Recently, I was walking back from the tennis courts on a crisp winter day when I had a flashback to my youth. Suddenly, in that moment, I recalled the wonderful sensation of my childhood, being outdoors, free of immediate demands and responsibilities. I was just enjoying the air, the green, and the sky all around me. I could feel my mental state improve and my body and mind relax. You see, during my childhood, the only entertainment we had after school was to go outside and find things to do. My memory of childhood was outdoors, walking, experiencing whatever the weather was serving that day along with whomever I could find to play with. My walk from the courts reminded me of the joyous feeling that my experiences of youth had created. On that walk home, I began to wonder, what the children growing up today will remember as their happy place? Where will that place be that brings out the relaxation reflex in your children, twenty years from now? An interesting question and one that every parent should ponder because you have a lot to do with the kind of childhood your children have. So stay tuned, for the next edition of Portable Practical Pediatrics where we will ponder the question of where your children will recall the joy in their childhood? Continue reading
I’ve got a very interesting subject to talk to you about today that I discovered while listening to a podcast! Yes, not only do I make podcasts but I am an avid listener of them as well. In this particular podcast, I heard Dr. Cal Newport, a computer scientist, interviewed about the negative effects of interruptions on learning, memory, and creativity. I thought that what he was saying had so much relevance for your children that I couldn’t wait to introduce my listeners to his research and ideas. Please take a few minutes to listen to this post that I call Distraction Free Thinking Vital for Kids. The message is so vital for all parents to hear that I don’t want you to miss it. Continue reading
In November of 2011, the Academy of Pediatrics experts revised their guidelines for pediatricians when it comes to the management of children with ADD. In this edition of DocSmo.com, Dr Smolen introduces parents to the new changes when it comes to helping children with ADD along with some of his own insights and opinions. Informed parents will certainly want to listen.
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My partners are really smart people with a lot of experience under their collective belts. I pay a lot of attention when they speak, because I always learn from their wise insights. Such was the case the other day in the lunchroom, when the subject of practical ADD management tips came up. One of our doctors has a child with ADD, so she is speaking from more than doctoring experience, which gave the conversation a whole new perspective. Here are the highlights:
Things are not always what they appear: Dr. Kimberly Riley recalled stories of children whose main problem was not attention span but learning disabilities. She has noticed that after their learning problem had been identified and helped, the impulsiveness and inattention faded away. They didn’t have ADD, simply a learning disability that had not been recognized. Dr. Riley also pointed out that if a child has severe learning difficulties, genetic testing may aid in looking for recognized genetic problems that impair learning. Conversely, Dr. Downing has noticed that in her experience, many of the children that present mood problems like anxiety, depression, or oppositional behavior really have ADD as a core feature dominating these children’s personality. Both the mood problem and the ADD issue need to be addressed for the child to get maximum benefit.
Sleep problems usually seem to accompany the ADD personality: all of the doctors agreed that many children who are diagnosed with ADD have innate sleep difficulties. Certainly, the medications that are used to treat ADD can cause sleep problems on their own, but this is not the root cause. Dr. Plonk has noticed that initiation of sleep can be very difficult for these children, going all the way back to infancy. He believes that this problem has a neurological basis. Drs. Plonk, Riley, Moorman, and Downing all recommend 1-3 mgs. of Melatonin about 30 minutes before bedtime to help children get to sleep; they feel that this OTC hormone is both safe and effective. They also have found that a homeopathic product called Calms Forte can be effective in children with ADD. Both of these products have unfortunately not been tested by the FDA for safety or effectiveness since they are non prescription products. Keep in mind, however, that both parents and doctors are fans of melatonin so I think you can be confident giving it a try.
Beware of the easy fixes: My colleagues believe that ADD is a neurologically based “chronic” disorder. Chronic means just that, chronic. They have noticed that as children mature, they almost always improve in their ability to concentrate and to avoid distractions but often don’t catch up with their age-matched peers until adolescence or beyond. For those who need help, the combination of behavioral therapy, attention to learning problems and associated mood problems, and possibly medication seems to get the best results. The doctors were pretty unanimous declaring that dietary supplements (except fish oil), strict dietary restriction of sugar, gluten and preservatives along with other assorted therapies seem to have limited effectiveness. As you will hear in the Pedcast featuring Dr. Kilbane, other physicians strongly disagree with that contention.
Let’s not forget there is a kid with feelings behind that diagnosis of ADD: Drs. Plonk, Riley, Downing, and Moorman became very animated and forceful when the subject of a child’s self image and self esteem came up. They all strongly feel there is a need to speak directly and honestly to children who have this diagnosis, reminding them that they are not “bad kids” and that to a large degree, they can’t help this impulsive behavior and lack of attentiveness. Dr Downing even noted that one of her patients declared to his mother just after this conversation, “You owe me, Mom” (an apology I presume). Understanding that the ADD behavior pattern is not anyone’s fault can be a huge relief to many families. As Dr. Downing points out, guilt is a strong emotion, and doctors can be very useful in mitigating some of this emotional baggage.
Conclusions of the doctors: My partners feel that the best approach to helping a child with an ADD diagnosis includes: having their learning problem and mood difficulties addressed, managing sleep problems if they exist, making sure that the school they attend provides appropriate accommodations to help the child with behavior and learning, initiating good behavioral management strategies at school and home, and most of all treating the child and his/her family with the respect and patience they deserve. That is the Lunchroom Lowdown for this week.
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So, the establishment has come to you and said there is something wrong with your child’s behavior. They say that he or she is not meeting the school’s expectations. Maybe he or she doesn’t pay attention well in school. Perhaps they are more active than other children. Or, maybe they are simply more impulsive than their friends. What next? Where do you turn? How should you react? In this post I am going to give you my advice–and hopefully some insight–about how to handle this situation should you find yourself faced with it.
First, I think you need to understand that your child’s teachers have his or her best interests at heart. They want your child to succeed and learn as much as possible. Most likely, your child’s teachers are coming to you with concerns and observations that are important for you to know. Try not to get angry or defensive, because this will not help. I recommend that you listen and evaluate what you are being told, but keep in mind that the teacher’s opinion is just one of many. As you will see from this discussion, input from as many sources as possible is essential. The teachers are simply reporting a pattern of behavior that they are observing in the classroom. Your child’s behavior is complex with many factors that have influence. Many of life’s twists and turns can make a normal child exhibit ADD behavior, including: stress of family problems, an impending big life change such as a move, a medical issue, or a sleep problem, just to mention a few. You know your child best. Give all these factors consideration when trying to evaluate his or her behavior.
If the school establishment believes that your child has ADD or ADHD, it is useful to back up and recall the definition of ADD and ADHD. All of the following criteria must be met to justify the diagnosis:
– A child who is healthy and of schoolage (less than 7 years) who is found to have a shorter attention span than normal and to be more impulsive than his/her peers.
-These impairments need to be seen across many settings such as school, church, camps, etc.
-These impairments must be chronic, which is defined as at least 6 months in duration.
-These impairments must be affecting the child’s ability to learn in a classroom setting.
Without ALL these features, an ADD or ADHD diagnosis is not justified. So ask yourself, does my child fit all these criteria? If so, you need to proceed. If not, maybe watching and waiting is in order.
Assuming that you and the school feel that the above criteria are met, it is time to proceed to the level of professional help. After all, this is your child’s academic success we are talking about. At minimum, standardized measures of attention and other factors should be completed by both parents and teachers, the two most common of which are Conner’s and Vanderbilt scales. Even better is a full psychological assessment by a psychologist including an actual classroom observation. At the same time, your child should also visit a healthcare provider who knows them and your family. During this visit, your child’s doctor will be trying to find things that are known to interfere with learning such as chronic sleep problems, difficulty with mood, family stress such as alcohol abuse or violence, genetic problems, vision or hearing problems, or any other factors that could be affecting learning.
If your child made it to this level of inquiry and met the initial criteria, it’s time to make some decisions and recruit as much help as possible. ADD is considered a disability under the 1990 Americans with Disabilities Act. Schools must provide accommodations to help your child if they have an ADD diagnosis. These can be very helpful. More testing time, quiet test areas without distractions, closer supervision by the teacher, and special academic tutoring are a few examples of accommodations that can be made to help your child succeed in school. Take advantage of them. Also make sure that your child’s school sets up a formal behavior program to address troublesome behaviors that get in the way of his or her learning.
My experience and research confirms that the most successful approach to assist a child with ADD is what is called the multimodal approach; that means the combination of school accommodations, behavior management, counseling for the family, and medication for the child. Many families are very leery of the strong medications that are used for children with ADD. It is a big step, but the results can be amazing. Keep an open mind when this subject is discussed. Your child’s doctor needs to do the same and recognize that not all children with ADD either need or can tolerate these medications. If you have access to an integrative pediatrician, I recommend you get their input as well. If your child has a disturbance of mood, is oppositional, or has major learning disabilities, I think a pediatric neurologist or psychiatrist should be in the mix.
Here is an important thought I want you to consider if you have a child with ADD–don’t despair, the news is not all negative. Remember, children with this pattern of behavior have many advantages over their non ADD friends such as high energy, enthusiasm, and sometimes, incredible creativity. Unfortunately, their learning style does not fit well in a traditional classroom. This fact is something that you and your child are going to need to deal with but can overcome. Remember, slow and steady wins the race, always has and always will. School is likely to be more difficult for your child as well as for your family, but success can and will be yours if you persist. I see this everyday. Families where education is valued, learning is made fun, intellectual stimulation is plentiful, hard work is encouraged, and failure is not an option will have success.
I also want you to remember that there is a person inside that child who is struggling to meet the school’s expectations. Despite their academic difficulties, they are most likely very intelligent! They are going to need a lot of encouragement and praise whenever possible. Not fake praise, but the real thing. Make sure you notice and compliment progress, determination, and creativity. Eventually, your child’s impulsiveness and inattentiveness will wane, but we want to be left with a confident and self-assured adult, not someone who feels like a longtime failure. You are your child’s best advocate. Be relentless!
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