Pay Attention.

Lately, I find myself giving the same speech. It takes me a while to get the language right in explaining difficult concepts about child development, so when I do, I like to make it count and use my new speech whenever possible (apologies to people who attend meetings with me on a regular basis and get to hear me say the same thing). Anyhoo, I think my latest speech/analogy is a fairly decent one, so I will share it with you.

At my school sites, I have been getting a lot of requests for assessment for Attention Deficit Hyperactivity Disorder (ADHD) that sound a little like this: “So and so is inattentive and hyper. Does she have ADHD?” It’s a legitimate question, but it is not an easy answer. As in previous posts, like the one where I went to a Circus School to assess a student for ADHD (true story), ADHD is a complex assessment. Especially if you yourself are distracted by trapeze artists during your “school observation.” But I digress.

My new speech/analogy is:

“Attention is the ‘fatigue’ of the psychology field.”

Here is what I mean by that. I want you to imagine you have fatigue and you go to your doctor and say, “Doc, I have fatigue. Do I have Chronic Fatigue Syndrome?” The doctor (if they are any good, of course) would have to investigate all the potential causes for fatigue before concluding anything. Offhand, (and I’m not that kind of doctor), I can think of about a hojillion reasons for fatigue besides Chronic Fatigue Syndrome: the flu, cancer, pregnancy, working in a school district, depression, hyperthyroidism, hypothyroidism, anemia, seizure disorders, poor sleep…..and it goes on and on. “Fatigue” is a non-specific symptom.

The same is true for attention. Offhand, the “causes” of inattention can be: (um, all medical conditions above), ADHD, difficulties focusing because of a learning disability, anxiety, depression, low IQ, high IQ, autism, social-emotional distraction, situational factors, psychosis…..and it goes on and on. So, when people ask me if I will “test for ADHD”, they are really asking me to test for everything else as well. I enjoy ADHD evaluations. I feel like a detective looking for clues and hitting a bunch of dead ends until I get to the bottom of the inattention symptoms.

That is why it burns my soul just a little bit when I get reports from outside professionals who give one rating scale to the parent, and if it is elevated in attention problems, they get the diagnosis. They don’t interview the teachers, they don’t observe the kid at school, and they don’t rule out the other causes of ADHD-like symptoms. Really, it gives “my people” a bad name to do an incomplete evaluation like that.

Second pet peeve about ADHD evaluations is when a doctor then “prescribes” an IEP or Section 504 plan based on their results, without seeing if the inattention is really having an educational impact that requires special education or accommodations. I have had students with ADHD on the honor roll, earning all As and Bs, and the outside professional recommends an IEP. I always wonder what service they think the kid needs. Then I have a fantasy of calling them up and telling them what psychopharmacological medications to prescribe. Because you know, if they’re going to tell me what to do in my school without knowing what their talking about, surely I can pretend I’m a medical professional and tell them what to do. It’s only fair.

I realize that doctors and outside professionals are only trying to help. But I think that school psychologists are the ones best equipped to assess for ADHD (given they have had training and aren’t super old school psychs who should have retired during the Clinton administration or sooner). In some districts, school psychs are not allowed to assess for ADHD, and in some they are. In some, they do screenings and send the information to a doctor. In my private practice as a clinical psychologist, I do ADHD evaluations all the time. In my role as a school psychologist, it has gone back and forth about whether or not I am allowed to do them, even though I have the training. I feel bad for parents, whose doctor says to go to the school for an evaluation and the school says to go to the doctor. It’s confusing, and then the kids with legitimate issues get bounced between professionals.

I am curious how other school psychologists and districts handle referrals for ADHD. I find that it varies from district to district, school to school, and even by school psychologist comfort level in assessing for ADHD. I would be curious from other school psychologists what your district policy is on how ADHD evaluations are handled in your district. Discuss amongst yourselves...and feel free to try on the fatigue analogy at your next meeting!

Sleep. So Hot Right Now.

I presented this evening on the power of sleep for children and learning at one of my schools. Inadvertently, I became my own case study this week on the effects of lack of sleep. I got little sleep this weekend because of a holiday party on one night, and then getting up at 5am on Sunday morning to get to the Antique Faire. I know, I'm psycho. But all the good mid-century modern stuff goes in the first hour. Early bird gets the Hans Wagner wingback chair that looks like Dr. Evil would sit it in. Mwa ha ha.

This week at school, I have gotten terrible sleep as well. One night, my 80 lb dog was all up on my side of the bed and I was cramped all night. Another night, I slept like junk because of an ill-fated decision to have a Mocha Milan Latte at 5pm the night before. And so, I am functioning poorly this week. My symptoms are masquarding as ADHD--Inattentive Type: trouble initiating tasks, poor task persistence, faulty executive functioning (yes, came to school today without my lunch and the test protocol I needed), and irritability/restlessness. This is after only 3 nights of poor sleep. Can you imagine the impairment if it's habitual?*

Apparently, kids get about one hour less of sleep than they did 40 years ago. And apparently, 90% of parents think their kids are getting enough sleep and they are not. Here's the recommended amount for preschool children through adolescence, per the National Sleep Foundation:

Toddlers (age 1-3): 12-14 hours in a 24 hour period (naps count)
Preschoolers (ages 3-5): 11-13 hours
School Aged Children (ages 5-12): 10-11 hours
Teenagers (13+): 9-10 hours.

I know for sure that the teenagers I work are not rockin' 10 hours of sleep a night, that's for sure. The reason I know this is before I test them, I always ask when they went to bed the night before and when they got up. The reason I do this is because the research is so clear that even a little sleep debt or depravation affects you in the following ways:**

1) Learning is consolidated and enhanced during sleep. Kids with more sleep have higher grades, and higher IQs. Even 15 minutes more sleep makes a difference. Kids are terrible at estimating their sleepiness too. Their cognitive scores are lower even if they claim they got enough sleep.

I see sleepy kids trying to learn all the time. One the other day wrote a sentence from the prompt "Write a sentence with the word 'as' " that read: "I am as sleepy as a sloth." For the word "of" he wrote, "All I can think of is sleep." Some kids straight up put their heads down. I have had kids stay up all night doing work, or taking care of newborn siblings.*** The cumulative effect is that they don't learn as much. Kids need their sleep to learn. Just ask my little poppit in the Spanish immersion program who wanted to call the fire marshall to shut down school so he could go home and get a nap.

2) Lack of sleep may cause depression. Think how you are after having poor sleep. I'm guessing if you're like me, you're not Miss Mary Sunshine. There can be reasons for this--emotionally laden memories are stored when we sleep. Positive memories are processed in the hippocampus and negative in the amygdala. Lack of sleep causes impairment in storing memories in the hippocampus. So guess what? We file away bad memories more often than good when we are sleep deprived. I have teenagers I work with who I swear would not be as depressed if they got more sleep.

3) Lack of sleep makes you have symptoms of ADHD. Um yeah, my case study above (n=1) proves this. Plus, studies show that sleep loss debilitates the body's ability to extract glucose from the bloodstream. Without this stream of basic energy, one part of the brain suffers more than the rest--you guessed it--the prefrontal cortex. The one that helps you with executive functions--planning, organizing, attending, and sustaining effort.

4)Sleep loss makes kids fat. Obesity increases 80% for each hour of lost sleep. Kids with less than 8 hours sleep have a 300% higher rate of obesity than those who get 10. Yikes! Sleep loss triggers hunger and stress hormones. No wonder after my 3-day sleep debt I kept going for the wheat thins all day.

I think I'm going to start adding the recommended sleep hours to my list of recommendations at the end of my reports. It seems that would help learning and mood right away.

I also think I'm still in sleep debt from earlier in the week. So now if someone could call the fire marshall and shut down my computer, that would be great. I need a nap...

*"YES!!!" exclaims anyone with an infant child. Three exclamation points.
**From Nurture Shock, Chapter Two: The Lost Hour
***Yeah, I called the parents on that one. Please don't give your 12 year old the 12-2am feeding slot for your newborn.

Special Education, IEPs, and Due Process, Oh My.

For those of you who missed it, here's my appearance on Learning and Laughter with Louise on the topic of special education. I did this radio appearance at 6:00 am on my summer break, since Louise is on east coast time. That means I had to get up at 5:30 to make a coffee the size of my head to be somewhat normal by 6am. I did it for the children.

We talked about a variety of topics, from the basics of Individual Education Plans (IEPs) to warning signs for Autism. At the end, there is a Q and A with parents who want to know if their child's behavior is typical, or a sign of a disability.

Also, may I note that I never want to hear myself laugh on the radio again, even if it is on a show called Learning and Laughter. I checked the url to make sure it was the right episode and I managed to skip right to the part where I laugh at my own joke. I die of embarrassment.

Enjoy!

Click here to download the episode onto iTunes. I tried for 2 days to embed a media player in this post so y'all could just listen here, but alas, FAIL. I guess if I were one of those fancy Web2.0 education people, I could do it. And if I even knew what Web 2.0 was, that would be even better.

Judgy Jugerson Gets a Karmic Punch in the Face

I live in the San Francisco Bay Area and commute with 8 hojillion people to work over the Bay Bridge. This allows me lots of “think time” and time to judge what bumper stickers people put on their cars.* In my recent survey of bumper car stickers, I would say that about 9 out of 10 people in the Bay Area supported Obama (duh) and about 2 people with trucks enjoyed the likes of McCain. I also know that most Priuses (sp?) support NPR and that quite a few people enjoy broadcasting their stupid sexual nuances (e.g. “Nurses do it with patience!”) Ew.

Anyhoo…where was I going with this? Ah yes, advertisements on vehicles. I was behind this bus a while back that had a public service announcement that read:

Los ninos estan cayendo de las ventanas!

This, loosely translated, is “Children are Falling out of Windows!” There were these creepily drawn grotesque cartoon children featured, telling me in Spanish, to put screens on my windows. It was sponsored by Children’s Hospital of Oakland. I was stuck behind this bus for 45 minutes, and thus had the time to ponder:

1) Surely there isn't such a high proportion of children falling out of windows in Oakland that it necessitates an entire public service announcement? I mean, really? I mean, one is too many, but this is shocking to me that a group of people chose this theme for a PSA.

2) IF there are a high number of children falling out of windows in Oakland, unless an unusually high proportion of these children are Latino, it is kind of insulting and/or racist to think that Latino parents wouldn’t think to keep their children from falling out of windows.

I then reached a fantastic 26 miles an hour and passed the bus. Didn’t think much about it until a couple of months ago….

I was working with this 9-year-old child with Attention Deficit Hyperactivity Disorder (ADHD), the super impulsive type. We had been working on study skills, executive functioning, and self regulation (how to calm yourself down and focus). We were working on the 4th floor (Face it. you know where this is going. You want to stop reading but you can’t help yourself), and I leaned down to get some materials out of my bag and when I looked up approximately 2 seconds later, he was across the room, HALFWAY OUT THE WINDOW, feet off the ground and everything. GAK!!! I didn’t think that he would do this, because he wasn’t Latino and he didn’t give me any sort of verbal indicator, like “look at the pretty birds outside!” or anything.

Then, those creepy grotesque cartoon children from the bus popped in my head and taunted me. I cursed the school I was working in for not having friggin’ screens on their windows. Surely this is some kind of OSHA violation?!?

And then I cursed myself for mocking the advertisement a few months ago. I hate Karma. Please excuse me, I am going to equip all my windows at home with screens now, and write a strongly worded letter (with angry font, like ARIEL BOLD ITALICS) to my local school district facilities department.

The funny part of this story is that after I pulled the kid back inside and told him in my best positive request/redirection teacher voice, “That’s not safe! Feet on the ground, now!” he said, “Relax. If I fell, and I lived, I would encourage my parents not to sue you, because it wouldn’t have been your fault.” Awesome.

*In addition to calculating my gas mileage, my car does this analysis of my average speed per tank of gas. It is 24.3 miles per hour. I take the HIGHWAY to work. Feel my pain.

The Greatest Assessment on Earth!

For those of you who don’t know what a school psychologist does, a big part of our job is to assess children for disabilities. A popular referral question is: “Does my child have Attention Deficit Disorder?” An assessment for ADD is often the most complex of all assessments because there is no “test” for ADD. It is a process where you assemble of tons of data, including psychoeducational assessment, executive functioning tasks, observations, interviews, and rating scales to see if signs point toward other disabilities, or if it is a true disorder of attention.

You have to show there are severe behavioral symptoms such as lack of focus, disorganization, memory difficulties, difficulties with sustained attention, distractibility, and the like, that are unusual for the age (a 3 year old is distracted all the time and that's normal). The symptoms need to have started before school entry, and need to be pervasive (meaning you can’t have ADD only during math class, or only in school and not at home). Sounds pretty straightforward until you think of all the other reasons you could have symptoms of inattention:

-A learning disability that makes it difficult to concentrate, organize, or learn
-Emotional or social problems that deflect your focus (ever try to do work when you’re really upset?)
-Situational factors such as being in a disorganized environment
- Auditory processing/language deficits that make it hard to focus (just think of having to be in a foreign language class all day when you don’t know what the heck anyone is saying. Hard to stay focused.)
-Anxiety (you are preoccupied with worry thoughts, and thus can’t focus)
-Depression (you don’t have the energy to focus)
-Being gifted (you get bored easily!)

And the list goes on. But testing for ADD is one of my favorite assessments to do, because it is like being a detective.

One time, I was asked by my school district to assess a student for ADD during my spring break. At first, I resisted. I mean, it’s called a “break” for a reason, right? Then, I found out that the child was not enrolled in the public school, but was in Circus School, and happened to live in our district. There was a time crunch, and it would have to be done ASAP. I thought about saying I couldn’t do it, but c’mon, it was Circus School!

Now, you’re probably thinking (as was I), “How on earth do you test a kid for symptoms of inattention in Circus School?” What would that write up look like?

Caroline appeared distracted by the TIGERS JUMPING THROUGH FLAMING HOOPS.

I couldn’t wait to see what this Circus School was all about. It was worth sacrificing my spring break. Caroline was a 9-year old girl, specializing in contortionism.* She was indeed quite flexible, but she did kind of seem like she wasn’t listening to her trainer. But seriously, what child could focus in this environment?

I ended up testing her and she came up fine on every test, with some difficulties in visual-motor planning and impulsive answering. No anxiety or social-emotional problems. Her focus was fine one-on-one, but that’s not too unusual, even for kids with ADD. Her circus teachers* rated her “at-risk” for attention difficulties, and her mom rated her as the most unfocused child on the planet. Ug. I didn’t have enough data to say for sure what was going on.

Then I hit the jackpot. I found her cumulative folder that included teacher comments from preschool through 2nd grade, prior to enrolling in Circus School. And there were comments all over the report cards about her lack of focus, distractibility, and not meeting her potential. There was enough data to tentatively diagnose her with ADD, with ongoing monitoring of symptoms.

So for all you teachers out there, who are spending this week writing a zillion report cards, seek comfort that years from now, you will be helping some school psychologist make better diagnoses! Here’s where I normally would pull this posting together with a lovely metaphor about contortionism and circus arts, but it’s Sunday and I haven’t had my coffee yet. I guess there would be something about “disentangling” symptoms or "jumping through assessment hoops."

Please excuse me, I’m going to need to go to Peet’s Coffee now.

*I feel like I’m making this up as I write, but I swear I am not.

Sensory-Integration Disorders

When I first started my clinical practice at a Children's Hospital, I got referrals left and right to assess children for "Sensory Integration" disorders. The classic referral was from parents who were concerned that their 2 year old was clumsy (aren't they all kind of clumsy?) or didn't like tags touching them (who does?). I thought maybe I missed that day in graduate school, because at the time, I had never heard of such a disorder. Sure, I had heard of children with Autism and ADHD who had sensory issues, but not a "Sensory Integration Disorder," per se. All I knew was that when I brought it up to other professionals, it was met with an eye roll 9 chances out of 10. Over the years, I have heard the term less and less, but for those wondering what the heck it is, and if it's even a real disorder, check out this posting on Quack Watch. I'd love to hear what others think on this issue.

Study Skill O’ The Week: Dingers!

Back in the 20th century, when I was in high school, I had this social studies teacher who would give away all the test answers the day before the test in a game called “Dingers.” We would line up in two groups and when it was your turn, you sat face to face with a classmate, game-show style, and in between you was one of those Dinger things that you ring for service. He would read out the question and whoever got their hand practically punctured by the other person’s hand slapping on top of yours slapping on top of the Dinger got to answer the question and earn points for the team. There was no delicate plucking of the bell, as pictured. Years later, I realized he wasn’t giving away the answers, he was teaching us how to study for the test. Curses! Tricked into learning again! So with full props to my 10th grade social studies teacher, here is the game, modified for the 21st Century.



1) Obtain a Staples “That Was Easy!” button. In today’s litigious world, one wants to avoid the “How did my son puncture his hand again?” conversation. The button is nice and soft, and has the added bonus of saying, “That Was Easy!” every time you push it.*

2) Line people up, Family Feud style, with half the class in a line and half the class in another. The two people in the front of the line sit down at a table, place their thumbs under the table and 4 fingers on the table to have an equal start.

3) Teacher reads out a question and whoever hits the “That Was Easy!” button gets to guess. If the person gets it right, they get 2 points: one point for getting it right, and one point for being correct that it was indeed “Easy.” If the person gets it wrong, the other team automatically gets 1 point because the other team misjudged the difficulty of the question.**

4) At this point, the other team can accept the 1 point and walk away, or choose to “steal” for an additional point by hitting the “Easy” button and getting it correct. If they get it wrong, they walk away with zero points.

5) Please expect a classroom full of students screaming, “It’s easy! It’s easy! Do it! Dude!” when there is a stealing opportunity. So if you are opposed to that, set up a ground rule in the beginning that teams lose points if someone yells out. I think the yelling out is kind of fun for them, but everyone has their own tolerance for noise.

6) Also, if you have a particularly aggressive student who you feel cannot handle the controlled slapping of button, put him/her in charge of keeping points on the whiteboard or reading the questions with you.

7) If your test questions are better in written form (say, like doing a math problem) then you can have two baby whiteboards and dry erase markers at the Dingers station and they can work out the problem on their individual boards, then hit the Easy button.

8) Try it out, and let me know if “That was Easy!”


*So annoying after a while. Kids of all ages love it though. Also, I do not endorse any particular office supply store. But if Staples wants to throw me a kick-back, feel free!

** This is in place so that our more impulsive friends (read: ADHD, those with Executive Functioning deficits) can evaluate the difficulty of task first, which is an important study skill. We’ve all seen the kid who rushes through something, thinking it’s easy, and does it all wrong. This is a good inhibition (“stop and think”) practice for test taking.

Study Skill O’ the Week: Swatters!

“If it’s not fun, they won’t learn!” – 5th grade teacher, Inner City Elementary

I overheard this teacher say this the other day, and I must say, her classroom does seem to be pretty fun. Whenever I go in there, the kids are smiling and on-task. Almost every day in her class is a total Learning Party. Wheeeeee!* I don’t know how she does it, working in the inner city, and every day she is so excited about teaching. I wonder if this teacher wakes up on Monday, jolts out of bed, claps her hands together, and exclaims, “TGIM!”

Anyway, with full credit to this teacher, I want to share a technique she uses to help her students memorize facts. I incorporate this in my study skill coaching repertoire, because it really is more fun than traditional “Drill and Kill” techniques with flashcards. It’s called “Swatters” and I thought I’d pass it on as a way to make memorization fun. Do let me know how it goes.

1) Obtain two fly swatters.

2) Explain to the class that they are not to be used for swatting flies. Very important, as I forgot to do this once and had to go buy a new swatter because I was too grossed out to use it again. Bleeh. Fly Guts.

3) Have the students put the answers to certain memorization questions on flash cards. I have used vocabulary words, possible test questions, and math facts. Place the answers on the blackboard in a random array.

4) Have the class line up in two parallel lines, facing the board, with about 6-10 feet in between the board and the first two kids. I’d put a masking tape line there as a start line so you avoid the “He’s cheating!” conversation.

5) Explain the rules. If anyone swats a fly or a classmate, they are disqualified. If anyone pushes anyone, they are disqualified. Whoever hits the flashcard first wins—in the event that both kids hit the correct card, this is determined by whose swatter is on the bottom.

6) Teacher calls out the question, such as “When was the constitution signed?” or “What’s 2 X 5?” and the first two in the rows run up to the board and swat the correct answer. The team with the swatter on the correct card gets a point, and the two return to the back of the line.

7) Proceed until you, or the kids, are bored, or you run out of questions. I have found that even the most ADHD kids ever want to do this game for like 45 minutes, only because they finally get to use that energy.

*Baffling, I know. I want what she has for breakfast.

Pay Attention!

I recently got in a fender bender in my car, which I could blame on my dog for being so cute in the back seat, but really, it was all my fault. I was distracted by said dog, and just rolled right into the lady in front of me. She was really nice, but she kept saying, “Why did you do that?” and “Why weren’t you paying attention?” I kept apologizing, but after the 10th time she asked my why I wasn't paying attention, I whined, “I ran into you because it was an accident! That is why it is called an accident and not an on-purpose!”

In general, I have excellent focus. If you reviewed my school records, it would not say what I see over and over as a school psychologist reviewing records: “Rebecca has potential when she pays attention.”* But this week, I guess I was literally driven to distraction. I felt bad enough for hitting this woman, and then even worse when she kept blaming me for my lack of focus. Not. Helpful.

I couldn’t help but think of my students with Attention Deficit Disorder (ADD) who are constantly being told they need to pay attention. I wonder if that is also not helpful. I wonder if there is a cumulative effect of discouragement when every time someone says your name it is to tell you to pay attention, focus, or get “on task.” There are certainly times when all students need reminders, but if you have ADD, I bet you get them all the time. I will make a point this week to use my springing social skills* in the classroom by ascending upon children who are focused this week, and praise them.

*Preschool teachers did note that, “Rebecca would like others to think she is shy, but she really likes to socialize.” What does that mean? I spring my extroversion on unsuspecting peers? I have this image of shy 5 year old me hiding behind the bookshelf in the reading corner and then jumping out at a small group of kids screaming, “HA! Play with me!”

Auditory Processing (Psychoeductional, Part V)

This next post in the series on Psychoeducational Assessments (Background History, Testing Observations, Intelligence/Cognition, and Visual-Motor Integration,) has been extraordinarily daunting for a number of reasons:

1) I have a hojillion actual psychoeducational assessments to complete before my darlings all leave school for the summer.*

2) Every single area of “processing” is so much more complex and multidimensional than it seems at first glance.

3) Low scores on measures of “Auditory Processing” can sometimes not be due to “Auditory Processing Deficits” but rather attention, social-emotional distraction, second-language acquisition, phonemic instructional casualties, motivation, hearing loss, etc etc etc.

4) An “Auditory Processing Disorder” is an umbrella term used by a hojillion* different professions in a hojillion* different ways. Sometimes, the diagnosis falls in the realm of a Speech Language Pathologist (especially when called "Central Auditory Processing Disorder", or CAPD), though a multidisciplinary approach is the best for these reasons.

With those caveats, here’s my best attempt. I’ll start with the “classic” cases I see as a school psychologist working under the guidelines for Special Education law. I’ll explain them like I do in my everyday job, to students and parents. It’s just what I’m used to.

Phonological Processing: This is the way the brain hears the sounds in words and is able to take them apart and put them back together again. For example, you use phonological processing to hear that the word “Cat” is three different sounds, or when I say three sounds (/c/ /a/ /t/), you can tell me that the word is “Cat.” When you have a “phonological processing deficit,” it can look like a number of other things, such as not hearing the difference between “card” and “cart.” So when a teacher is helping the student look at an unfamiliar word and says, “Sound it out!” it is very difficult because the student doesn’t hear the sounds the same ways as others. It can also be hard to remember which letters make which sounds. This is why it takes students with this problem longer to read.

Short-Term Auditory Processing (aka Auditory Working Memory):**This is the ability to hear and remember what is said long enough to do something with it. It’s the same process we all use when someone gives us a phone number and have to remember it long enough to dial it (without the benefit of pencil/paper or punching it in your cell phone), or doing mental arithmetic at the store. You also need your auditory working memory to listen to directions, especially multi-step directions, such as “Get out your book, turn to page 247 and start on section B.” Kids with auditory memory problems may get out their books and have forgotten what to do next.

Language Processing: Language processing can be subsumed under “Auditory Processing” for the purpose of IDEA definitions, but certainly is more in the realm of Speech and Language. Please refer to “Notes from the Speech Pathologist,” if it exists. What? It doesn’t? Okay, here goes, from a School Psychologist’s perspective: Difficulties with overall language processing can be as varied as taking a long time to come up with the word you need (“Lexical Access”) to not being able to make links between verbal concepts (“Abstract Verbal Reasoning”).

For example, a student with language processing problems might have a hard time coming up with answers to inferential questions, where the answer is not stated, but implied. This type of learning happens all the time in reading comprehension or listening comprehension tasks (e.g. Why do you think the character did that? What do you think will happen next? Who do you think is the bravest in the story?). If it wasn’t exactly stated that the bravest character was Judy, the student may not make the connections between all the other bits of information needed to make that assumption, like “Judy raced out of her house as soon as she heard about the crisis” and “Judy had a card up her sleeve.” Sometimes the student has difficulties interpreting the non-literal language, as in the “card up her sleeve” idiom. It does not explicitly say that Judy is brave, but one can infer it. This type of verbal reasoning can be impaired in students with language processing problems.

Overall, “Auditory Processing Deficits” are the hallmark of traditional “Learning Disabilities” sometimes referred to as “Dyslexia.” Contrary to popular belief, reading disabilities are not typically visual in nature (e.g. seeing “b” for “d”) but are typically a problem with the auditory processing channels. And as the length of this post suggests, the variations in what constitutes an “Auditory Processing Deficit” is not exactly cut and dry.

And if I ever want to finish my actual psychoeducational reports I need to write, I might want to look into abandoning the blog for Twitter, where there each post is required to be 140 characters or less. Somehow, ”Auditory processing is complex. It involves sounds, memory, and language” doesn’t really satisfy me.

*Hojillion (hoh.jill.eee.on). (Adj.) A large and exaggerated number somewhere between a hundred and a million, typically used at the end of the school year to purport an overwhelming sense of a ticking time table for work completion.

**Ug. Such a huge topic. So much overlap with other disabilities, such as Attention Deficit Hyperactivity Disorder. Distilling it to a paragraph makes me queasy, but here goes.

Attention Deficit Disorder: The Golden Years

Recently, I saw a movie in which two kids, about age 10, were walking along a path and the following dialogue ensued:

Young Boy: So what’s new?
Young Girl: I found out I have Adult ADD.
Young Boy: Don’t you mean you have ADD?
Young Girl: Somehow, I got the adult kind.

So what is the difference between “Regular ADD” and “Adult ADD”?

Like many areas in our field, the diagnostic criteria and how the disorder progresses across the lifespan is clear as mud. Researchers have long debated whether ADD is due to a brain “deficit” or rather a “delay” in development. That is, can one grow out of ADD or is it a permanent deficit?

A recent study led by Dr. Philip Shaw at the National Institute of Mental Health may shed some light on this issue. Basically, the researchers compared brain scans from two groups of children: one with Attention Deficit Disorder (ADD) and the other without. The scientists tracked the children from ages 6 to 16, taking multiple scans on each child. They found that on average, certain areas of the ADHD children’s brains developed more slowly that the non-ADHD groups’ brains. The delays were centered in areas of the brain that control higher-order executive functions, such as the regions that suppress inappropriate actions and thoughts, focus attention, remember things from moment to moment, work for reward and control movement. The lag in development in the ADHD group ranged from 3 to 5 years later than their peers. On the positive side, the motor cortex matured faster in the ADHD children, presumably because they are always on the go.

The researchers concluded that ADHD likely involves a delay, and not an abnormal brain. They indicated that about 3 in 4 children do grow out of the problem by early adulthood, but caution that more research is needed to uncover why some kids grow out of it and why some don’t. There were methodological issues present as well, such as 80% of the sample had been on, at some point, stimulant medication. Stay tuned for the next 100 years or so when it is uncovered what the effects of stimulant medication on children are. Brain chemistry and development could not be less complex. Shoot. There goes our parsimonious explanation for why Johnny can’t sit still.

Perhaps my PBS special tonight will shed some light on the matter. Don’t fret. You know I’ll take notes and get back to you.

Caught in the Middle: Part III

Social Factors

The following is a confabulated* transcript based on a conversation with one of my 6th grade middle school students. He was referred to me for special education testing because he was suspected of having Attention Deficit Hyperactivity Disorder. He reported hating his English teacher and was constantly being kicked out of class for getting out of his seat without permission and talking out. None of the other data supported a diagnosis of ADHD. He was attentive in his other classes and previous report cards from his cumulative folder never mentioned inattention or hyperactivity. But there was still the issue that he was disruptive in class and hated school.

Dr. Bell: Let’s play a game called ‘I start a sentence and you finish it’
Middle School Boy: Ok.
DB: I like to…
MSB: Play video games.
DB: My favorite part of school is…
MSB: Recess.
DB: If I were president, I would…
MSB: Cancel school forever!

(Interjection: Great, I have uncovered that he doesn’t like school. Not exactly new info)

DB: Teachers are…
MSB: Mean. My teacher is always mad.
DB: What makes her mad?
MSB: I get out of my seat to sharpen my pencil. I was allowed to in 5th grade!
DB: What else makes her mad?
MSB: When I ask my friends what they got for answers.
DB: What does she say?
MSB: That I’m cheating! But we always worked in groups in my elementary school so I thought it was ok.

This confabulated* transcript highlights what studies have shown about the difficulties that students have in making the transition to middle school. It has been shown that student motivation and attitudes toward school tend to decline during this transition. The theory goes that there is a poor fit between the developmental needs of preadolescents and the social environment of middle school (Eccles et al.).

Stage-environment Fit

Essentially, the theory goes, middle school aged students are beginning to want more autonomy, peer groups are becoming more important, and many middle schools are not set up to support these developmental needs. Beginning in middle school, there is more academic tracking, increasing competition, and fewer opportunities for decision-making. This is what was going on for the kid I was working with. His developmental need for independent learning and collaborating with his classmates was mismatched with the teacher’s style. Now there is value in him learning how to adapt to a mismatched teacher, so we had a consultation meeting and the two began to understand each other better.

Also remember that our friends with the developing prefrontal cortexes now have several classes and teachers and new procedures for each. We should not expect our middle school children to wake up for 6th grade with all the knowledge on how to navigate such a new environment and successfully organize all their materials for each class. There are some students who do have these skills already, but don’t assume. We didn’t expect our 4 year olds to wake up and know how to tie their shoes—we had to teach them.

Some tips for middle school parents (and educators) on how to help your middle school student if they are having difficulties adjusting can be found at a great website by the National Middle School Association.

Peers

I would be remiss if I didn’t discuss peers in a post about the social factors that contribute to adolescence. Unfortunately, this would take 6, maybe 7,000 hours and I have to go to work. Stay tuned for a snippet about peers for tomorrow’s post (It will be post 1 of a 7,000 part series). I will leave you with a teaser:

Ugliest Girl in School.


*I have always wanted to use the word confabulated. Thank you for the opportunity.

Executive Functioning

Executive Functioning. Ahem. *insert professor voice here*

Executive functioning involves the components of inhibiting actions, restraining and delaying responses, attending selectively, selecting goals, planning, organizing, as well as maintaining and shifting set. Deficits in executive functioning have been associated with the impairments in students with Attention Deficit Disorder.

What???

Sadly, that phrase came straight from one of my own psychoeducational assessment reports. Clear as mud, right? Let’s just say that “Executive Functioning” is a phrase that would be a good one to include in "Educational Jargon Bingo". It is a term that is extensively in the neuropsychology research and is trickling down to use in the schools, as it becomes inextricable from the symptoms associated with Attention Deficit Disorder and Nonverbal Learning Disabilities.*

So what is “Executive Functioning” ?

A good reference I found to explain Executive Functioning comes from Philip David Zelazo, Ph.D. from the University of Toronto. He has a good three-part series on " Executive Functioning." Have a look.

The way I explain it is through metaphor (I’m big on metaphors, in case you hadn’t noticed). The one I’ve heard that I like is the “CEO in your head.”

Imagine there is a “Li’l Chief Executive Officer” in your head. Basically, your boss is hanging out in your pre-frontal cortex. (Scary thought, I know). But pretend s/he is sort of an authoritarian type boss. S/he tells you what to do, when to do it, when to change your focus, what not to do, to foresee how you will tackle a long-term project at work, and regulate how you feel about all that.

Meanwhile, s/he also controls aspects of your personal life. (Sheesh, s/he is bossy!) So s/he is also telling you that you can’t hang out with your co-worker during lunch because you have to finish a project, you can’t listen to music during work because it distracts you, and you will have to put off all fun tasks until you finish a dull task. She also stops you from telling her what your really think about her in no uncertain words.

In essence, s/he is telling you how to plan, organize, put off (inhibit), and execute tasks. S/he is Executive Functioning.


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*I have 1892748927589347 ideas for posts about ADHD and Nonverbal Learning Disorders. I am open to suggestions to tailor it to my audience (I’m referring to the ones of tens of you who have found my blog thus far! Speak up!)