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ADHD

The following are past questions and answers from Dr. Larry Silver on this topic.

My son's accomodations will change when he starts middle school. Who should I talk to about this transition?

I have a son who's 12 years old now. He has moderate LD mainly in visual processing, working memory, and expressive language. If he has no ADHD, should I still consider medication? He will start his middle school next week. In elementary school, he was pulled out for 45 minutes a day each week. Now, he will go to special education class for his language arts and social class.

I don't know whether it is good idea to place him in non-mainstream classes. Would this destroy his self-esteem? Should I insist on putting him in the regular class (though only push-in service will be provided)?

If your son does not have ADHD, he should not be considered for an ADHD medication. I cannot answer your questions on placement in middle school without knowing more details. You should be meeting with the special education (IEP) team to discuss what he will need for middle school. Has this happened yet? If you are unsure of the recommendations made by your school, seek a private consultant who can help you decide what is best for your son.

Can learning disabilities and ADHD get worse in high school?

Help! I am a sophomore in a private school. When I was in first grade I was diagnosed with ADHD and a visual processing disorder. I got help, medication, and accommodations so I eventually worked my way up through the system.

By eighth grade I was a straight-A honors student with almost no late assignments and not that many late nights. The perfect success story… until this year. It was like I hit a brick wall a quarter into the year.

All of a sudden I was staying up until 2am or 3am every night trying (and often failing) to get my work done. I frequently only had time to eat one actual meal a day. My parents and I were a little less than pleased and talked to my guidance counselor and the learning support teacher at school. We are pursuing retesting. I now have preferential seating and can get extensions on due dates.

But the problem isn't gone. At all. I am still up late and stress and my parents and I still donít like it. Can learning disabilities and ADHD get worse? I didnít think that they could. What can I do to work better and focus better? I'm really tired of it taking me up to an hour to write a one-page paper. I've read everything on this Web site about visual processing and have done extensive research on ADHD. What do I do now? What else can I try? I'm running out of ideas.

Here's what I have tried: multiple types and doses of meds; assistive technology with reading; keeping a planner; prioritizing; using a timer when working; outlining and other organizational techniques for papers; taking notes; placing an object under the text; quiet work space; consistent work time; taking breaks; taking notes/ highlighting while reading; writing on the computer or with different paper/pens/pencils; being well rested; no cell phone distractions; working early in the morning after sleeping; caffeine; different lighting; classical music; enlarged print; underlining; reading/saying it aloud; and color coding.

I suspect that you have executive function disorders. These problems often become an issue starting in middle and then high school. Problems might include difficulty organizing your school materials, papers, reports, and assignments. Thus, you might lose or misplace things or leave things at home when you go to school.

You might also have difficulty organizing and keeping track of your personal belongings (backpack, coat, pencils, etc.) and keeping your personal space organized. Often, there is a problem with monitoring time.

Added to these problems might be difficulties with retaining what you have read or with organizing your thoughts when you need to write something.

If this description sounds like you, you will need updated psycho-educational testing to clarify how best to help. Usually, an organization coach is needed but often more is necessary. Show my answer to your parents and ask that they arrange such studies. Good luck!

My son is on Concerta for his ADHD, but still struggles with multi-tasking and is falling behind in class. What is causing this?

I have a 9-year-old son in the third grade. He has ADHD and is on Concerta. The meds definitely help calm him down so he can focus more at school.

Academically, he is very smart but he constantly needs help from the teacher or a student to keep up with the class. According to his teacher, he is always many steps behind the rest of the kids in class. He does not do well with multi-tasking and this often causes him to fall behind. And he's very slow at finishing every assignment.

At the same time, his teacher says that he is the hardest working person in the classroom and he'll keeping working until it's done. He does no goofing off whatsoever. Any idea what might be causing this? Could it be the meds he's on?

About 50% of children with ADHD also have learning disabilities. It sounds as if your son might have both. Discuss this concern with his school professionals and ask that they evaluate for this possibility.

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.

Can ADHD meds help with an auditory processing disorder?

My fifth-grade son failed two subtests for auditory processing. I do not know if we are dealing with ADHD. We have tried ADHD meds and he says that he can hear the teacher better.

Is there any evidence to indicate that ADHD meds would impact auditory processing? Everything I've read seems to indicate no, but he insists that is the one difference for him.

You ask good questions; however, I cannot be specific. You need to sit down with the person who diagnosed him with an auditory processing problem and ask these questions. Usually, such an area of difficulty would interfere with reading skills and writing skills (e.g., spelling).

There are other questions to ask this person. What two tests did he fail and what does this mean? Did you do any other studies to see if he has areas of learning difficulty? Push to get clarification.

My son has an auditory processing disorder and is struggling but the school is only offering a 504 plan. What can I do?

My son is 12 and has been diagnosed with an auditory processing disorder. He has a hard time comprehending the material in school. I'm told he doesn't focus or engage in asking questions. I wonder if he has ADHD, although the doctor said he only has an auditory processing disorder.

What can I do to help him in school? He can't retain the information and the workload is too much. I'm not getting any help from the school. My son is a good kid who tries extremely hard. I don't want him to give up. He is extremely nervous giving a presentation or performing in front of people to the point that he hunches over and starts crying. Please help me! The school would not give him an IEP. They recently said they may consider a 504.

My first question: Who diagnosed him with an auditory processing disorder? This person should be advising you. Such a disorder often causes learning disabilities. Was he evaluated for this? If not, this needs to be done. Where are his skills in reading, writing, math, and organization? What you describe does not sound like Attention Deficit Hyperactivity Disorder.

I support your not accepting a 504 Plan. This plan would provide accommodations but not remedial services. You need to be assertive about wanting a full assessment leading to an IEP. Under an IEP, he should get both accommodations and services. Maybe you need a special education consultant to advise you on your rights under the education law and how to approach your school.

(If you want to read more on this, look in my book, The Misunderstood Child, Fourth Edition, published by Random House/Three Rivers Press.)

Good luck. Don't give up. If all of the above fail, e-mail back.

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.)

My son is in kindergarten and cannot write his name, but the psychologist says he's on track. Should I request testing anyway?

My son is 5 and is having difficulty in school. He started in a child development program last year at age 4 and had a lot of trouble learning anything. We thought it was due to his ADHD and behavior. He could not spell or write his name, did not know colors, numbers, or any of the alphabet.

This year he is doing much better with his behavior. But he has been in school for nine weeks so far and still cannot spell or write his name without assistance. He only knows three letters of the alphabet and can only recognize the numbers one to five. He has trouble gripping a pencil tight enough to write.

He is in speech therapy and has been since last year. My husband was LD in school. My son has been evaluated by the school psychologist but she thinks that even though he has attended school for over a year, he is where he should be. Should I be concerned and request additional testing for him, or is he too young to be diagnosed with dyslexia or other LD?

I share your concerns. Yes, he might be too young to meet the school requirements to be identified as having a learning disability. (Most schools use a model that requires a child to be about two years behind and he is only five.) But, there is the opportunity to evaluate and help a 5-year-old without needing to conclude why the problems exist. If testing shows that he has areas of deficit, services can be provided without the formality of testing. Speak with the principal about getting such help.

If you are not successful, you have two options. First, you could get psychological and educational testing done privately and then take the results to the school, insisting on help. Or, you could set an appeal process in motion. To do this, send your principal a letter, requesting a meeting to discuss the need to evaluate your son. The principal must call such a meeting within 30 days (based on education law).

At this meeting, request an evaluation. If the team does not agree and does not agree to informally provide services, ask for the guidelines on how to appeal the team's decision. Such a process is required by law. Then, appeal to the next level within your school system. If the principal refuses to call a meeting, comment that IDEA, the federal education law, requires that the principal call such a meeting. If he or she still refuses, ask for information on how to appeal.

(Should the principal refuse, I would meet with your superintendent of school or an assistant. Bring your notes about each step you went through and ask what your rights are.)

Good luck.

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.

What do I do about teachers who belittle my son in front of other students and do not follow his IEP?

I have a 9-year-old son, who was diagnosed with dysgraphia and ADHD in second grade. He has a special education plan, which his teachers usually follow, but because he is in lots of special groups, math help, reading help etc., he has lots of different teachers.

I am really having issues getting them to positively reinforce him. I fight with them all the time and it is just the same thing over and over — he gets a new teacher who is supposed to follow his IEP and instead they make fun of him or belittle him because he does not learn the same as other children. I am so sad and frustrated, I want to just follow him around and stop anyone who hurts him, but I can't do that.

Is there anything I can do to help his beaten self-esteem? Or maybe a different way to approach the teachers? He is just a little boy and he learns a little differently than others. I have had teachers use him as an example, saying things like, "If you don't do your homework, you'll end up like him." They have told him, "If you don't stop making your letters backwards, you will never have a job or a drivers license." Any help or advice you can give me will be greatly appreciated.

Sincerely,

Shelly

If your son has an IEP that clarifies your sons disabilities and the services needed, do not tolerate any teacher acting the way you describe. Keep a log of each occurrence. When you have enough examples, request an IEP meeting to discuss your sons progress. At this meeting, present your log and ask that this issue be addressed.

If your son has a 504 Plan, based possibly on the ADHD, follow the same process. Here, you would request a 504 meeting to discuss his progress.

Do not allow this to continue. But, you must document, document, and document. If your only data is from your son, see if you can get validation from another student, an aide, or someone else.

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."

Our second-grade daughter is struggling with depression and ADHD. What do we do?

I have a 7-year-old girl who is in second grade and struggling. She was diagnosed with Adjustment Depression and ADHD last March. She was treated for depression with an SSRI and counseling. She is currently on an ADHD medication and has stopped the depression meds. The counseling was stopped this fall because her counselor could see no reason to continue.

We have struggled since she started school. She is a very strong-willed little girl who knows a lot more than what she is willing to show us or the teachers. Her work at school fluctuates from day to day. She can do the work with ease one day and then struggle the next with the same work. Her teachers are as perplexed as I am. I have tried many different things for her such as Hooked on Phonics, Sylvan, special tutoring at school, and working with her in different ways at home. The things we try seem to make an impact the first couple of weeks but then she no longer is interested in them and does not want to participate. There seems to be a battle of wills.

How do we go about finding the thing that will allow my daughter to be as bright as we know she is without traumatizing her or bringing back the depression and making things worse? Her teachers feel she should continue counseling. They are disagreeing with the diagnosis of ADHD even though we went through several hours of testing. I fear that if she is held back (which I am thinking may be next) that she will be traumatized from this and will not recover.

Her social skills are lacking. She avoids crowds and does not warm up to people like a typical 7-year-old. She would much rather play with younger kids and avoid group activities. She has no problems making new friends as long as it is just her and the other child. Could her social behavior be contributing to her academic behavior and, if so, how do we go about making changes?

Your questions and concerns are on target. You need to find out more about why your daughter is struggling. It is possible that her depression was the result of her frustrations and difficulties at school. Once some of these were addressed, her depression went away.

If you feel that you are not getting the answers you need from her school professionals, you might have to seek help from others. First, meet with the person who did the hours of testing to conclude that your daughter has ADHD. Discuss your concerns with this professional. Why is she struggling in school? Why is she inconsistent? Were there any test results that might suggest that she has a learning disability or is at risk for such a disability? Discuss the fact that her school staff do not agree with the diagnosis of ADHD and ask for help in responding to the teachers.

If these efforts do not help, seek a private special education consultant who can review all of the records and testing (by school and privately) and advise you on what is best to do.

One added thought: Many professionals within the school and private sector use a guideline for diagnosing someone as having a learning disability. They must be significantly behind expected grade level. If a student is in second grade and a year behind, he or she might be shown to have difficulties, but the degree of deficit is not great enough to use the formal term learning disabilities. Discuss this theme with both school and private professionals. Challenge them by asking, “Are you saying that I have to wait until she fails third grade before you can identify her as having a disability?”

Does my inattentive disorganized teenage son have ADHD?

My question or questions concern my son who is now 15. He has had struggles his entire tenure as a student thus far. His teachers say that he is to often off of the task at hand. He tells me he has trouble concentrating at times. Having him sit by himself is very little help in terms of him not getting distracted. I had him tested four years ago for ADD and he doesn’t seem to be a ADHD candidate because he has no problem staying still, with the exception of his concentration problems. He gets good grades at times and then it seems at testing time he fails. Teaching methods attribute to some of it, but not all.

He is very disorganized and even if I take the time to get him set-up to be organized (i.e. notes), he often gets classes mixed up. This leaves him with a result of mixed-up paperwork that needs to be deciphered for determining which notebook it goes in. The doctor who gave him the test years ago said that the results were such that he didn’t think he was ADD or ADHD and that he would probably always be a high maintenance student. He is now a freshman struggling and I cant help but feel he is slipping through the cracks. He does not cause problems, although when he is off task and tries to socialize during class, it can cause additional distraction for his teachers. Please advise on where I should go from here.

Thanks,
Harold

Your son is fortunate to have a father who cares and is concerned. Your worries are appropriate. How would a 15-year-old reflect that he might have ADHD? First, he would have difficulties with activity level, ability to attend, or with impulsivity. For adolescents, we often also find problems with organization and with time planning. You describe him as distractible and inattentive. He is also disorganized.

The second step in establishing the diagnosis of ADHD is to show that the identified behaviors have been present since early childhood (chronic) and that they occur in most life situatiions (pervasive. I believe that you describe such a chronic and pervasive pattern. Finally, you need to show that these behaviors are having a significant impact on areas of his life — home, school, peers. The answer again is yes.

Based on your description, your son seems to have ADHD. I encourage you to see a physician who is knowledgeable about ADHD. If my impression is correct and he does have ADHD, treatment will make a significant difference.

How can I help an ADHD child with "sluggish cognitive tempo?"

After extensive testing by various places, my son has been diagnosed by a psychologist with ADHD-PI and sluggish cognitive tempo. He has just started taking band and playing the flute. Band is held at the end of the day when the other students have a study hall. As expected, he is having difficulty finishing tasks and tests in class.

The teachers want me to withdraw him from band to give him extra time to finish these things. He wants to continue band. He does not have an IEP yet. I am waiting for the written report from the psychologist to schedule an appointment with the counselor. The school tells me that with ADHD he does not qualify for additional resources.

Is sluggish cognitive tempo considered a learning disability? Will the diagnosis qualify him for additional resources, such as a resource teacher or just an IEP? Should I withdraw him from band and make him concentrate on academics or should I insist that the school make other accommodations to allow him to finish his unfinished assignments?

It appears that the school has done formal testing, called psycho-educational testing. These data should clarify why he has “sluggish cognitive tempo.” The most frequent causes are weaknesses in what is called processing speed or in what is called working memory. If these are the reasons, targeted special education tutoring should help.

You are correct — ADHD is not a disability under education law, thus, an IEP will not be done. ADHD can be considered under what is called a “504 Plan” and would include some assistance, such as the study hall.

Your options: You might let him stay in the band and provide a private special education tutor to work on his areas of difficulty. If formal psycho-educational testing has not been done, you might request that the school do these studies (or have them done privately).

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.

Please help!

Jackie

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.

My child went on ADHD medication and is now depressed. What now?

My daughter, who is now 7 years old, has been diagnosed with ADHD, Dyslexia, Motor Function delays and Executive Function disorder. This diagnosis came after about four months of testing and evaluation. The ADHD diagnosis came as a surprise, not just to us, but to her teachers and specialists as well. They just didn't see it.

The plan of action included continuation with what we are already doing and medication. We tried the medication and were told we would see an immediate change. The medication did nothing other than make her depressed. She is known for her sweet personality so the change was obvious. We tried other meds with the same result.

I am wondering if she has been misdiagnosed. She is now reading and writing through the help of a specialist as well as at home. She is also doing well with math. She is still struggling with her ability to stay focused and follow directions (ie. if I ask her to face me she will turn around with her back to me). At this point in her treatment, do you have any advice as to what I can do next? Thank you, in advance, for you time and consideration.

I would trust your observations and judgment. It is possible that her inattention is the result of her learning, motor, (and probably language) disabilities. If so, medication may not help; remedial tutoring, OT, Speech-Language will help. I suggest that you hold off on trying medication and give the interventions a chance to help. If the professionals working with her feel that her inattention is a major concern, you might want to have her reassessed by a Child and Adolescent Psychiatrist to explore why the medications did not work and to find if other interventions might help.

If a nine-year-old suddenly starts having trouble focusing in school, is it ADHD?

My gifted nine-year-old, who is an advanced reader, writes and illustrates stories, finds patterns and relationships in math problems, and likes to have theological discussions, has suddenly started having extreme difficulty focusing in school. For example, his teacher often saw him staring off into space for long periods of time during standardized testing and his gifted teacher said that on a recent assignment he wrote only 12 words in one hour without one complete sentence!

He still has all A's in classes except for Science, in which he has a low D. Lately, the Science assignments have been done on your own during center time while the teacher helps small reading groups. The gifted teacher has mentioned the possibility of ADD since this seems to go beyond occasional daydreaming and reminding him to focus really isn't cutting it.

Do I ask the school to test him? Do I take him to our pediatrician or ask that his office's psychologist test our son in some way? Should I go first to an eye doctor since he recently mentioned seeing double at times? Where do we start? I would like to look into this before he goes into fourth grade next year (known to be harder and faster paced).

ADHD is a neurologically-based disorder. Key to making the diagnosis is to establish a chronic and a pervasive history of the behaviors noted. That is, if inattentive, there needs to be evidence of inattention/distractibility since preschool or kindergarten. And, these behaviors should be noted in most situations (home, school, with friends, on vacation , etc). If the problem of focusing "suddenly started" at age nine and seem to be related only to "difficulty focusing in school," other possibilities need to be considered.

I would start by meeting with his teachers and other school professionals to explore what might be the cause. Ask that someone come to the class and do observations to clarify when this problem is present and to explore for possible causes. Don't rush to have further studies done until you have more observational data.

Why would a child diagnosed with ADHD have trouble retaining letter sounds?

My 7-year-old son has ADHD and an IEP in class at his school. He is very good in math, but when it comes too letter sounds, he cannot retain them so he can't read or write. How do I, as his mom, help him too remember from one day to the next? And why is it he can retain all the things to do with math and not reading? I am confused?

Vickie

About 50 percent of children with ADHD also have Learning Disabilities. Your son sounds like this might be true for him. If not yet done, a comprehensive psycho-educational evaluation will clarify why he is having difficulties and clarify how best to help him.

I'm fifteen and think I have ADD. What are your ideas?

Hello! My name is Rebecca Phipps, and I'm 14 years old, almost 15. I recently got accepted into this awesome new high school, West Florida. It's a difficult new school, and most people would just die to go there. I've always had a little bit of ADD, but because of the new stresses and other components, it's gotten worse. It's really embarrassing when I am talking to the teacher and I randomly forget what I was talking about.

My mom knows about this, and my brother has ADHD. I talked to my older sister about it and I tell her a lot of things I don't tell mom. The other day we were talking about my situation, and I want to talk to my doctor about getting the medicine for it. I figured there's not very much to lose. I was wondering if you had any suggestions about opening up a conversation with my mom about really considering talking to my pediatrician. Could you please help?

Thank you for trying to understand yourself. Yes, please talk to your mother. Explain what you describe above. Ask her to set up a consultation with your family doctor. When you have this appointment, list your observations and your concerns. Best of success.

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).

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.

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.

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.

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.

Thank you,

Judy

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.

Can a really busy person get diagnosed without spending much time at it?

Is there a way I could be diagnosed without having to go to my general practitioner? During the week, I have college and have to work so I never have spare time to go to the doctors. But I want an official diagnosis that I have ADD or ADHD. It would help me get a little extra help in college

There is no easy or quick way to diagnose or treat ADHD. You need to be seen by a physician to establish the diagnosis and to receive treatment. Maybe you could find someone at your college's Health Services so that you do not have to travel. Again, if you have a problem that is impacting on your success, you must find the time to get the proper diagnosis and treatment.

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.

Thanks
Bruce

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.

What happens if medication does not seem to be working well?

My son was diagnosed with ADHD and learning disabilities at the end of third grade. He is now in ninth grade and gets very frustrated to the fact that he can't concentrate and do well in school. I feel frustrated myself because I don't know how to help him get out of his frustration.

He used to take Concerta until last year. He now refuses to take the medicine because it makes him feel a different person and he gets angry and aggressive when he takes it. I stopped giving it to him.

Please provide me with some feedback as to how I can help him succeed.

Lvonne

Let me focus first on the ADHD. Maybe he can't concentrate in school because his ADHD is no longer being treated. You should know that there are two consequences of being on too high a dose of Ritalin (Concerta). First, the individual may be more emotionally fragile - more angry or upset. Second, the individual may feel spacey - like someone flattened his personality. Perhaps if he saw someone who knew how to adjust the dose and monitor the medication, he would not resist. Discuss this with your physician.

Second, he has learning disabilities. And, now he is in high school. Does he have the compensatory strategies to handle high school work? Does he have the necessary accommodations in class? Could his frustration also be because he is no longer receiving adequate services?

Where can an adult be formally diagnosed with ADHD?

I have been diagnosed with adult attention deficit. I am currently taking Concerta. Where can I take a diagnostic test? Is it a formal test in which I can take so I can seek professional help? I just retired from the military and I would like to be able to go to college and able to really learn and not only pass a test.

I am getting ready to go to college this fall and I am assuming they would like some type of formal evaluation, test type documentation. The more a read about ADHD the more I see myself back in my early age.

Thank you,
William

The formal criteria for diagnosing someone of any age with ADHD is in a diagnostic manual called the DSM-IV.

The first step is to confirm the presence of hyperactivity and/or inattention and/or impulsivity. Then, it is necessary to show that these behaviors have been present since childhood (chronic) and that they exist in many aspects of your life (pervasive).

Finally, it must be clear that there are no other disorders that might explain the problems. A physician makes the diagnosis. Check around to find out which physicians, often psychiatrist, are knowledgeable about ADHD.

Do you have any tips for teenage drivers with ADHD and/or LD?

I am a 17-year-old girl who has been diagnosed with ADHD and a type of LD. I have had my license since August of 2005. Since then (not including the minor bumps against the garage), I've had two severe car accidents resulting in totaling both cars. The first one was inexperience, but the second one was failure to pay attention and my reaction time.

My parents are restricting my driving right now but they don't want to take it away because they don't want me to lose my freedom. Do you know of any tips or books for teenagers living with ADHD and driving?

Thanks
Ashley

You are wise to ask for help.

Start by learning what type of LD you have. Hopefully your parents or a school professional will know. You need to find out if this disability might be contributing to your problem. For example, if you have visual-spatial or visual-motor difficulties, you might have trouble judging distance, closeness.

Then, clarify in what ways you have ADHD. Are you hyperactive? Are you inattentive and easily distracted? Are you impulsive? If you are any or all of these, it would be important that you be on the proper medication when you drive. This medication would reduce or stop such behaviors.

Now, to be more practical. Ask your parents to check with the driving schools in your area. Ask if any program has a teacher that works well with students who have ADHD or Learning Disabilities. Even though you already have a license, it would be helpful to take more practice lessons with someone who understands and who can give you practical advice.

Good Luck.

How can I get a good diagnosis for my child who might have a learning disability?

My 5-year-old son was recently referred for testing by teachers. We filled out forms and brought him to the pediatrician who promptly diagnosed my son as ADHD and prescribed Focalin.

I asked about other possibilities related to LD maybe being part of the problem as his skills are severely delayed (about 1.5 years behind other children). I was told it was possible he had an LD that caused him to lose interest and focus OR it could be ADHD that caused him to have problems learning. I asked how do we know which it is and was told the solution was to medicate and see if it works or not.

I described in detail his ability to learn and retain information verbally just not visually so much. I asked about testing for learning disabilities before we started medicating my child.

The pediatrician referred me to a developmental clinic who does not take private insurance, only Medicaid, and costs around $10,000 for a full screen for LDs. I need to have an alternative as I cannot afford this screen and am hesitant to make my child a guinea pig with medication that he may or may not need.

Please help - what do I do? What resources exist for us?

Thank you,
Jenni

You ask good questions. Your son's problems might be due to evolving Learning Disabilities or due to ADHD or due to both. It is important to clarify.

Did your pediatrician do a full assessment? Did he/she use the required criteria to diagnose ADHD? (Presence of hyperactivity and/or inattention and/or impulsivity that has been present for several years and that are noted at school, home, with friends.) If not, don't accept the diagnosis.

I would suggest you find a good educational diagnostician, experienced with early childhood. You will not have to guess. If there are developmental delays or LD, testing will clarify. This assessment should not cost more that $1,500 to $2,000, depending on what is done. (I have no idea what a developmental clinic would do that would cost $10,000).

How do we help a child with ADHD and auditory processing deficit?

We are trying to decide which therapy would be better for our daughter who has been diagnosed with a mild case of ADHD and a possible auditory processing deficit. We are currently considering the NILD Discovery program or neurofeedback. We cannot find information comparing the two.

Thank you so much for replying.

Sincerely,
Lori

First, and most important is that the diagnoses are correct and that other possible causes for the problems have not been missed. Has she had formal psycho-educational testing? Has she been diagnosed with ADHD by a professional who uses the criteria required to make this diagnosis? Please do not jump into any type of treatment until you know what it is that you are treating.

For ADHD, medication is the treatment that works best. For auditory processing problems or learning disabilities, speech-language or special education therapy works best.

Don't spend your money and your daughter's time on NILD Discovery or neurofeedback as an initial step. Neither has been documented as being effective treatments for ADHD or for auditory processing problems.

If you want more information on evaluation, diagnosis, treatments, you might want to read the book, The Misunderstood Child.

Should ADHD medication be given only when a child is at school?

My step-son is taking Concerta. Shouldn't he take it every day? His mom only gives it to him through the week, not on the weekends, or only when he's in school. When we have him, he says he feels weird on Monday at school. I want to know if it is harmful to him because he's on and off it so much.

Thanks,
Shaun

Medication for ADHD, such as Concerta, should be taken whenever the hyperactivity, inattention, and/or impulsivity could interfere with the child's ability to function and perform.

If weekends are casual and there are no sports activities or homework to do, he might be ok without medication. If you notice that his ADHD behaviors create behavioral, social, or academic difficulties when he is with you, it might be important for him to be on the medication.