Ask Dr. Silver
The following are past questions and answers from Dr. Larry Silver on this topic.
My high school son is off ADHD meds but now he's struggling with organization and self-motivation. What should I do?
Dear Dr. Silver,
I have a high school senior who has a learning disability, not ADHD. He was thought to have ADHD and was medicated when in middle school. However, when he started high school things changed and we stopped the medication due to behavioral misconduct that appears to have resulted from the medication.
As parents we have tried to help him with his behavioral problems. They have improved, but his grades have not. He starts off well but by the end of each semester he always falls short.
I am lost as to what to do. My son wants to be successful but is lacking the determination and motivation to get there on his own. He constantly needs reminders and supervision. How do I groom him to become independent, determined, and self-motivated?
Your description of his problems sound like a possible executive function disability (problems with organization and time planning). This disability might be a reflection of ADHD or of LD and often begins to be a problem in middle and high school. Discuss this possibility with the professionals at his school.
How can I help my son who is calm at home but disruptive in class?
My son is in kindergarten. Although his behavior seems calm and normal at home, he is constantly disrupting his class. As of now his learning is being affected. He is behind the rest of the students. He can count to 20 but cannot recognize numbers or letters. I have tried visiting his class and I work with him at home but he always gets frustrated and turns away. Please help!
I cannot be specific about the cause. I can share your concern. You need to discuss these problems with the school professionals to explore what his problem areas are. His areas of difficulty might reflect that he is developing at a slower pace than his classmates or they might be the first clue of a possible learning problem. If no one will respond, you could seek a private evaluation.
My son forgets things everywhere. Is this a sign of a disability?
Hi Dr. Silver,
My son forgets things in school, on the bus, in the park etc. He needs a reminder or he will forget things.
Is this related to any disability? If so, how can he be helped? Also, could it be possible that he can't process multiple tasks at the same time?
Without your son's age, I cannot be specific. But the behaviors you describe suggest that he might have what is called an executive function disorder. He has difficulty organizing schoolwork, and loses, forgets, misplaces papers and other materials. He gets to school and leaves things at home. Then he leaves school and forgets things that need to come home. He might have similar difficulties with his personal belongings (coat, pencils, etc.).
If he has executive function disorder, it might be a reflection of Attention-Deficit/Hyperactivity Disorder, Inattentive Type or it might be a reflection of a learning disability. I would discuss these problems with his teacher. If the teacher notices the problems as well, speak with the principal about the possibility of having a special education team evaluate him.
(If you want to read more about these problems, look in my book, The Misunderstood Child, Fourth Edition, published by Random House/Three Rivers Press.)
How can I help a teacher understand her student's behavior disorder?
I am the principal of an elementary school. I have an eighth grade student that has a behavior disorder. He is a great kid and has made great strides in the past few years. He is on medication and when he takes it he does well.
He has problems with a certain teacher and I am struggling to help her understand his disorder. He does not deal well with any kind of pressure and often times this pressure is because of something that is going on at home. He is easily irritated and frustrated. He often closes himself off when he becomes agitated and won't do any work. He becomes easily worried and depressed. He does not like to write and when an assignment requires extra writing he shuts down. (We have offered a computer to type assignments, but it is not an appealing alternative to him.)
He is a very intelligent boy but this behavior is all his instructor can see. She cannot understand why he shuts down sometimes. She becomes easily frustrated and continues to single him out in front of his peers when he chooses not to work. This only agitates him further. She honestly feels that he is making a decision to act a certain way just so he is in control of every situation.
The special education teacher and I have both tried to explain the behavior disorder to her. We are unsuccessful in our attempts. What would you say to her that might help her understand that kids with behavior disorders really are not able to control themselves all the time?
May I thank you for being so sensitive to the needs of your students. My first proposal might not fit your administrative style. I would transfer the child to a teacher who does understand the child's disabilities. I would then request that the teacher he now has receive help in learning how to teach a child with special needs in a general education setting.
If this is not possible, I would assure the current teacher that she will receive supportive help from the special education program. However, this teacher must (not it would be nice if...) follow the recommendations made.
Explaining has not helped. A specific list of teaching approaches that are expected and that will be monitored might work best.
The last thing I would want is to have the child continue to suffer because of the teacher's lack of knowledge and sensitivity.
How do we make sure our daughter with ADHD does not get bullied in middle school?
My daughter will be 13 in September and is going to middle school. I am very worried because she has ADHD and has a hard time making and keeping friends. She gets bullied a lot of the time. I don't want that to happen as she enters middle and high school. So how do we help her make friends, hang with the right crowd, and not get bullied?
I share your concerns. One option is to speak to the counselor who works at the middle school she will be attending. Ask for guidance and for help when she arrives.
The other option is to speak with the professional who is treating your daughter for her ADHD. Ask for a referral to a mental health professional who works with middle school students who have ADHD and social problems.
The school wants to put my social, bright 13-year-old daughter into an all-day program. What should I do?
My 13-year-old daughter has had trouble learning, retaining, and applying information since kindergarten. She has been in a resource program since fifth grade. This year I was informed she needed to attend a special day class that is more intensive than the one she is in. I went to visit the classroom and was so surprised to find 10 6-8th graders with very low functioning ability.
My daughter is bright and social, and never causes problems in school. I feel putting her in an all-day class like this will really hurt her self-esteem. I am wondering if she could have ADHD, although the testing doesn't indicate this.
She also scored low on her intelligence test. However, she comes across as a normal 13-year-old. She is on the cheerleading team and is very good at dance and athletics. Can you please give me some advice?
Your school professionals appear to have developed an IEP to address your daughter's needs. If you are not comfortable with this IEP, you have two choices.
First, you can appeal the decisions (such as diagnosis, needs, and class placement). Your school must then have another team from outside of your school review the case. Or, you can see a private professional knowledgeable in special education problems and request a private assessment. Should this professional agree with you, you can request another meeting of the IEP team and bring this person.
How can I get my daughter to stop procrastinating and do her homework without a fight?
I have a 12-year-old daughter who procrastinates terribly when she is supposed to be doing homework or studying and we are constantly threatening, bribing, reasoning with her to get her to do her work. She is often up late at night still doing it and we're always fighting. She frequently refuses when told to do things she doesn't want to do and I just can't make her.
Her behavior is so stressful to the rest of the family and we are all constantly on edge. How can I get her to complete her assignments without all the defiance and yelling? She is on Focalin and is a good student (with a lot of our badgering to do her work).
Please stop the arguing, bribing, threatening, etc. It is not working and does not work. Shift your focus to why she is acting this way rather than trying to make her change. I have yet to meet a 12-year-old who really wanted to fail or to disappoint his/her parents. There must be a reason and it is your job to find out what it is.
For example, I assume she is on Focalin because she has ADHD. If she takes the medication in the morning, it has probably worn off by about 4 or 5pm. Could this be a reason she struggles at night? Second, if she has ADHD, there is a high likelihood that she also has learning disabilities. Has she been tested to see if she might? If not, do so.
The answer to your question is not to increase the consequences and hope she will change. The challenge is for you to find out why she is struggling and to address the reason. Have you ever sat down with her and said, "I know you don't like to do poorly in school and I know you don't want to disappoint us. Let's work together. Help me understand what is hard about doing the work. Let's figure out together what we can do to help you be more successful."
I have LD and ADHD and struggle to regulate my emotions. Could I have Asperger’s Syndrome, too?
My name is Rachel and I am 23 years old. I was diagnosed with combined-type ADHD and a learning disability when I was 8.
As a child, I had a delay in fine and gross motor skills, I had trouble expressing my emotions, trouble communicating with others, and threw constant, severe tantrums when I didn't get my way or for no reason. During these severe tantrums, I would slam myself on the ground kicking and screaming, and I would rock and bang my head. I also did not know how to make friends or keep them.
As an adult, I have been diagnosed with generalized anxiety disorder and depression. Do you think I have Asperger's Syndrome, too?
Rachel: I am so pleased to hear you describe your problems. All too often, I see young adults who spend all of their time blaming others for their difficulties. You are correct. Something is not right in the way you regulate your emotions. Plus, there are other learning problems.
What you describe does not sound like Asperger's. If you have not done so as an adult, ask to see a psychiatrist for a comprehensive assessment. (Even though you are an adult, you might find that a child and adolescent psychiatrist would be best. These professionals are trained to work with adults as well. And, they are more likely to know about the types of difficulties you describe.) Don't give up until you have answers and a treatment plan to help you.
How do we help a kindergartner who cannot complete assignments independently and gets distracted easily?
Dear Dr. Silver,
I have a 5-year-old son that is in kindergarten. Prior to this year, he attended some daycare but never attended pre-k.
We have been experiencing problems with his learning. His teacher complains to us everyday that he does not complete his assignments in class. She has shown my husband the packets they need to do in class and his are blank. I have noticed that if I sit down with him, he will finish the work. However, if he does not have supervision he gets distracted.
This happens consistently. Please tell me your suggestions on what to do. I am very concerned about his learning ability. He is a normal child - he communicates normally and understands my instructions when it comes to home duties. But when it comes to school he does not seem to get it.
Ask to meet with the principal of the school. Explain your concerns and the comments from his teacher. Request that the principal assign the school psychologist or other school professional to observe your son and to talk with the teacher.
Then, ask that the principal, this professional, and the teacher meet with you to discuss their ideas on why he is having difficulty. (If you make this request to the principal in writing, the principal must respond and schedule this meeting within 30 calendar days.) Don't accept a no or a "let's wait until the end of the school year." If you hear this, seek help from a private educational consultant.
What is a good reaction for a parent to have when the school wants the child tested and they are not sure it is a good idea?
Today at a parent teacher conference, my second grader's private school is suggesting psycho-educational testing due to his behavior issues in class and want us to meet with their resource teacher and principal. They report that he sometimes refuses to do work, talks out of place, and doesn't listen. In essence, he has a bit of an attitude — which, of course, we address at home through consequences for poor behavior and rewards for positive behavior. The negative behaviors were evident in kindergarten and first grade, but seem to be improving each year. I thought these improvements meant he was simply growing up.
I am concerned about their request for testing at this point. He is a straight A student with a history of excellent grades, can sit still, can focus in spite of distractions, and has a rich social life. I am worried that the school is “jumping” to test him out of frustration as he makes them work a little harder. They have not suggested that he is “gifted” and in need of more challenging work.
I suspect many school personnel push for diagnosis and medication to make their job easier, and believe many children are unnecessarily diagnosed and medicated in this country. I fear a label and a diagnosis for my son that will hurt him rather than help him. I want to tread carefully, while respecting the schools opinion. I simply want what's best for my son. I intend on having an independent evaluation — not with the professional the school recommends. What advice can you offer me?
May I start with your comment that you want what is best for your son. I also believe that his teacher and principal also want what is best for your son. This shared desire needs to be the starting point. Sit down with them and listen to their concerns. You mention that he has had similar problems since kindergarten; thus, if the school professionals are concerned again this year, something needs to be clarified. Ask questions about what they are observing in class. Share what you are seeing at home. Try to find common ground on what the current concerns are and think through with them why these concerns might exist.
I believe that behavior is a message. Our task is to find out what message your son is sending. Why does he show an attitude? Why does he sometimes refuse to do his work? Why might he talk out of place or not listen? Where are his academic skills now as compared to where they should be? Try not to be defensive. Listen. Think about their concerns. Raise your questions: “Is he gifted and bored? Are you not setting consequences for his behaviors?”
At the end of this meeting, try to plan next steps. Maybe they will try additional efforts and meet again in month. Maybe you will agree to studies to clarify why he is having difficulty. If testing is done, ask to meet again after the results are available to discuss the results and to plan any needed interventions.You and the school professionals share a concern about your son. Don’t react in frustration or misread their intentions. Do what we teach our kids. Sit down and talk.
What should a parent do with an ADHD first grader who hates school?
I have a six-year old son who was diagnosed with ADHD. He started first grade this year and we have hit a wall. He has told me that he hates school and he is very reluctant to let me go in the mornings. He is a very active child and has a very volatile temper. What can I do to help ease him into the new routine of first grade?
If your son has ADHD, is he being treated for this disorder? Without treatment, he might be hyperactive, inattentive, and impulsive in school. Since about 50 percent of children with ADHD also have learning disabilities, it will be important that you request that he be evaluated for this possibility.
Maybe his behaviors are due to frustration. Discuss your concerns with the principal. Ask for a meeting to discuss how to help your son. At this meeting, request that further studies be done. His behaviors are a loud red flag that he is hurting. You must find out why. Is it untreated ADHD? Is it unrecognized LD? Or, is it something else?
How do you get the school to help a teenager who is acting out?
My son is 15. He was diagnosed ADHD & Dyslexic in the fourth grade. My biggest problem is that I feel like the schools are against me. We didn't get any help until junior high. By that time, my son was so frustrated that he began to act out. I am currently trying to learn the steps to take to fight the schools to get the help he needs and deserves.
Should he be tested again to see if anything has changed? Or does the diagnosis just remain the same? We had outside testing done. Otherwise, I would not even be asking because unfortunately, I don't have much trust in the school system. I believe that they try to give out the least amount of help as possible. This web site has been a wonderful source of education for me. My biggest fear is that I will have a son that quits school because he gets frustrated just like I did when I was young.
Thank you for answering all of these questions for all of the people that have the same issues as mine, but some in different areas. Please just remind people that they are their children's voice and that they need to help them.
I share your anger that your school system did nothing until he was frustrated and acting out. You need to do two things as a first step. Act now before he does give up. First, go to your family doctor and ask that a report be written confirming the diagnosis of ADHD. Then, send a written request to the principal of his school, requesting a meeting to discuss the need for updated testing and the probable need for an IEP.
If you put this request in writing, the principal must respond by calling such a meeting. If ignored, contact your Superintendent of School and complain. I would encourage you to take your own educational consultant to this meeting. You and your son have rights. Sometimes you have to remind the school system that this is true. Good luck.
How can I help my daughter who has lost all of her former friends?
My daughter has lost all of her good friends. She claims it is them and not her, yet I am not so sure. Do I step in and call her friends to see what is wrong, or do I ignore this and hope that she will get some new friends? She is ADD and OCD and is a smart, beautiful young lady who has zero confidence in herself and always sees faults with everyone else.
You note several possible reasons why your daughter might not have successful social interaction skills. Her ADD, OCD, and lack of confidence might be the issues. Start with the school counselor. Ask that he/she observe your daughter and speak with her teachers. See what you can learn. Observe her when she is with other kids and try to clarify why these kids react the way they do.
If she has ADD and OCD, she is probably under the care of one or more professionals. Seek their thoughts on the problem. She might need to be in a social skills group therapy or in another program that helps her understand her behaviors and how they impact on others.
What's wrong with a child who throws tantrums, refuses to listen, and can't concentrate?
I am worried about my five-year-old grandson. He refuses to listen, has trouble concentrating, throws tantrums, and asks the same question over and over. He is very bright, cute, funny, imaginative and loves to be the center of attention. He doesn't sit still if there is external stimuli. I literally can't take my eyes off of him. He doesn't know boundaries. He doesn't sit to eat a meal. The doors have to be locked from the inside, he may decide to visit the neighbor or go on a journey. Two years ago, I thought it was a phase, but it is getting worse. It's as if he has no control.
The behaviors you describe suggest a possible Attention-Deficit/Hyperactivity Disorder. Have your grandson's parents explored this possibility with their family physician? If not, you might suggest that they do. If they are resistant, ask them to learn more about this disorder. Have them check the ADHD Basics section of LD Online, ADDITUDE and CHADD.
What should a teacher do with a defiant child?
I have an LD student who is oppositionally defiant. Academically, he is quite capable of doing his grade level curriculum other than reading. The problem is motivating him. I have created a separate Behavior Intervention Plan for his behavior, but this particular student just does not care what he does or what rewards or consequences are attached to his plan. He ends up spending way too much time in "time out" not learning anything other than his General Ed teacher gives him strikes to place him in "time out" and out of her classroom.
In the student interview, he told me nothing motivates him, he hates school, doesn't need school, won't do his work no matter what, and wants me, his special education teacher, to leave him alone. Any suggestions before he ends up suspended from school as a third grade student? Anything you can suggest will be helpful. Thank you in advance.
After 40 plus years of practicing Child and Adolescent Psychiatry, I have yet to meet an eight-year-old who did not want to please his parents and teachers. Most kids hate school if they cannot perform at the level required. The question is not why he is not motivated. The question is what is keeping him from being successful. The oppositional behaviors and avoidance are his way of not doing tasks that either are too hard or that he is unable to do.
Don't join with the teachers and "blame the victim." Request formal testing to clarify why he is having difficulty. For more on diagnosis, see the LD OnLine section of Evaluation/LD Testing and my article What Do You Do If You Suspect Your Child Has a Learning Disability.
Can an ADD child get addicted to video games?
I have an 11-year-old son with ADD. A doctor has stated that there is research showing that a) kids can become addicted to violent video games and that b) gaming raises cortisol levels in people who play video games. A counselor says that ALL electronics can cause the above two situations. What is your take on this? What about active video games such as Dance Revolution or the wii games? How should a parent address this? Take them off all games, etc? Permanently or just take a break?... HELP!
This doctor is providing part of the research. May I refer you to a website that will provide more facts: notMYkid (then click on Internet addiction). Another site is MediaWise (then click on game addiction).
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.
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?
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.
How do you get a teenager with a learning disability to accept help when he says he doesn’t want services?
I work with a high school student who is in foster care and was on IEP that lapsed due to numerous placement changes and bouncing from school to school. He recently was evaluated and found eligible for special services. The student has refused to accept these services because he believes that special education means “retarded.” He is failing all classes. How can I influence this student's decision to accept services?
Your brief description suggests that this high school student has been through a lot. He probably does not feel very secure, safe, or good about himself. Getting him to accept yet another problem, “I’m dumb,” will not be easy.
Maybe the school counselor can help him. Maybe a concerned tutor can show him how the help will be useful. Maybe the concept of a learning disability might not be used but, “You know, you have had to move around so much that your education has not been good. You need help to make up for what your school did not teach you.”
How should ADHD be treated when there is also an anxiety disorder?
My eight-year-old son was diagnosed with inattentive ADHD and Central Auditory Processing Disorder (CAPD). He has always been a shy anxious child and uncomfortable socially. We have been trying different stimulant medications for him that have helped the inattentiveness, but have exacerbated the anxiety (separation anxiety and peeling his finger tips particularly).
We are now going to try Straterra. Should he get a formal diagnosis for anxiety disorder and be taking something more like Wellbutrin, or should we see how he responds to the Straterra? I have always been bothered by his anxiety issues and feel that the professionals I have seen seem to focus more on the ADD issues. Only now is the present doctor recommending he also has therapy for anxiety.
When someone has ADHD and also has an anxiety disorder, it is not uncommon for the medication used to treat the ADHD to exacerbate the anxiety disorder. It is best, therefore, to treat the anxiety disorder first.
Once this disorder is under good management, it should be possible to reintroduce a stimulant medication to treat the ADHD. The most frequent medications used to treat anxiety disorders are called “Selective Serotonin Reuptake Inhibitors.” Discuss this approach with the prescribing doctor.
What can a child do when their cousin with a learning disability often hits or kicks them?
My name is Alexis and I am 12 years old. My cousin has a learning disorder and gets mad really easily and he takes it out on me. He can hit, pinch, kick, and even bite! But I sometimes do something back to him and he runs crying and I get in trouble. And when I try to tell my Aunt that he hurt me also she doesn't even care about my feelings. I hate it!
Do you have any advice that might make my life run more smoothly? Also do you have advice that might make my Aunt start listening to me?
Wow. You do have a problem. And, I am afraid that you will not be able to explain to your aunt what her child is doing. Discuss your problems with your parents. Help them understand what you are dealing with. Ask them to observe. Your aunt's brother or sister (one of your parents) might be listened to before they listen to you. Good luck.
What happens when family members have ADD and other disabilities such as depression, anger-control problems, and anxiety disorders?
My daughter, who is 11 years old, was diagnosed with ADD. She is on Focalin. For the most part she is doing pretty good but she has her occasional breakdowns. How do you help get a person out of a meltdown without a lot of screaming, yelling, crying from that person?
My wife suffers from depression and also is ADD. She is on medication which does not help when my daughter has one of her meltdowns. Then my wife starts to have a meltdown. Sometimes panic attacks arise from what my daughter is saying etc during a meltdown. Any suggestions would be grateful in dealing with my wife and daughter.
It is important that you learn about what is called comorbidity with ADHD, as I discussed in my book, The Misunderstood Child. Fifty percent of children with ADHD will have one or more of a pattern of emotional regulatory problems. These include anxiety disorder (with panic attacks), depression, anger control problems, and obsessive-compulsive disorder.
These comorbid conditions are neurologically-based as is the ADHD. Usually, each of these problems existed over many years and can occur in school as well as at home. The medication may have made each worse but may not be the cause. Often, there is a family history of similar problems. It sounds as if your daughter might have one or more of these regulatory problems. I recommend that you have her evaluated by a Child and Adolescent Psychiatrist. It is essential that you clarify all of her problems so that a comprehensive treatment plan can be done.
How can I work with the professionals who help my son to improve his behavior difficulties?
My 4-year-old son has some language processing difficulties. I need advice on how to deal with his tantrums of hitting, throwing stuff, peeing on his pants, etc. when he is in his very frequent temperamental behavior. He does not behave like this in school though. This is affecting my other normal six-year-old son's life terribly. Not to mention mine, as well. Please help. Time out or ignoring his tantrums does not help. His tantrums most of the time is due to him not being able to interpret as to what we are asking him to do or him not having it his way.
Who identified that he has a language processing problem? I hope it was by a speech-language therapist or a special education team. Do these language processing problems interfere with his ability to process what he hears and what he tries to speak? Do they interfere with early preschool learning like letter and number recognition?
I would suspect that his behavior at home is the result of his frustrations with handling life. If he does not always know what he hears or has difficulty finding the words to express himself, he will be angry and upset. If he cannot do play activities or peer interactions at his age level, he will be frustrated.
Start by sitting down with the professionals who diagnosed him as having a language processing difficulty. Ask this person(s) to help you answer your question about his behavior. Have them explain the frustration and teach you how to help you son be less frustrated.
Note from LD OnLine: For more information on Language Processing Difficulties, visit LD OnLine's Speech and Language section.
How can a sibling help their younger brother with Aspergers Syndrome?
My name is Matthew White and I am 15 years old and I have a younger brother who has Asperger's syndrome. When I babysit, it is always a hassle to get him to brush his teeth or do something when it is his turn to do it. He will fight with me and be so persistent that it annoys me to the point I just give up. I was wondering if you could give me some suggestions to help my house run a little more smoothly and so my parents aren't so overwhelmed.
I was also wondering if you could explain why he does these things. What I can do to help everything run smoother and help make our family more "close-knit"? I think that once we get this under control we can be a happier family in the long run.
All I know about the subject is that I just can't get mad at him, because once I get mad at him he just doesn't listen at all and then there is no way to get him to do what you want.
Your brother is very lucky to have a brother like you. Your awareness and sensitivity go beyond your 15 years of life. It sounds like both you and your parents need help. I would hope that this help was available through your brother's school program or though a parent support group.
Ask your parents to go to a website - Online Asperger Syndrome Information and Support. This site will provide lots of information on the questions you ask and will provide resources for you and for your parents.