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!

Emotes.

Anyone who has been a therapist or counseling with kiddos for a while will appreciate this post. I don't know about y'all, but there are some things in my play therapy kit that I kind of want to throw away because every kid seems to want to play it and I'm so over it (Uno and Connect Four, I'm looking at YOU guys!). I often need play therapy toy "crop rotations" to mix it up. Of course, sand tray is always a classic that never leaves, but sometimes I throw a new dinosaur in there to see if it morphs into the principal or a bully at school. It's a good time.

There are some kids though who don't play with anything in the room or get bored easily with the materials you have. I had such a kiddo a while back. He was a kindergarten kiddo who was referred because of impulsivity and aggression in the classroom. He spent most sessions complaining about my toys and asking why he had to be there. At the same time, I had his middle school equivalent in my office a few hours later. Only instead of aggression in the classroom, he also showed aggression in the community. And would you believe I found a series of toys and activities they BOTH liked???

I think sometimes that boys present an extra challenge when it comes to helping them express the range of feelings they have. They tend to endorse "anger" pretty easily and the other stuff takes a long time to get to. That is, unless you have this fabulous tool called "Emotes".*



I was at a convention and was drawn to these little guys who each represented a different feeling, positive, negative and nuanced. For example, "Boom" is the angry one, "Joi" is the happy one, and "Can't" is the frustrated one. I bought the starter kit and the introduction book to try them out. My boys LOVED them. My kinder poppet wanted to read the story every time, and he loved finding the ones that matched his feelings (he gravitated toward Imp-the mischievous, Boom-the Angry, and Super-the confident). He started drawing them in class spontaneously and would do almost anything for a sticker of one of his guys. He even referenced them in reflecting on his own behavior (e.g. Dr. B, I was like "Hype" today in class and got in trouble) Como se dice AWESOME?

My middle schooler, who was notoriously "too cool for school" ignored their pointy little faces for about 2 weeks, and then finally gave in. He started playing with them and wanted to draw them and go on the website and find coloring pages or more stories about them. I did not see that coming! It gave us a way to talk about the feelings that underlie anger without him feeling like I'm a cliche "How does that make you feeeeeeeel?" counselor. Genius.

So after testing them out on my two toughest customers, I contacted the Emotes peeps and asked for them to send me more goodies so I could start integrating these little guys into the Kinder and 1st grade classes as class-wide feeling vocabulary lessons. Okay fine, I guess I am a "How does that make you feeeeeeeel?" kind of gal after all. I just think this is a more fun way to go about it. Plus, they have the books in Spanish. Holla.

Check out their stuff when you get a chance at www.emotes.com. Oh, and if you're looking at it at work, turn the sound down because it starts off with a jaunty little song and a loud exclamation, "How are you feeling today!" It made me feel like "Jumpi" the first time. But the kids love the website because they have comics and whatnot. Enjoy!


*Note: Not related to the term "Emo". When the term "Emo" first started percolating a few years back in the lexicon of my yoots, it took me a while to figure out what they were referring to. At first, I thought a group of students was calling a girl "Elmo" from Sesame Street, and I couldn't work out what it was about, until I asked. It's very different than Elmo, trust me. When I say Emotes, I also over-enunciate the "-tes" part of the word EmoTES to make sure I am clear. Emo has a bad connotation for kids.

Ain’t Nuthin’ But an Educator Paaaaarty

This week was my spring break (yes, this late). It was so late this year, I almost tricked myself into thinking it was summer break. The good news is, when I go back to work tomorrow, it is practically May, so it won’t be long. You think kids are the only ones who get Spring Fever? Ha!

Anyhoo, I spent my spring break in NYC. I had only been one time before, in February, and I wrote off the entire city at that point for being a miserable place. Turns out, in the spring, it’s lovely! Who knew? Everyone but me, probably. I had a great time touring the city with my husband when the weather was nice enough to enjoy it. But by far the best part was meeting up with my Internet BFF, "Mrs. Mimi" for the first time.


People, if you don’t know “Mrs. Mimi” of Its Not All Flowers and Sausages blog, you simply must. She is a teacher who GETS IT. We became Internet besties a few years ago and we are just one broken heart necklace away from being Best Friends in real life too. We met on the Upper West Side (West Siiiiiiide!)* for brunch. It was totally an East Coast meets West Coast Educator Party. It was kind of like when 2Pac and Snoop Dogg got together to make Gangsta Party and they done just put two of Amerikaz most wanted in the same *bleep* place at the same *bleep* time. Wait, they were both west coast rappers. Nevermind. But kind of like that, but not. I digress. ANYHOO, it was a bi-coastal urban-education-love-fest. My husband couldn’t believe we had never met before, the way we were talking nonstop for two hours.**

And I won’t steal her thunder, but DO check her blog in the next few weeks, she has some fabulous things going on right now. Even though she is no longer in the classroom, she is doing some great things in the world of education. Sure, we miss the stories of her getting a g-string for Christmas from one of her students, stories of administrative dysfunction junction, and bodily fluid stories***, but she has some fabulous new projects in the works we will all be excited about. Plus, she has such fancy news from just this past week, I’m dying to congratulate her publicly! But you know how BFFs are, we keep these types of pinkie swear secrets quiet, and we don’t gossip into the blog-o-sphere. We just allude to them so you’ll check out her blog.

After we talked shop over brunch for over an hour, she suggested we go eat the world’s best chocolate chip cookies together (seriously, she’s a gal after my own heart). Could she be more fabulous? The cookies were a.ma.zing. And so was meeting the infamous Mrs. Mimi.

*Sorry, I have 2Pac Tourettes from time to time. RIP, 2Pac *tips 40 to his mem’ry*
**Hubby is such a trooper. His eyes only glazed over a few times as we talked about the state of public education today.
***For more stories, get her fab book by the same name—just clicky click here or on the right side of my blog under “Buy Yourself Something Pretty.”

The Reveal.

During March Madness, my sports aficionado husband was all over watching the college basketball games. I lost interest after my itty bitty alma matter from undergrad, University of Northern Colorado got knocked out in the first round and my grad school alma matter, UC Berkeley was nowhere to be seen. I did have a little interest in picking the final four based upon my favorite mascots. I have a husky mix dog, so I did quite well in my predictions.

During this time period, husband and I had a nice agreement that we would have a balanced evening television routine, and we got to also watch the Do-it-Yourself Channel’s “Mulch Madness” series as well. I became slightly obsessed with Yard Crashers, in which a lovely man comes up to people in home stores and offers to redo their whole yard in a weekend. Husband I and look for this guy every time we are at OSH or the Home Depot. Where is he? I have some major yard needs and no time. Unfortunately, the guy is nowhere in sight, so we are on our own.

Last weekend, I started my weeding and planter box project I meant to start in 2010 and it was so therapeutic. In the DIY shows, they are big on “The Reveal”—when they show the homeowners the final product. In truth, I’m not sure how this falls under “doing it yourself,” as I always see a team of a dozen or so professionals doing all the work and then voila! Here’s your perfect yard in a half an hour! My planter box project, however, was truly DIY, and I got to do “The Reveal” with my husband, and it looks great. I was so friggin’ pleased with myself, you would have thought I won the final four of gardening.

Later, I thought about why it was so satisfying to me, and I realized that it is because my work as a school psychologist is the opposite of that. I spend my days digging out weeds of negative influence on kids, teaching gardeners how to take care of my students, planting seeds of ideas, and waiting. Then waiting. Then more planting, more teaching, and more weeding. And waiting. I don’t get to see The Reveal that often. I wish I could fix up a kiddo in my office, then present him or her back into the classroom, all prettied up and blooming, academically, behaviorally, and emotionally. Voila! All better!*

In reality, I just have to trust that all the ugly demolition of old ideas phase, and the replanting phase will eventually come to fruition and that no one will stomp on my student’s new seeds of ideas about how to change for the better. Sometimes, I just wish it was easier, and I could storm into a classroom, ala Yard Crashers, with my tv crew and team of professionals, pluck a kid out to fix in a weekend, and everyone would be happy with the final product. Until then, I will just have to keep planting, waiting, nurturing, and having faith in the process.




*I had an intern once who wanted to go into school psychology because as she said, she had a "fix it personality." I tried not to squash her dreams, not at least until second semester. At her final evaluation, I told her that a "fix it personality" may be a double edged sword, because we don't really have the power to "fix" all kids. She said, "Okay! I'll fix that about my personality!" I loved the enthusiasm. I hope she is doing well in our field...

Dance with the Tiger.

Twice this week, I embarrassed myself by making an obscure reference to an obscure part in an obscure film to make a point. Has anyone else besides me and my husband seen Cedar Rapids, starring John C. Reilly and Ed Helms? No? Well then you would have looked at me with the same look these two groups of people did. But I like the analogy, so here you go.

In the soon-to-be-classic film, Cedar Rapids, starring John C. Reilly and Ed Helms, the main characters are insurance agents attending a conference to battle for the prestigious “Two Diamonds” award for excellence. In one scene, John C. Reilly’s character gives Ed Helms’s character advice: that in order to meet his goals, he can either “fight the tiger” or “daaaaaaance with the tiger.” In the context of the movie, it is basically a decision to fight the guy in the jacked up insurance system or work the guy and the system to your advantage.* And it’s funny because John C. Reilly he does so in his underwear and does a tiger dance.



In one case where I embarrassed myself this week, the school staff and district muckidy mucks (sp?) were having a strategy meeting before a highly contentious parent meeting. The parent has had her child assessed three times over the course of the kid’s school history, and each time, the child came up in the intellectually disabled range cognitively (formally known as mentally retarded). She claims that the school district each time has not assessed him properly and further, that she is entitled to a hojillion dollars in compensatory education at the district’s expense for failing to bring him up to state academic standards. Oh, and the child is autistic as well. Like, biting other people autistic. Low and behold, the last assessment also came up with low cognitive scores as well. As the conversation turned to how to fight this mom and her denial, I told the staff, “I think on this one we should daaaaaance with the tiger” and I made a dancing gesture not unlike the one John C. Reilly does.

[Crickets chirp]

So I went on to explain the movie, and then suggested that we might partially validate mom’s concern, without totally caving in. I get denial. Dealing with the truth is painful. Externalizing blame happens. I can’t claim that if I had a severely disabled kiddo that I wouldn’t be a fighting tiger for his or her rights. I’ve never been in that situation, and can empathize with the grief and anger of having an out of control child. I know that some districts do not provide a very good education for some groups of kids. We're not perfect, and we have no money to create perfect programs. But if I were in the parent's situation, I would like to think I would not sue poor urban school districts for a squillion dollars in compensatory education and blame the teachers for my child's disability. One never knows though.

Anyhoo, the mom’s big thing was that her child had untapped potential. And maybe there is untapped potential we can’t see because the kid is off biting and punching people in class. In my post-doc years, I learned a great way to describe the concept of untapped potential in kids with Autism. I had the great fortune to train with the amazing Bryna Siegel, autism guru, and author of The World of the Autistic Child and many others. She explained it something like this:

Each child’s cognitive potential is like a bowl. Some bowls are deeper than others. We can measure cognition in kids without Autism, because they comply with “on demand tasks” (as in, put these blocks together, answer this question right now, finish this puzzle this fast). Kids with Autism (or behavior problems, for that matter) have saran wrap over their bowls. We don’t know how deep the bowl is, because they have trouble performing on demand. The bowls could be very deep and untapped potential is in there, or the bowl could be shallow. We don’t know until we peel the saran wrap off. We peel the saran wrap off by working on the behaviors that are interfering with joint attention.

I proposed that we use the analogy with this mom. That way, we are acknowledging there could be untapped potential, but in order to fully see it, we have to address the behavior and work on “peeling the saran wrap” off. Instead of arguing about how “deep” his cognitive bowl is, we can shift the conversation to helping this kid connect to others and be safe. I am sure this is a mutual goal of the mom. Let’s just hope after the meeting, it looks a little something like this….



Wish me luck. I do want to have a productive and positive meeting. No one likes getting swiped in the face by a tiger mom.

Pink Slips.

Well people, March 15th, the deadline for possible layoffs in the schools has come and gone, and I did not get a letter that I am on the potential pink slip list. I can officially stop stalking my poor mailman. Its a bittersweet moment, because while now I don't have to look for another job and re-title my blog, "Notes from the Former School Psychologist Who Got Stabbed in The Back By the People She Gave 10 Years of Her Life To," there are many of my colleagues who did get the dreaded letter and may not be returning. Some of the best psychologists are our new people, and the policy "last hired, first fired" is causing our department and some of my schools to potentially lose some of the best people.

In my moment of crisis when I wrote this post about the Ides of March drama, I received many wonderful emails from people lending me their support. One such teacher, Nancy, of The Teacher Geek Blog wrote me an email that brought me to tears. She also shared a link to an article she recently wrote about how to deal with being laid off from a school district, and I found it really helpful. So here it is for my colleagues and blog friends who are sadly in this position: Surviving Unemployment:Purgatory.

If anyone else has any tips for our colleagues in limbo with a potential layoff notice, feel free to post them here. The best thing written to me, that I can share is Nancy's quote: "Working in a large urban district, you have already shown that you have amazing resilience. That same resilience will will get you through this."

Holla, Nancy.

I'll Take Questions I am Not Prepared to Answer on the Spot for $800, Alex

I know how you all just love School Psychology Jeopardy, so here you go with the "So Unprepared For This Question" category:

Scene: Recess

Kindergarten kid #1: My daddy's in jail!

Kinder kid #2: My daddy used to be in jail.

Kinder kid #3: My daddy said mommy went to Wal-Mart for a long time. But it was really jail.

Kinder kid #4: Dr. B, what's jail?

Me: [As whole kinder class is now listening] Erm, uh...jail is um.. [I then remember one of the most awesome teachers I know responding to this question last year, and channel her] Well, jail is like time-out for grown ups. When they make a mistake they go to jail and learn how to not make that mistake again.

Wowza. Talk about interesting playground talk, right?

As many of you know, I work in a community where it is common for the poppits I work with to have a parent in jail. It is always a difficult discussion to have with kids, but just because it's uncomfortable doesn't mean we shouldn't have the conversation. Sometimes, teachers, family members, and school psychologists need a little help with finding the right words. The following is an excerpt from the book "What Will Happen to Me?" and I think it does a nice job of outlining how to answer these difficult questions.

Ten Question Often Asked By Children Whose Parents Are In Prison
By Howard Zehr and Lorraine Stutzman Amstutz,
Author of "What Will Happen To Me?"

Children need time to adjust to the separation caused by having a parent in prison. But it takes more than time. As we have heard in their voices, children also need to make sense of what has happened to them and to their parent or parents. Because of this, they have many questions.

Some of the questions they ask are straightforward. But sometimes their questions come out indirectly or in their challenging behavior. Incarcerated parents, as well as caregivers of children or other adults in their lives, often have to answer their uncomfortable questions.

Children who are present when a parent is arrested, especially young children, are usually not told where their parents are being taken, when they will be coming home, or why they have to go away. As time goes on, the children have even more questions.

Our childhood experiences shape much of our adult lives. Children who live with these kinds of questions, many of which are not answered to their satisfaction, experience trauma as a result. Frequently that leads to their general mistrust of authority, especially the legal system. Not having their questions answered can also lead children to blame themselves for their parents' absence or to believe that they are destined to follow in their parents' footsteps.

Here are questions that children whose parents are incarcerated often ask, along with suggestions about how to answer them. We will address some of the questions more fully in later sections of the book.

1) Where is my Mom or Dad?
Parents and caregivers often believe it is best to protect children by not telling them where their mothers or fathers really are. Children may be told that their parents are working in another state, going to school, or serving in the military. Sometimes children are told that their parents are ill and had to go away for special treatment.

Sooner or later children will realize the truth and know they have been lied to. This tends to hurt their relationship with the persons who have told them the untrue stories and can lead to feelings of distrust that affect their other relationships as well.

While the adult who hides painful reality does so believing it is in the best interest of the child, such an action (or inaction) creates a family secret that results in children feeling ashamed. Most childhood experts advise that children be told the truth.

2) When is he or she coming home?
The outcome and schedule of a parent's arrest and/or imprisonment is often uncertain. However, it is important to keep children up-to-date about what parents or caregivers do know. Children need to have concrete information they can deal with, even if it is, "We don't know what will happen yet."

3) Why is she or he in jail or prison?
Sometimes an innocent person is arrested. But when a parent has done wrong, it is important that this wrongdoing is acknowledged. Children need to know that there are consequences when people do things that are against the law or harmful to others.

At the same time, they also need to be reassured that even if someone sometimes does something wrong, it doesn't mean that s/he is necessarily a bad person. While a child's parent may be serving the consequences for something wrong s/he did, the parent is still worthy of love and capable of loving.

A child can learn to trust a caregiver who is honest about what a parent has done wrong. This practice of honesty allows the child to believe other things that the caregiver tells her or him as they progress together on this journey.

4) Can I talk to my mom or dad?
Jails and prisons have specific and often constraining rules about prisoners talking on the phone to their loved ones. Phone calls from prison are often quite expensive and restricted in length. Many times a parent does not have enough money to call home because it is so expensive.

When phone calls are difficult, letters can be especially important. Although young children may find it hard to express themselves through words, they may find it more meaningful to make drawings. As Stacy Bouchet, now an adult, suggests in her reflections, children often treasure the notes and letters they receive from their parents, as she did from her father.

5) When can I see my mom or dad?
It is helpful to explain to children that prisons have specific times for visiting, and their caretakers will get that information so that they can see their loved ones. If a parent is incarcerated at a distance, the child should be prepared for seeing his or her mother or father infrequently.

Some children are angry and do not want to see their parents, or at least they're ambivalent about the possibility. In general, though, it seems important for children to visit their parents as regularly as possible.

Before the first visit, they should be prepared for the circumstances of the visit. The caregiver should explain the security around the prison. The children should also know that there will be limits upon where they can visit and what they can do with their parents.

Most children want to know what their parent's life is like in prison. They may imagine frightening scenarios. Giving them a sense of mundane details of everyday life in prison can be helpful. If the child is interested, a caregiver can encourage the parent to describe his or her cell or room and tell what a normal day is like.

6) Who is going to take care of me?
Children in this situation often feel insecure. It is important to let children know who will be caring for them. If there is uncertainty about their living arrangements, children may need to be told that, but they also need to be reassured that plans for their care are being made and that they will not be abandoned. As much as possible, they need stability in their living situations and their relationships.

7) Do my parents still love me?
When children are separated from their parents, they often worry about whether their parents love and care for them. Most children need reassurance that they are loved by their parents no matter where the children happen to be living and with whom. They also value other loving relationships in their lives, but they still want to know about their parents' interest and love.

8) Is this my fault?
Children often blame themselves for being separated from their parents or even for their parents' misbehavior. They may imagine that if they had behaved better their parents would still be with them. They need reassurance on three fronts: that what happened to their loved one is not their fault, that it happened because that person did something wrong or harmful, and that this does not mean that their parent is a bad person.

9) Why do I feel so sad and angry?
Sadness and anger are children's common responses to a parent's incarceration. But most children do not understand their feelings or the origins of them. It is helpful for them to be reassured that their feelings are normal. Ideally, they can be encouraged to talk about their feelings of sadness or anger. If they cannot talk to their immediate caregivers such as their grandparents, they can be invited to talk to school counselors or social workers or even friends. Children often find it helpful to know other children in similar situations because they can understand each other's feelings. Children who find it hard to articulate their feelings can be encouraged to express them through their drawings or other art work.

10) Can I do something to help?
Children typically feel helpless and responsible. They need to know that their loved ones usually appreciate letters and pictures. They can be encouraged to send them as often as they want to.

The above is an excerpt from the book "What Will Happen To Me?" by Howard Zehr and Lorraine Stutzman Amstutz. The above excerpt is a digitally scanned reproduction of text from print. Although this excerpt has been proofread, occasional errors may appear due to the scanning process. Please refer to the finished book for accuracy. Reprinted from What Will Happen to Me?. © by Good Books (www.GoodBooks.com). Used by permission. All rights reserved.