How does the doctor figure out medication dosage?
My question is in regards to my son's ADHD med, Adderall XR. He seemed to be doing really well with it for the past four months. However, he has been having trouble lately focusing. Our physician suggested raising it to 15MG, which didn't seem to help. He then suggested 20MG. I don't feel really comfortable raising it that high, as our son is only six years old.
Is it possible another medication may work better, even in the same stimulant family, like Focalin that can be sprinkled? Is it unusual for a child to do really well on a medication for four months and then have difficulties again? Thank you!!
The dose of any of the stimulant medications used for ADHD (Ritalin, Adderall, Focalin, etc.) is not based on age or body weight. Thus, the only way to know is to start at a low dose, usually 5 mg. Then, about every 5 – 7 days, the dose is increased to 10 mg, then 15 mg, then 20 mg until the best dose is found. (Be aware that Adderall XR __ is an eight hour release form. Thus, Adderall XR 20 means that it releases about 10 mg initially and about 10 mg four hours later for a total of 20 mg).
(November 2007)
What is visual perception disorder?
Please tell me...what is visual perception disorder? How is it corrected? My granddaughter is eight years old and tries so hard to read and do her school work, struggles with reading and spelling. What can we do? Is there help with eye exercises? Is this recommended, and is it done by an optometrist or an ophthalmologist?
Thank you for any help.
A visual perception disorder might impact on several aspects of processing visual information received by the brain. These problems might include recognizing specific letters/numbers/shapes; the ability to distinguish left and right images of visual stimuli; the ability to analyze these visual stimuli and interpret there meaning. Intervention would depend on where the problems are. To clarify if such problems exist, it is best to do a formal psycho-educational evaluation. Your school might do this or you might need to have it done privately.
Visual perception problems are related to how the brain processes visual stimuli and not to the visual processes associated with the eye and vision. If your daughter has problems with vision (nearsighted, farsighted, astigmatism, etc.) this should be checked by an optometrist or ophthalmologist. If not a problem or if the problem is corrected by glasses, the focus should be on the role of the brain.
(November 2007)
How do I help a six-year-old boy who is developing unevenly and might have language problems?
My son is six years old and appears to have a language disorder. We have not ruled out an auditory processing disorder because of his age, but have noticed some red flags for ADHD. He has an amazing memory and is a very visual child. He also is already reading on about a second grade level and is interested in doing simple math.
He starts kindergarten soon - how is he going to get an appropriate education when his development is so uneven? What can I do to make sure he is keeping up and being challenged? My child is both "gifted" and delayed - it seems the school system may not recognize these two together. I need advice.
First, might I comment that six-year-olds, especially boys, often develop unevenly. Their language and/or motor skills might be more advanced than the other. These differences often resolve themselves by age seven.
However, if you are concerned, I encourage you to meet with the principal of the school he attends. Present your concerns. If you have speech-language or other evaluations, provide a copy. Ask that the principal schedule a meeting with his assigned teacher and the appropriate special education team at his school. Discuss your concerns with this group and ask that they respond to your concerns.
Should the principal have a “wait and see” attitude, suggesting that you wait until mid-semester or later and you do not want to wait, you might want to get more information on his inconsistencies from the speech-language professional to present to the principal.
(October 2007)
How can we support my "reading-challenged" son who is the youngest in his kindergarten?
My son, who just completed Kindergarten and turned six in June, is one of the youngest in his class. He recognizes all letters and knows all letter sounds, but just CANNOT put the easiest three letter words together by sounding them out. We just had an appointment with a Developmental Pediatrician because he show difficulties focusing, he seems bright but only concentrates when something interests him. Math and other subjects are fine, but in reading, he is below grade level and constantly has to be redirected.
I wanted him to repeat Kindergarten but in an EPT meeting, it was decided not to because he has the potential. The Developmental Pediatrician said that some kids just can't learn how to read before they're seven. Could he have some "blockage?" He may be dyslexic.
The doctor told us to wait half-a-year and see how he does in first grade and then, if his reading is still below grade level, to see a speech therapist / specialist for dyslexia -- do you agree? Do you think there is anything we can do to help him before first grade starts? He is already aware of the fact that all the other children can read and he can't. He almost seems like he's giving up.
Birgitt
As your developmental pediatrician mentioned, development can be uneven between three and six or seven, especially for boys. Some kids are reading by first grade and some are not. Let him know that it is perfectly normal that he has not yet learned. “That is what first grade is for.”
I would let him start first grade. If you find him behind in a skill area, discuss with his teacher. If you feel he is frustrated, you might try to get the school to provide more reading help or get a private reading tutor. It may be too early to jump to formal testing.
(October 2007)
What is the relationship between ADHD and sleep apnea?
Recently my seven-year-old son has been diagnosed with ADD and dysgraphia. He also has enlarged addenoids that have to come out. He only has 1 mm airway when he should have 10 mm. He has notable sleep apnea and is an aggressive snorer. Could his sleep apnea be playing into some of his focus and attention issues?
Sleep apnea can cause the child to be tired during school hours. If tired, he might be inattentive. I suggest that the sleep apnea be treated first. If, after he no longer has sleep apnea you still find him to be inattentive, it would be helpful to speak to his family physician about further evaluations.
(October 2007)
What treatment is needed for a teenager with dysgraphia?
I have a 17-year-old daughter who will be a junior this coming school year. She was diagnosed in elementary school with dyslexia and language processing disorder. A few years ago, writing became more difficult. When she goes to write, she can't seem to put the pen down and when she does, it is very scribble-like. They did an MRI and didn't find anything and diagnosed her with an intention tremor.
I mentioned dysgraphia to the doctor and he wasn't familiar with this. Can dysgraphia not appear until later in a child's life? Is there anything (occupational therapist, etc.) that can help? I have some accommodations in school but that won't help in the work world. She struggles just to sign her name.
Dysgraphia (difficulty with fine motor coordination resulting in difficulty writing) is difficult to treat. It is unusual for someone to develop writing problems at age 17. And, the description you give sounds like more than what is usually seen as dysgraphia. I encourage you to follow-up with the neurological workup.
If she has dysgraphia, occupational therapy might be able to help her with gripping and hand strength. Often, the treatment that works best is to switch to the gross motor skill of typing. If she can use the keyboard and type quickly and neatly, she should be allowed to use a laptop in class and when doing homework.
(October 2007)
Is it blaming the victim to say a child uses LD as a crutch?
Our 13-year-old daughter has a reading disability. How do you show her not to use the LD as a crutch when she does poorly in school? Also, her lying to make herself "look good" around others is disheartening? Help!
I need more information to fully answer. How significant are her reading disabilities? Does she receive special education services? Accommodations? If she is struggling in middle school with little help to address her disabilities and minimal accommodations, she should be frustrated and trying to avoid the work. If she has received the proper help in the past and continues to receive help, does she fully understand her disabilities and how to compensate for them?
Her poor self image and the need to cover it up to “look good” suggest to me that she may not have had the necessary help to compensate for her reading disabilities or that she is not receiving adequate services/accommodations now. If she has had all of this and still feels the way she does, she may need counseling to better understand/accept her disabilities. If she has not had adequate help and school (parents?) still “blame the victim” for not keeping up, then the adults need to rethink what they are doing to contribute.
(September 2007)
Should you wait until age seven to assess a child for ADD, LD, or other learning problems?
I am concerned that my bright five-year-old daughter may be displaying signs of ADD. Since starting school, she has displayed a high level of achievement in both reading and math. She has been well-supported at home. However, her teacher has commented that although she is very bright, she often day dreams and requires extra time to complete classroom tasks.
She is very quiet and appears anxious when answering questions, speaking in front of the class or meeting new people. We have also noted in the home environment that requests frequently have to be repeated up to four times before she answers. Having a general conversation is difficult because of her fidgeting, slow processing or her being cognitively engaged elsewhere. During homework tasks, she requires ongoing prompting in order to focus.
She becomes very frustrated when she makes mistakes and, out of frustration, becomes defiant. She is popular with her school friends and although shy, manages to make friends in new environments. Also, I am not sure whether this is relevant, but her motor function appears delayed and she has struggled in her attempts to ride a scooter or bike. She is also prone to accidents and falling when running.
I am unsure whether it is too early to seek an assessment or even raise the issue with the school. The general advice from the literature that I have read is that assessment should not be sought until the child is seven due to underdeveloped cerebellum. What is your general opinion on this?
Don’t be so quick to rush to ADHD as the cause. Your descriptions suggest more the possibility that she might have a language disability (difficulty quickly processing what she hears and difficulty organizing her thoughts to respond). Or, she might have a motor disability (Sensory Integration Disorder), resulting in her gross and fine motor difficulties. Although not yet in first grade, she shows early signs of a potential learning disability. The behaviors I least hear you describe would be those associated with ADHD.
I encourage you to request that her school professionals assess her. Waiting until age seven and the end of first grade is to wait until she fails. Act now so that the help she needs is in place during first grade. These studies would include a speech-language evaluation, an occupational therapy evaluation, and an educational assessment (called a psycho-educational evaluation). These test results will clarify her needs and the services she will need. If your school system refuses to test her until she is seven, try to get the studies done privately.
(September 2007)
How is a psychoeducational evaluation different from a nueropsychological evaluation?
I have an 8-year-old son who is struggling with reading and writing, but does fine with mathematics. I've taken him to a developmental optometrist, who found some problems with tracking and binocularity. He's also been tested by an audiologist, who found that he has problems hearing in background noise, but felt that due to his age, he might still be developing this skill.
I feel like I need to take him to someone who can give me an overall idea of what's happening. I'm unsure whether to take him for a neuropsychological exam to someone who does psychoeducational exams. Can you explain the difference between these two and tell me which you think would be better for him now?
It is important to identify why he has a reading and writing problem. Formal testing should provide this information.
Psychoeducational evaluations focus on identifying if the individual has cognitive/academic problems. If present, what are they, were are the strengths, and where are the weaknesses. The results help to develop an intervention strategy. A neuropsychological evaluation assesses does not focus on learning but on the function of most areas of brain function. The testing is more elaborate (and probably more expensive). The results will help to clarify if there is a learning disability and, if so, what to do about it.
Note from LD OnLine: To find out more about evaluation, please visit What Do You Do If You Suspect That Your Child Has a Learning Disability?.
(September 2007)
How does a person with a learning disability handle emotional trauma caused by LD?
I’ve had trouble reading and writing for as long as I can remember. I always did well in school and even enrolled in gifted classes. I managed to keep up with the work, but at the same time I struggled with my disability. I felt ashamed and stupid. It was a secret I had to hide and I was terrified that someone would find out.
I learned to cope and hide my disability and consequently I never received help throughout grade school. I believe my fear of reading out loud has developed into a phobia, which has triggered panic attacks.
In college as an engineering student, I insisted on being tested for a learning disability, so I could receive help for my writing classes. After testing positive for a learning disability, I discovered that the aid being offered by the school was not helpful. In addition, my high school study habits of doing the minimum amount of work was no longer cutting it. I eventually stopped going to school and started seeing a therapist.
After dropping out of school, I sunk into a deep depression. I may have other problems I have not been able to pinpoint yet. Despite seeing a therapist for a long time, I have not been able to get back on my feet. I currently live with my parents. I have no job and no social life. I have little will to work on my problems and become anxious thinking about taking steps to work on my problems. I have not been able to get myself to do much of anything for about two years now. I’ve had a few therapists and a psychologist diagnose me with emotional trauma.
I wonder if you know of any resources concerning emotional trauma caused by learning disabilities. I would also appreciate any wisdom you can send my way.
Your problems are serious and I am sorry you find yourself where you are now. It is possible that your depression is the result of your years of frustration and failure. If so, this might be the theme of the therapy. Or, it might be that the same disabilities that prevented you from being successful in school continue to impact on your ability to work or handle life skills. Or, the depression might be a disorder often found with individuals who have learning disabilities.
What ever the cause, medication can help to minimize the depression. Talking therapy often does not help as much as seeking an educational or vocational counselor to help you pick up the pieces and get on with your life. Included in this help would be any remedial work for your learning disabilities as well as helping you develop compensatory techniques. The focus will also be on vocational initiatives and knowing what accommodations you might need.
(September 2007)
How can a parent help their teenager with ADHD (and/or LD) who has trouble staying organized?
My 15-year-old son was diagnosed approximately three years ago with the inattentive form of ADHD. He is also a gifted honor student in a very competitive public high school. We should have addressed this issue much sooner, but he was always able to overcome his difficulties so I never gave a thought that he had any learning disability.
His main difficulties are that he constantly forgets things, has difficulty staying on task, misplaces things including homework on a regular basis, and is easily distracted. We have never tried medication, nor have we sought special accommodations in the school.
Ever since he was in the second grade and required to turn in homework, we have received notes home from teachers each quarter of every year about my son failing to turn in work that we know he did. He also forgets to write down assignments and sometimes even forgets that he has a test or quiz in a given class. We have purchased planners but he inevitably loses them or doesn't use them effectively. Although never diagnosed, I too have many of these same symptoms, so it is difficult for me to assist as I would like.
The main problem at this juncture is that he is seeking a Navy ROTC Scholarship. Therefore, by the Navy's rules, in the year prior to his being medically evaluated for the scholarship, he cannot take medications to treat ADHD, nor can he receive accommodations that other children do not get, or he will be medically disqualified.
What suggestions do you have, without using medications or school accommodations, for us to help our son be successful? He desires to study Engineering, which is an extremely rigorous program. We are very worried that his disorganization and lack of focus will make things very difficult for him to succeed without using medication or accommodations. Thank you for any help you can provide.
Chris
May I first answer the question for all students and then for the specific issues related to your son. Organizational problems might result from ADHD, from a Learning Disability (LD), or from a combination of both. If the problems are secondary to the ADHD, stimulant medication can make a significant difference. If the problems are the result of LD, medication will not help but special education tutoring will help. If the problems are the result of both, medication and special education tutoring will be needed.
The easiest first step for most students is to try a stimulant medication. If successful, great. If not, a psycho-educational assessment will be needed to clarify the issues.
Now for your son. It might be best to get a psycho-educational evaluation first. If the problems relate to LD, a private special education tutor (without accommodations) might be all that is needed. ADHD medications or ADHD accommodations would not be on records.
Note from LD OnLine: Visit our Tech Expert section to see Dr. Tracy Gray's response to the same question.
(August 2007)
Should the school system test a child to see if he should be put on prescription medication?
My seven-year-old son is in the first grade for the second time. Per his teacher and principal, they are encouraging me to have my son tested. I do not have a problem with having him tested.
My problem is this: all I'm hearing from them is he needs to be on a prescription drug. I can not see how a prescription drug is going to help him with his problems. After reading some of the articles LD OnLine has, I totally agree that he definitely has a learning disability, but the school system can not tell me why this requires prescription drugs.
I will do anything in my power to help my son develop. I will not shove prescription drugs down his throat until I understand how this will help him. Can you explain this to me?
Rebecca
Rebecca:
Good for you. School staff cannot tell a parent to put their child on medication. The question might be the one you raise. Are his academic problems the result of a learning disability, of ADHD, or of both.
If your son has been hyperactive, inattentive, and/or impulsive since early preschool, you might discuss ADHD with his family doctor. If the main issues relate to difficulty learning to read, to write, to putting thoughts on the page, and to learning basic math and/or relate to his ability to understand oral instructions or reply orally, formal testing is needed to explore for a learning disability. Request such testing.
Many school systems will not test children until the end of the third grade – a “wait until they fail” model. If this is your son’s school philosophy, you might need to have the testing done privately.
Go slowly and clarify the problems before starting treatment. What your school staff is doing is similar to a physician saying, “Your child has a stomachache. He should have his appendix out.” No – first you learn what is causing the stomachache and then you recommend treatment.
(August 2007)
Who should test a child for learning disabilities—the school or the doctor?
My nine-year-old daughter is in the third grade. Her work goes from good to okay to poor throughout the school year. She is getting ready to get out of school in less than two weeks. Since first grade, I have asked her teachers, school counselors, and her pediatrician to evaluation her for learning disabilities. Her biological father has ADHD and dyslexia.
I cannot get anyone to take the responsibility to test her. The school says it’s her doctor’s area, but her doctor says it is the school’s. Who really is the one who should be testing her? Her teacher says she spaces out in classes and she inverts digital 2’s and 5’s, the word “a” and “the,” and “b’s” and “d’s.” She also says her mind tells her to stand when she’s repeatedly told to sit, especially at her desk in school and at the table when eating anywhere.
Please help me help her. Her teacher even hinted she’d be better off staying back another year. I don’t know how she would handle that.
Thank you.
Wow!! Talk about passing the buck. Your descriptions suggest that she might have a learning disability and/or ADHD. One does not have to guess which. Given her difficulties with letter/number reversals and her not being where she should be academically at the end of third grade, the possibility of a learning disability is real. This possibility is even greater given that her biological father has a form of LD called dyslexia.
The only way to clarify is to have her take a battery of tests called a psycho-educational evaluation. Insist that her school professionals do such testing. See Sample Letter-Requesting an Initial Evaluation for Special Education Services. If she has LD, she will need special education services plus appropriate accommodations. The question of repeating third can only be answered after these data are available.
Should you have a history, going back to preschool of her being fidgety/hyperactive, inattentive, and/or impulsive, her family doctor should evaluate for ADHD. If she has this disorder, medication might help. Remember, it is not on or the other. Many children have both and both need to be addressed.
(August 2007)
Does a university student need a medical assessment to receive accommodation for learning disabilities?
I always did very well in school, but I always suffered with writing and presentations. My anxiety level has always been high, and I was diagnosed with GAD. When I reached the university level, I asked to be tested, but didn't have the $800. I completed two degrees after this, and when I was in the last semester of my third degree, I was told by a disabilities office that I could be assessed by a graduate student for a small amount.
I was assessed and a learning disability was confirmed, but the assessment was very vague and did not give a specific diagnosis. Now I am completing a Master's degree and am falling far behind. I showed the University the letter confirming my disability status that I received from the disabilities office, but they insist that it must be a medical assessment. I cannot afford further testing. I am working and studying. What can I do?
Jane
First, my deepest respect for your perseverance. Wonderful. If the earlier testing was comprehensive and confirmed LD, you should not need additional testing. If the concern is the wording of the report, contact the person who did the testing.
Explain your problem and ask that he/she edit the report and send you a new copy. If this is not possible, you might need updated testing.
A medical assessment would be needed if you request accommodations based on your Generalized Anxiety Disorder or if you had ADHD. There is no need for such an assessment if your disability is a learning disability.
(August 2007)
Can you suggest ways to ease the job interview process for someone with a learning disability?
Is there a specific learning disability that refers to someone who has trouble getting information from his head to the paper? He can learn well in a lecture atmosphere, but is working to read, study, and write. My son spent 14 years in the school system and never graduated. He has been working in a pretty good job for some time now, but the company is making some changes and I am worried that he will be laid off. Job searching, especially the interview process, is impossible for him. He is now 25 years old. Do you have any suggestions?
What a failure on the part of your school system that he spent 14 years and never graduated. I wonder if he was ever evaluated or if he received services during his education.
Learning Disabilities might involve reading skills. Some individuals have difficulty learning to decode and read. Others might have difficulty understanding what they have read (comprehension). Still others might have difficulty retaining what they have read and comprehended (fluency). Same thing with writing. Some may have difficulty forming the letters correctly and getting the words onto the page and in the proper place. Others might have difficulty with what is called “language arts,” spelling, grammar, punctuation, and capitalization.
Still, others might have difficulty getting the thoughts and words needed to respond in writing pulled from memory and organized. These students have difficulty organizing thoughts and getting them onto the page (writing fluency). The more difficult the task, the more difficult organizing one’s thoughts and writing is.
Many students might also have problems with math. They might have problems recognizing and using the number symbols and/or getting these symbols onto the page in the proper place. Some might have difficulty learning such concepts as addition, subtraction, multiplication, or division. Others might have difficulty reading and understand the word problems. And, still, others might have difficulty retrieving from memory the necessary math concepts, applying these concepts, and getting the steps written on the page (math fluency).
In order to get accommodations from your son’s employer, it will be necessary to document the disabilities. It might be necessary to have formal psycho-educational testing done. Such testing will clarify why he has difficulties. With this new knowledge, he might want to think about taking the GED with accommodations as well. LD OnLine has information on taking the GED tests and requesting accommodations.
(August 2007)
When are extra support and services from the school a good idea?
My son is in first grade. He is among the youngest in the class. He has a very extensive vocabulary, yet in kindergarten, they said it was uneven with his cognitive abilities. He has no motor skill difficulties, is very creative, artistic, and intelligent yet they recommended Reading Recovery for him. They feel he will reach his potential with this program.
His teacher feels he is very young and that is part of why he hasn't developed yet. The bulk of his class is turning seven and he just turned six, so we are hoping this will bring his reading up to speed. Yet at home, I feel he reads to me beautifully.
I don't now if it's the system pushing my child to have high scores in the district, if he has a learning disability, or if he is just young. Should I have him evaluated or wait to see if Reading Recovery works for him?
Mrs. Meyers
Boys do mature later than girls. Some of your son’s problems might be because of his age. Your school wants to provide additional support and services to see if these efforts might “jump start” him. This is a good idea. Listen to his teachers.
(July 2007)
What are some effects of language disabilities?
What helps a teenage boy who has a diagnosed dyslexic processing issue to fill in the gap between him being asked a question and his response? He has to develop a coping mechanism to not seem as if he is stalling the teacher or uninterested in a friend's story.
Vivien
Your description suggests that in addition to his learning disability (current school term for dyslexia) he might have a receptive/expressive language disability. If this is correct, a speech-language therapist will be able to help him. If this concept is new to you, learn about language disabilities.
(July 2007)
What is the best way to coach dyslexic people on a sports team?
I wanted to ask a question about team sports and dyslexia. Is there any research or resources about the best methods to coach players with dyslexia and to help them learn individual and team skills the most effective way?
Thank you
Your question and the sensitivity you have are applauded. Yes, students with learning disabilities (current school term for dyslexia) may need special accommodations when playing sports. It will be important for the special education team working with the individual to help you understand his/her strengths and weaknesses. Try to utilize the strengths and find a way to compensate for the weaknesses. Another source of guidance would be someone trained in adaptive PE. The fastest is to speak with the professionals working with this child in school.
(July 2007)
How can a teacher help a child with ADHD who has trouble reading and speaking?
I am a fifth grade teacher and I have a student who is medicated for ADHD with a patch. He shows an attention rate of about 85 percent throughout a school day. However, I have found that he experiences trouble in reading and in speaking at times. When called upon to orally read in class, he must stare at the text for approximately 20 seconds in order to verbalize his words. He also experiences this at times in beginning communication. Do you have any ideas of what the causes may be, or how I can assist him? Maybe games or skills practices that could help.
Thanks,
Donna
About 50 percent of students with ADHD will also have a learning, language, and/or motor disability. If your student is in fifth grade and struggling with reading, has he been evaluated by your school system for a possible learning disability? You also describe difficulties processing what he hears and what he must organize in his head before he can speak. Has he been evaluated for a language disability?
I think it is wonderful that you want to better understand and help. Start with getting psycho-educational and speech-language evaluations. These data will help guide your classroom efforts.
(July 2007)
Are memory difficulties considered learning disabilities?
Is the inability to memorize a learning disability? As a child, I was unable to memorize the arithmetic tables and to this day cannot add or subtract, multiply or divide accurately. As a teenager and an adult this inability to memorize has made it impossible to learn a second language because I'm unable to memorize and retain vocabulary.
Now at age 55, I'm under pressure at my job to learn a second language and even though I try to explain this problem, no one will believe that it is a learning disability. They keep pointing out that I have learned one language so I should be able to learn two. Of course, they all speak two or three fluently. I need some data to back me up. Can you help?
By the way, my IQ is 140 and I have an Ed.D. from Teachers College-Columbia University. I can learn, I just can't memorize.
Thank you,
Susan
There are many types of memory - working memory, short term memory, long term memory. And each type of memory is different for visual and for auditory processing. It is possible that you have a specific type of memory deficit that would make specific tasks, such as learning a new language difficult. I cannot be more specific. If it is important to you, you might request formal testing to clarify if you have a deficit in memory and, if so, in what areas.
(June 2007)
