; terminar lo que se empieza)

3. Control de las emociones (habilidad de tolerar la frustración; pensar antes de actuar o hablar)

4. Internalización del lenguaje (usar el lenguaje interno para controlar el propio comportamiento y dirigir acciones futuras)

5. La capacidad de aislar un hecho, analizarlo por partes, reconstruirlo y reorganizarlo como nuevas ideas (resolución compleja de problemas)

6. Capacidad de cambio e inhibición (cambiar de actividades, hacer un alto en las que se están desempeñando, detenerse a pensar antes de actuar o hablar)

7. Organización/planeación anticipada (manejo del tiempo, proyectos, materiales y posesiones)

8. Monitoreo (auto-monitoreo y auto-motivación)

Dos Categorías de Déficits en las Funciones Ejecutivas. Me ha parecido útil separar los déficits en las funciones ejecutivas en dos categorías generales:

1) Habilidades académicas específicas, tales como escribir ensayos, recordar lo que se lee (comprensión de lectura), memorizar información, resolver problemas matemáticos complejos, y

2) Habilidades esenciales relacionadas, tales como la capacidad de organizarse, empezar y terminar trabajos, recordar tareas y fechas límite de entrega, completar en tiempo asignaciones y proyectos de largo plazo, procesar información de forma eficiente y puntual, tener buena noción y administración del tiempo, internalizar el lenguaje para dirigir el propio comportamiento, usar reportes semanales y planear para el futuro.

Los déficits en las habilidades esenciales relacionadas se pueden confundir con holgazanería. Toda vez que las deficiencias en las habilidades académicas específicas se detectan fácilmente, los maestros están más dispuestos a dar los apoyos necesarios. No obstante, los maestros no tienen la misma disposición cuando se trata de deficiencias en las habilidades esenciales relacionadas tales como la desorganización, la falta de iniciativa y la incapacidad de entregar asignaciones en tiempo. Desafortunadamente, a primera vista, la incapacidad de llevar a cabo estas tareas parece ser una elección voluntaria; sin embargo, no es el caso, ya que un déficit neurológico hace que estas tareas se vuelvan extremadamente difíciles para quienes padecen de TDA. En consecuencia, los padres y maestros deben tener siempre en mente que, antes que otra cosa, este es un problema neurológico y no de holgazanería.

Elemento crítico de las funciones ejecutivas.

Analicemos más a fondo uno de los elementos de las funciones ejecutivas – el déficit en la memoria de trabajo y capacidad de recordar – y su impacto en el desempeño escolar.

Deficiencia en la Memoria de Trabajo y Capacidad de Recordar.

Contrario a lo que se cree, los investigadores han señalado que la funcionalidad de las habilidades de memoria es mejor indicador del éxito académico que los resultados que miden el coeficiente intelectual. Esto explica porqué los niños con TDA y altos coeficientes intelectuales pueden tener dificultades en el ámbito escolar. Tener un déficit en la memoria de trabajo y capacidad de recordar puede afectar negativamente a los estudiantes en varios aspectos:

1. El aquí y el ahora. Los niños con TDA tienen una capacidad de memoria de trabajo limitada que se refleja en sus comportamientos en casa y en el salón de clases:

- al recordar y seguir instrucciones,

- memorizar datos matemáticos, el deletreo de palabras y fechas,

- realizar cálculos mentales como por ejemplo cálculos matemáticos,

- completar problemas matemáticos complejos (algebra),

- recordar parte de una tarea mientras se trabaja en otra sección de la misma,

- parafrasear o resumir, y

- organizar y escribir ensayos.

2. Noción de eventos pasados: Toda vez que nuestros estudiantes tienen dificultades para recordar el pasado, tienen una visión retrospectiva limitada; es decir, no aprenden fácilmente de comportamientos anteriores. Esto puede explicar porqué los niños repiten frecuentemente malos comportamientos.

3. Noción del tiempo: Muchos estudiantes con TDA tienen dificultades para tener en mente ciertos eventos y usar su noción del tiempo para prepararse para eventos próximos y futuros. En consecuencia, tienen dificultades para juzgar el trastorno del tiempo con precisión.

4. Conocimiento de uno mismo: Como resultado de un pobre conocimiento de sí mismos, estos estudiantes no pueden fácilmente examinar o cambiar su propio comportamiento. Quizá esto explica porqué no son conscientes muchas veces de conductas que pueden alejar a sus amigos.

5. Noción del futuro: La mayoría de los estudiantes con déficits en la memoria de trabajo se enfocan en el aquí y el ahora y son menos propensos a hablar del tiempo o hacer planes para el futuro. De esta forma, tienen una capacidad de prevención limitada; en otras palabras, tienen dificultades para aprender de lecciones pasadas y cambiar comportamientos futuros. No es sorprendente, entonces, que tengan dificultades para prepararse para el futuro.

Problemas Académicos Comunes Relacionados al TDA y Deficiencias en las Funciones Ejecutivas

Muchos estudiantes con TDA presentan deficiencias en la memoria de trabajo y algunos incluso una lenta velocidad de procesamiento, mismos que son elementos críticos de las funciones ejecutivas. Estas habilidades son indispensables para escribir ensayos y resolver problemas matemáticos.

Un estudio reciente de Mayes y Calhoun ha identificado la expresión escrita como el problema de aprendizaje más común en estudiantes con TDA (65 por ciento). En consecuencia, escribir ensayos, preparar reportes de libros o contestar preguntas en exámenes o tareas es un gran reto. Por ejemplo, a la hora de escribir ensayos, los estudiantes suelen tener dificultad para retener, tener en cuenta y organizar ideas, hacer uso de reglas de gramática, pronunciación y puntuación almacenadas en la memoria de largo plazo, manipular información, recordar ideas para escribir, organizar material en secuencias lógicas, y finalmente revisar y corregir errores.

Dado que aprender es relativamente fácil para la mayoría de nosotros, algunas veces olvidamos lo complejas que pueden ser tareas que parecen sencillas a simple vista tales como memorizar tablas de multiplicar o resolver problemas matemáticos. Por ejemplo, cuando un estudiante resuelve un problema matemático, debe poder alternar sus habilidades analíticas y varios niveles de memoria (de trabajo, de corto y largo plazos). En el caso de problemas de palabras, debe poder retener números y preguntas mientras decide la solución al problema. Enseguida, debe poder accesar su memoria de largo plazo para encontrar la regla matemática adecuada para resolver el problema. Finalmente debe poder retener datos importantes mientras aplica reglas y usa información alternando entre su memoria de trabajo y la de corto plazo para resolver el problema y encontrar una solución.

Para complicar más las cosas, en algunos casos el TDA presenta comorbilidad con otros padecimientos graves. De acuerdo con en un estudio clave del Instituto Nacional de Salud Mental (National Institute of Mental Health) sobre el TDA (conocido como MTA), dos terceras partes de los niños con TDA presentan al menos un padecimiento coexistente como la depresión y ansiedad. ¡Es fundamental entonces proporcionar apoyos a los estudiantes con casos complejos de TDA! Estos niños están en mayor riesgo que sus compañeros de presentar una serie de problemas escolares tales como reprobar un grado, saltarse clases, ser suspendidos o expulsados, y en algunas ocasiones, dejar la escuela y no continuar con la educación media y superior.

Estrategias de Éxito Favoritas de las Escuelas

Con los años, he identificado varias estrategias de enseñanza y adaptaciones que funcionan bien con los estudiantes que presentan TDA. A continuación señalo algunas de mis favoritas:

Estrategias Generales de Enseñanza

- Hacer el proceso de aprendizaje tan concreto y visual como sea posible.

Expresión escrita

- Dictar información a algún “escriba” o a los padres.

- Usar organizadores gráficos que sirvan como recordatorios visuales.

- Usar notas “post-it” cuando se haga lluvia de ideas para escribir ensayos.

Matemáticas

- Apoyarse en un compañero que haga las veces de tutor.

- Trabajar en pares (el profesor explica un problema, los estudiantes hacen sus propios ejemplos, intercambian sus trabajos y discuten las respuestas).

(Después de aprobar con dificultad álgebra en la preparatoria y universidad, mi hijo logró la calificación más alta en cálculo además de un promedio de 10 en sus exámenes cuando el profesor utilizó esta estrategia).

Memoria

Usar estrategias nemotécnicas (estrategias de memoria) tales como acrónimos o acrósticos. Por ejemplo, HOMES para recordar los nombres de los Grandes Lagos.

Usar material visual con información clave en tiras de cartulina.

Modificar los métodos de enseñanza:

Usar un proyector para demostrar cómo se escribe un ensayo (los padres pueden usar una hoja de papel o una computadora para enseñar esta habilidad).

Usar colores para destacar información importante.

Usar organizadores gráficos para ayudar a que los estudiantes organicen sus pensamientos.

Modificar las tareas – reducir el trabajo escrito.

Hacer las tareas más cortas.

Revisar el tiempo que se dedica a tareas, y reducirlo si se considera apropiado (cuando el total de la tarea toma poco más de 10 minutos por grado tal y como lo han recomendado los lineamientos del PTA/NEA (PTA/NEA Policy); un estudiante de séptimo grado debe dedicar 70 minutos)

Escribir solamente las respuestas, no las preguntas (fotocopiar las preguntas).

Modificar exámenes y calificaciones.

Dar mayor tiempo para contestar exámenes.

Dividir proyectos de largo plazo en segmentos con fecha límite y calificaciones independientes.

Promediar dos calificaciones en ensayos – una para contenido y otra para gramática.

Modificar el nivel de apoyo y supervisión.

Designar “capitanes de fila” para revisar que se lleven a cabo tareas y posteriormente se entreguen a los maestros.

Aumentar el tiempo de supervisión y monitoreo para estos estudiantes, si es que presentan dificultades.

Emplear tecnología.

Usar computadoras tan frecuentemente como sea posible.

Usar software para enseñar habilidades.

Desafortunadamente, los estudiantes con TDA son castigados frecuentemente por sus deficiencias en funciones ejecutivas tales como falta de habilidades organizacionales y de memoria que interfieren con su capacidad de llevar a casa las tareas y libros adecuados. Espero que después de leer este artículo, maestros y padres de familia desarrollen estrategias de intervención más innovadoras. Por ejemplo, una alternativa efectiva sería que alguien (amigo o asistente de profesor) se reuniera con el estudiante en su locker para recoger los materiales necesarios para tarea. A la larga, este proceso de “moldeado” del comportamiento en el “punto crítico de desempeño” ayudará al estudiante a dominar habilidades, o por lo menos, le enseñará a compensar sus limitaciones.

En Conclusión

Claramente el ámbito escolar presenta dificultades para los estudiantes con TDA. Sin embargo, cuando el TDA se acompaña de deficiencias en las funciones ejecutivas, los problemas que se presentan pueden ser abrumadores para los estudiantes y sus familias. Tradicionalmente, maestros y padres de familia eran poco conscientes o comprensivos ante los retos derivados de dichas deficiencias. ¡Con suerte, hoy en día maestros y padres de familia entenderán que el TDA es un padecimiento muy complejo! Es mucho más que un caso de hiperactividad. Cuando existen además déficits en las funciones ejecutivas y problemas de aprendizaje relacionados, ¡los estudiantes fracasarán en la escuela a pesar de hacer su mejor esfuerzo!

¿Qué deben hacer entonces los maestros y padres de familia con esta información novedosa? Identificar:

1) Los problemas de aprendizaje específicos del estudiante (por ejemplo, la expresión escrita o las matemáticas), y

2) sus déficits en las funciones ejecutivas (por ejemplo, memoria de trabajo, desorganización, descuidos, o limitada noción del tiempo) y, ¡proporcionar apoyos en ambas áreas!

Les dejo una idea para pensar: “¡Tener éxito en la escuela es una de las experiencias más terapéuticas que puede tener un niño! ¡Haga cualquier cosa que sea necesaria para ayudarle al niño a tener éxito en el ámbito escolar!”

Comentario Personal: Nuestro hijo menor, Alex, tuvo muchas dificultades en la educación media y superior a causa del TDA y déficits en las funciones ejecutivas. Estamos orgullosos de que desafió la adversidad y se graduó de la universidad. Así que si su hijo está teniendo problemas en la escuela, no se dé por vencido. Mi familia es ejemplo de esperanza y apoyo para quienes presentan TDA y padecimientos coexistentes.

Por favor visite mi página electrónica www.chrisdendy.com para tener más información de mi familia y de cómo hemos sobrellevado el TDA. Están también a su disposición varios artículos para descargar y compartir con amigos. ¡Les deseo éxito escolar a ustedes, sus hijos y a los estudiantes que padecen de déficit de atención!

Referencias:

Barkley, Russell A. Attention Deficit Hyperactivity Disorder, (3era edición) Nueva York: The Guilford Press, 2006.

Brown, Thomas E. Attention Deficit Disorders and Comorbidities in Children, Adolescents, and Adults.

Washington, DC: American Psychiatric Press, 2000.

Dendy, Chris A. Zeigler. Teaching Teens with ADD, ADHD, and Executive Function Deficits, Bethesda, MD.

Woodbine House, 2000 (2da edición lista en el verano del 2011)

Dendy, Chris A. Zeigler. Teenagers with ADD and ADHD, (2da edición) Bethesda, MD: Woodbine House, 2006.

Deschler, Donald D., Edwin S. Ellis, y B. Keith Lenz. Teaching Adolescents with Learning Disabilities Denver, CO: Love Publishing Company, 1996.

Levine, Mel Educational Care. (2da edición) Cambridge, MA: Educators Publishing Service, 2002.

Mayes Susan D. y Susan Calhoun “Prevalence and Degree of Attention and Learning Problems in ADHD and LD”. ADHD Reports, v. 8, n.2, Abril 2000.

Chris Dendy tiene más de 40 años de experiencia como profesora, psicóloga escolar, consejera y administradora en salud mental además de, quizás lo más importante, ser madre de tres hijos ya mayores con TDA. La Sra. Dendy es la autora de tres libros reconocidos en TDA y la productora de tres videos, Teen to Teen, the ADD Experience y Father to Father. Un nuevo DVD para niños y adolescentes, Real Life ADHD, con la participación de 30 adolescentes, se encuentra actualmente en producción. Ella y su hijo Alex son coautores de un libro específico para adolescentes: A Bird’s-Eye View of Life with ADD and ADHD: Advice from Young Survivors. Ella y su esposo son miembros del Consejo Presidencial de CHADD. Formó parte del Consejo de Administración Nacional de CHADD de 2001 a 2005. Fue incluida en el Salón de la Fama de CHADD por sus destacadas aportaciones al campo.

More by Chris Dendy: Click here.

Extended time improves reading comprehension test scores for adolescents with ADHD

kerch — Mon, 07 Nov 2011 20:19:19 +0000

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.

The Proper Purpose of Assessments in the IEP process: It’s a Lot More Than Reporting a Score.

kerch — Thu, 22 Sep 2011 21:40:51 +0000

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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Mistakes Improve Children’s Learning – Marilyn Price-Mitchell, Ph.D.

Harold Meyer — Tue, 13 Sep 2011 14:14:21 +0000

Helping Kids See the Good Side of Getting Things Wrong

Published on September 7, 2011
by Marilyn Price-Mitchell, Ph.D.
in The Moment of Youth

Everyone makes mistakes and children are no exception. What’s important is how we learn from them. Yet, children grow up in a society that pressures them to be perfect and intelligent – to achieve the highest SAT scores, land prized scholarships, and get into the best universities. Parents reinforce this pressure at home when they cover up children’s mistakes, correct homework to improve grades, or drill knowledge into kids until they get it right. Stress is increased when children are constantly praised for their intelligence. How does this focus on perfection and IQ affect learning? And how can we help children and teens believe in themselves by accepting their mistakes and learning from them?

Oops! We All Make Mistakes

A recent Scientific American article, Getting it Wrong: Surprising Tips on How to Learn, supports a number of learning and developmental theories. Historically, many educators have created conditions for learning that do not encourage errors. And parents have followed suit. For example, if we drill children over and over again with the same math problem, they will eventually remember the answer. And if they are lucky, they will remember the answer on a standardized test.

This approach to learning assumes that if students are allowed to make mistakes, they will not learn the correct information. However, recent research shows this to be an incorrect assumption. In fact, studies have found that learning is enhanced when children make mistakes!

Whether it involves homework, developing friendships, or playing soccer, learning is enriched through error. Making mistakes is part of how kids are challenged to learn to do things differently. It motivates them to try new approaches.

Carol Dweck, a professor at Stanford University, studies the importance of challenging children, even if they get things wrong. Her research shows that praising children for their intelligence can actually make them less likely to persist in the face of challenge. She and her colleagues followed hundreds of 5th grade children in New York City schools. One group was praised for their intelligence while the other group was praised for their effort.

When the 5th graders were challenged with an extremely difficult test designed for 8th graders, a surprising result occurred. The students who had been praised for their effort worked very hard, even though they made a lot of mistakes. The kids praised for being smart became discouraged and saw their mistakes as a sign of failure. Intelligence testing for the kids praised for their effort increased by 30% while the kids praised for their intelligence dropped by 20%.

Dweck’s work, described in the book MindSet: The New Psychology of Success reminds parents that glowing, unconditional praise that masks errors and mistakes is harmful to children’s development. Being too quick with praise can be as detrimental as correcting homework mistakes that would have provided opportunities for learning.

Children make many kinds of mistakes. Some mistakes, like forgetting a homework assignment or not studying for an important test, have expected consequences. Others like lying, cheating, or actions that negatively affect friendships, have more complicated causes and are more complex to remedy. But all mistakes contain seeds of learning.

Ten Parenting Guidelines that Help Kids Learn from Mistakes

Acknowledge that you don’t expect your children to be perfect.
Let them know your love is unconditional, regardless of their mistakes or lapses in judgment.
Don’t rescue children from their mistakes. Instead, help them focus on the solution.
Provide examples of your own mistakes, the consequences, and how you learned from them.
Encourage them to take responsibility for their mistakes and not blame others.
Avoid pointing out their past mistakes. Instead, focus on the one at hand.
Praise them for their ability to admit their mistakes.
Praise them for their efforts and courage to overcome setbacks.
Mentor them on how to apologize when their mistakes have hurt others.
Help them look at the good side of getting things wrong!

Photo Credits: Ktpupp; Lil Larkie

About the author:

Marilyn Price-Mitchell, Ph.D.

Dr. Marilyn Price-Mitchell is a developmental psychologist, educator, researcher, and writer who studies how today’s youth grow into healthy, successful, and engaged adults. She synthesizes multidisciplinary research in psychology, education, sociology, child & adolescent development, social psychology, and neurobiology to bring trusted, evidence-based research to parents, teachers, mentors, coaches, and all those who support kids. Visit her blog at Roots of Action; Twitter; Facebook.

ADHD and Emotional Regulation Video by Dr. Russell A. Barkley

Harold Meyer — Mon, 29 Aug 2011 21:36:34 +0000

Dr Russell Barkley, Ph.D giving a lecture on ADHD at The Centre for ADHD/ADD Advocacy Canada (CADDAC

Dr. Barkley’s website can be found at: http://www.russellbarkley.org/

Books and videos by Dr. Barkley: CLICK HERE