Mark Bertin's Blog, page 11
November 19, 2012
Wisdom in 4G: Here Today, Everywhere Tomorrow
"My mother had always told her kids: If you're about to do something, and you want to know if it's a bad idea, imagine seeing it printed in the paper for all the world to see."
- From the novel Gone Girl by Gillian Flynn (2012)
These days, we don't have to worry only about appearing in the newspaper one day. With the Internet, Twitter, texting and camera-ready smart phones, in an instant, we may know of anything done by anyone, anywhere. From the mundane to the frightening, we have one-click access to everything. Whatever we do or say has the potential to zip around the globe with or without our consent.
This social-media driven way of living is not likely to change any time soon. Our potential exposure to the entire world has become an actual possibility, so maintaining an Internet-savvy perspective that "everyone might see me do this" has become more essential to remember than ever. Yet modern as this outlook may seem, its roots date back generations.
Look Both Ways
With advice applicable across any religion or spirituality, one of the most profound teachings of the Buddha offered guidance on how to live with strength and compassion. He suggested we strive "(to) not do the slightest thing that the wise would later reprove." Today we live in a world where any communication we send, any photo we take and any action we select may be captured and in a moment shared with millions -- or at very least our boss. So it remains timely advice to recognize the potential impact of our behavior, separate even from any judgment of it being right or wrong.
The dictionary definition of "reprove" is "to correct with kindly intent," not "to imprison." Certainly, that's one way the wise condemn our actions -- they send us to jail. It potentially could become harder and harder to break laws when a single photo or a mishandled email can reveal the crime. But that's not the point, since there's a substantial list of behavior for which the wise might reprove... and not choose to prosecute.
"What would the wise think?" is a larger concept than getting caught misbehaving; it's about living well day-to-day. A parent recently told me that when she manages not to get flustered over her son's lost homework, he's more likely to admit his mistake and agree to make up the work. When she shouts, he gets defensive and yells back. What action would the wise, whoever they are, suggest? What action would you, in your most sage moment, recommend to your best friend?
In more modern terms, if someone posted this interaction online, how would you come across? Not only focusing on right or wrong, but if someone wise stumbled upon this moment, what would they say? How would the collective wisdom of society reflect on my tone and language with my child right now? Not would they judge me for it, but how would they recommend I proceed?
This fundamental guidance can become as instinctual for parents as teaching how to cross a road safely. Instead of fighting the fact that our next misstep could end up on Facebook, we can emphasize a basic concept about free choice. Model a practice for ourselves and our children of pausing and reflecting, asking yourself, 'am I selecting a path of wisdom right now?' If millions of people see me on YouTube, or if my children or grandchildren one day read this email or see this photo, will they reprove?
Proceed with Caution
Being 'wise' doesn't mean being overly strict or moralistic. We all have made decisions in the moment we later regretted or have completely mishandled some situation. All of us say dumb things and do dumb things. And most of us do stuff as teenagers we wouldn't repeat as adults. That's life. At least in my experience, the truly wise laugh at their inane adolescent experiences, cut themselves some slack even when electing to make amends for screwing up and release themselves from any unobtainable goal of perfection.
All we can do is aspire for wisdom, notice when our aim is off and try again. Have fun, act silly, push boundaries, take risks, live on the edge. Do whatever feels natural while maintaining a broader perspective: What is the potential impact of my action right now, on myself and on others? Is this who I believe I am? Is this how I want to be perceived by the world? Living this way when some event goes completely off the rails we can still acknowledge that we've done our best to care for ourselves and those around us.
We can create a habit for ourselves and our children: Over and over again, pause and reflect. Even alone in the woods, with no technology in sight, recall the teaching of the Internet. What's the intention behind this next action of mine? Would the wise reprove? Would the world reprove, or would I, if this particular moment goes viral?
- From the novel Gone Girl by Gillian Flynn (2012)
These days, we don't have to worry only about appearing in the newspaper one day. With the Internet, Twitter, texting and camera-ready smart phones, in an instant, we may know of anything done by anyone, anywhere. From the mundane to the frightening, we have one-click access to everything. Whatever we do or say has the potential to zip around the globe with or without our consent.
This social-media driven way of living is not likely to change any time soon. Our potential exposure to the entire world has become an actual possibility, so maintaining an Internet-savvy perspective that "everyone might see me do this" has become more essential to remember than ever. Yet modern as this outlook may seem, its roots date back generations.
Look Both Ways
With advice applicable across any religion or spirituality, one of the most profound teachings of the Buddha offered guidance on how to live with strength and compassion. He suggested we strive "(to) not do the slightest thing that the wise would later reprove." Today we live in a world where any communication we send, any photo we take and any action we select may be captured and in a moment shared with millions -- or at very least our boss. So it remains timely advice to recognize the potential impact of our behavior, separate even from any judgment of it being right or wrong.
The dictionary definition of "reprove" is "to correct with kindly intent," not "to imprison." Certainly, that's one way the wise condemn our actions -- they send us to jail. It potentially could become harder and harder to break laws when a single photo or a mishandled email can reveal the crime. But that's not the point, since there's a substantial list of behavior for which the wise might reprove... and not choose to prosecute.
"What would the wise think?" is a larger concept than getting caught misbehaving; it's about living well day-to-day. A parent recently told me that when she manages not to get flustered over her son's lost homework, he's more likely to admit his mistake and agree to make up the work. When she shouts, he gets defensive and yells back. What action would the wise, whoever they are, suggest? What action would you, in your most sage moment, recommend to your best friend?
In more modern terms, if someone posted this interaction online, how would you come across? Not only focusing on right or wrong, but if someone wise stumbled upon this moment, what would they say? How would the collective wisdom of society reflect on my tone and language with my child right now? Not would they judge me for it, but how would they recommend I proceed?
This fundamental guidance can become as instinctual for parents as teaching how to cross a road safely. Instead of fighting the fact that our next misstep could end up on Facebook, we can emphasize a basic concept about free choice. Model a practice for ourselves and our children of pausing and reflecting, asking yourself, 'am I selecting a path of wisdom right now?' If millions of people see me on YouTube, or if my children or grandchildren one day read this email or see this photo, will they reprove?
Proceed with Caution
Being 'wise' doesn't mean being overly strict or moralistic. We all have made decisions in the moment we later regretted or have completely mishandled some situation. All of us say dumb things and do dumb things. And most of us do stuff as teenagers we wouldn't repeat as adults. That's life. At least in my experience, the truly wise laugh at their inane adolescent experiences, cut themselves some slack even when electing to make amends for screwing up and release themselves from any unobtainable goal of perfection.
All we can do is aspire for wisdom, notice when our aim is off and try again. Have fun, act silly, push boundaries, take risks, live on the edge. Do whatever feels natural while maintaining a broader perspective: What is the potential impact of my action right now, on myself and on others? Is this who I believe I am? Is this how I want to be perceived by the world? Living this way when some event goes completely off the rails we can still acknowledge that we've done our best to care for ourselves and those around us.
We can create a habit for ourselves and our children: Over and over again, pause and reflect. Even alone in the woods, with no technology in sight, recall the teaching of the Internet. What's the intention behind this next action of mine? Would the wise reprove? Would the world reprove, or would I, if this particular moment goes viral?
September 28, 2012
Election 2012: Children on the Ballot
On your mark, get set, go. Off they race, the children of America, into our collective future. The end point of this particular race is a healthy, happy and productive adulthood. So here's the question: Are the odds equal that anyone who puts in the effort will reach that finish line?
Basic Training Starts Here
The premise of a certain 2012 presidential platform (you decide which one) appears to be this: Life is an even playing field. As long as we try hard enough we all equally thrive. It's as if the secret to success is effort alone, and if you're not successful you're just not trying hard enough.
Research in child development contradicts this idea entirely. By the age of five, environmental experiences often handicap a child throughout a lifetime. Does effort matter? Absolutely, but countless factors affect the cognitive and emotional development of young children long before they make their own active choices about how to live.
The United States will never be the 'land of opportunity' for everyone without addressing this reality. Thankfully, many of these hurdles can be eliminated through interventions both compassionate and cost effective. To tackle these inequalities, some basic necessities of early childhood include:
A safe and stable home environment
The concept of 'toxic stress' may seem vague, but from a medical point of view excess stress has a significant impact on development. As outlined in a 2012 American Academy of Pediatrics statement, prolonged, excessive stress stacks the odds against children. Early adversity affects the entire body, from the brain through the immune system and even influences which of our genes express themselves. Too much stress can cause lifelong impairments in both physical and mental health and, as the authors state, "many adult diseases are, in fact, developmental disorders that begin early in life."
Making sure children are well fed and have health care is a start. Being undernourished or chronically ill affects an adult's capacities in daily life profoundly, children even more so. Additionally, programs that educate at-risk parents about supporting their children's development are impactful. Down the road, people who have received appropriate services while young are more likely to be reasonably settled when they have children -- and then their kids are better off. Adults who grew up in stable environments are more likely to be doing well in general, and less likely to require ongoing medical attention, mental health care or financial support from the government.
Education
The average low-income child has heard thirty million fewer words than peers by the age of three years, and this pre-school vocabulary score predicts language ability at age nine. Falling behind in these skills puts youth at high risk for school failure. School failure itself places children further in jeopardy of unemployment, underemployment, poor health choices and other difficulties.
Further compounding their disadvantage, these children exhibit a 'knowledge deficit' which stems from decreased exposure to general information about the world. Limited content knowledge affects reading comprehension and related abilities, as understanding text relies on the reader's own background knowledge. One study showed poor readers who were baseball fans tested better for comprehension on a baseball passage than more skilled readers with little interest in the topic. While the more advanced readers could read the words, they didn't have the context to sort out jargon like 'a 6-4-3 double play.' Reading comprehension correlates with academic achievement, and also success after schooling ends; home and school based programs can help address the gap.
The types of schools we create matter greatly, as well. A strong education starts with reasonably sized classrooms run by well-trained teachers. Children with mental health concerns, ADHD, autism or learning disabilities typically need services to keep up academically; these interventions are often unavailable or underfunded in low-income neighborhoods. Quality schools, developmental services, and mental health care head off long term problems for not only individuals, but the community. Without intervention, these same children are less likely to become healthy and independent adults.
- The opportunity to learn through play
Free play is a foundation for later cognitive, communication and social skills. It also encourages emotional resilience and creativity. While you might think all children get an equal chance to play, many don't. Poverty interferes with play at home, at school and after school. Educating parents about the importance of free play and creating both community and school-based environments that facilitate it promote long-term development.
Team in Training
Failing to emphasize these early childhood services fails society as a whole. It perpetuates problems such as early school drop-out, teen pregnancy, substance abuse and many other issues exacerbated by unstable childhoods. Investing in children at an early age even saves money over the years; without early intervention, we pay almost exponentially when adults later struggle. A RAND study, for example, suggested a minimum near two-to-one return for every dollar spent on early childhood services, and potentially as high as seventeen to one.
Eliminating early childhood programs turns a blind eye to the stark reality that life is not, in fact, a level playing field. Children need healthy nutrition and health care to grow. They need to be raised in nurturing, mentally engaging environments that encourage activities like imaginative play and reading. They require appropriate schools and stimulating after school experiences. Without intervention, these same kids often end up having children similarly at risk and the cycle continues.
When society abandons children before age five, we leave them adrift for a lifetime. Only through a concrete and prolonged investment in early childhood do we truly create an opportunity for all individuals to thrive. As the American Academy of Pediatrics states,"a vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development." Any plan that cuts or eliminates early childhood services fails not only our children but our communal desire for a successful and stable society.
Basic Training Starts Here
The premise of a certain 2012 presidential platform (you decide which one) appears to be this: Life is an even playing field. As long as we try hard enough we all equally thrive. It's as if the secret to success is effort alone, and if you're not successful you're just not trying hard enough.
Research in child development contradicts this idea entirely. By the age of five, environmental experiences often handicap a child throughout a lifetime. Does effort matter? Absolutely, but countless factors affect the cognitive and emotional development of young children long before they make their own active choices about how to live.
The United States will never be the 'land of opportunity' for everyone without addressing this reality. Thankfully, many of these hurdles can be eliminated through interventions both compassionate and cost effective. To tackle these inequalities, some basic necessities of early childhood include:
A safe and stable home environment
The concept of 'toxic stress' may seem vague, but from a medical point of view excess stress has a significant impact on development. As outlined in a 2012 American Academy of Pediatrics statement, prolonged, excessive stress stacks the odds against children. Early adversity affects the entire body, from the brain through the immune system and even influences which of our genes express themselves. Too much stress can cause lifelong impairments in both physical and mental health and, as the authors state, "many adult diseases are, in fact, developmental disorders that begin early in life."
Making sure children are well fed and have health care is a start. Being undernourished or chronically ill affects an adult's capacities in daily life profoundly, children even more so. Additionally, programs that educate at-risk parents about supporting their children's development are impactful. Down the road, people who have received appropriate services while young are more likely to be reasonably settled when they have children -- and then their kids are better off. Adults who grew up in stable environments are more likely to be doing well in general, and less likely to require ongoing medical attention, mental health care or financial support from the government.
Education
The average low-income child has heard thirty million fewer words than peers by the age of three years, and this pre-school vocabulary score predicts language ability at age nine. Falling behind in these skills puts youth at high risk for school failure. School failure itself places children further in jeopardy of unemployment, underemployment, poor health choices and other difficulties.
Further compounding their disadvantage, these children exhibit a 'knowledge deficit' which stems from decreased exposure to general information about the world. Limited content knowledge affects reading comprehension and related abilities, as understanding text relies on the reader's own background knowledge. One study showed poor readers who were baseball fans tested better for comprehension on a baseball passage than more skilled readers with little interest in the topic. While the more advanced readers could read the words, they didn't have the context to sort out jargon like 'a 6-4-3 double play.' Reading comprehension correlates with academic achievement, and also success after schooling ends; home and school based programs can help address the gap.
The types of schools we create matter greatly, as well. A strong education starts with reasonably sized classrooms run by well-trained teachers. Children with mental health concerns, ADHD, autism or learning disabilities typically need services to keep up academically; these interventions are often unavailable or underfunded in low-income neighborhoods. Quality schools, developmental services, and mental health care head off long term problems for not only individuals, but the community. Without intervention, these same children are less likely to become healthy and independent adults.
- The opportunity to learn through play
Free play is a foundation for later cognitive, communication and social skills. It also encourages emotional resilience and creativity. While you might think all children get an equal chance to play, many don't. Poverty interferes with play at home, at school and after school. Educating parents about the importance of free play and creating both community and school-based environments that facilitate it promote long-term development.
Team in Training
Failing to emphasize these early childhood services fails society as a whole. It perpetuates problems such as early school drop-out, teen pregnancy, substance abuse and many other issues exacerbated by unstable childhoods. Investing in children at an early age even saves money over the years; without early intervention, we pay almost exponentially when adults later struggle. A RAND study, for example, suggested a minimum near two-to-one return for every dollar spent on early childhood services, and potentially as high as seventeen to one.
Eliminating early childhood programs turns a blind eye to the stark reality that life is not, in fact, a level playing field. Children need healthy nutrition and health care to grow. They need to be raised in nurturing, mentally engaging environments that encourage activities like imaginative play and reading. They require appropriate schools and stimulating after school experiences. Without intervention, these same kids often end up having children similarly at risk and the cycle continues.
When society abandons children before age five, we leave them adrift for a lifetime. Only through a concrete and prolonged investment in early childhood do we truly create an opportunity for all individuals to thrive. As the American Academy of Pediatrics states,"a vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development." Any plan that cuts or eliminates early childhood services fails not only our children but our communal desire for a successful and stable society.
September 19, 2012
School Planning for Autistic Spectrum Disorders in 500 Words Or Less
A child with an autistic spectrum disorder does not intuitively understand the social world. Severely affected kids may have little apparent interest in people around them. Someone with mild impairment may be quite motivated socially, but lack the skills to initiate or maintain social exchange or play. Regardless of whether the diagnosis is autism, Asperger's syndrome or pervasive developmental disorder (PDD)-nos, this difference in social development defines the disability.
Educational planning for children with autistic spectrum disorders is often complex and difficult to negotiate. When children have severe impairments, they often end up in specialized classrooms -- and sometimes are mainstreamed too quickly. For children more able to integrate into mainstream settings, an appropriate balance between class time and services to address their special needs can be hard to define. They benefit from, and hopefully enjoy, time with mainstream peers and teachers, but they still are behind developmentally and require services.
The bottom line in educational planning, however, is this: As long as a child continues to show symptoms of an autistic spectrum disorder of any kind, he or she requires continued and targeted special services. Even children with mild social impairments, who are able to get by in mainstream classes and frequently do not act out in any way, require services. To meet a child's long-term potential, we must define and develop a long-term plan that addresses the often subtle social and communication skills that lag behind peers.
As the school year beings, here's an overview of educational planning (in 500 words or less):
1. Behavioral therapy is the core intervention.
For intense impairments, a self-contained classroom with an autism-specific behavioral program is the quickest way to catch a child up. With milder impairment, children still benefit from direct instruction. As long as symptoms of autism persist, children require ongoing behavioral intervention, considering both individual and group interventions, to teach core social skills. Exposure to typically developing children alone doesn't accomplish enough. If they could instinctively learn from peers, they probably wouldn't have autism.
2. Speech language delay is part of the autism diagnosis.
Regardless of how high-functioning children with autism appear, they have language deficits. It's a defined part of the diagnosis. Some have profound delays in expressive skills and comprehension, but for others the delay is more subtle.
Pragmatic language refers to all the unspoken, nonverbal aspects of human communication. Pragmatic language delays are inherently part of having autism, so children require ongoing speech-language therapy. Importantly, pragmatics are impossible to quantify, so we cannot rely on test scores to define needed services. As long as social awkwardness, lack of awareness, or communication concerns persist, skillful language intervention has a role.
3. Daily repetition is needed to learn social skills.
If the absolute most important thing in the world was for your child to become a concert pianist by age 16, she would have to practice multiple hours almost every day to get there.
Similarly, for children with autistic spectrum disorders the development of social and communication skills is the absolute most important thing in the world. Their educational plan, considering what happens both in and out of school, should include daily reinforcement through a variety of services. As children catch up, or for those with very mild impairment, the intensity can be decreased.
4. Monitor the need for related services.
Occupational therapy addresses fine motor, handwriting and sensory concerns when present, all of which are common with autism. Physical therapy addresses primarily gross motor concerns. Psychoeducational testing should look for these types of impairments, with an emphasis on daily living and adaptive life skills.
5. Monitor for other academic difficulties.
Children with autism frequently have symptoms of attention deficit/hyperactivity disorder (ADHD). They also can have learning disabilities. Obsessive, rigid thinking may affect classroom performance. On a more subtle level, pragmatic difficulties impact their ability to understand and interpret reading assignments, social studies, and other work. This means they likely will need ongoing intervention to address a broad range of educational difficulties.
6. Many children with autism need more support during unstructured time than structured time.
The social rules in a classroom are simple: Sit down. Be quiet. Raise your hand when you want to speak. On the playground, in the lunchroom, and during recess social rules are constantly in flux. A recent study suggested half of children with autism become victims of bullies, which is much more likely during unmonitored time. Planning should address this unstructured, often unsupervised time of the day.
Educational planning for children with autistic spectrum disorders is often complex and difficult to negotiate. When children have severe impairments, they often end up in specialized classrooms -- and sometimes are mainstreamed too quickly. For children more able to integrate into mainstream settings, an appropriate balance between class time and services to address their special needs can be hard to define. They benefit from, and hopefully enjoy, time with mainstream peers and teachers, but they still are behind developmentally and require services.
The bottom line in educational planning, however, is this: As long as a child continues to show symptoms of an autistic spectrum disorder of any kind, he or she requires continued and targeted special services. Even children with mild social impairments, who are able to get by in mainstream classes and frequently do not act out in any way, require services. To meet a child's long-term potential, we must define and develop a long-term plan that addresses the often subtle social and communication skills that lag behind peers.
As the school year beings, here's an overview of educational planning (in 500 words or less):
1. Behavioral therapy is the core intervention.
For intense impairments, a self-contained classroom with an autism-specific behavioral program is the quickest way to catch a child up. With milder impairment, children still benefit from direct instruction. As long as symptoms of autism persist, children require ongoing behavioral intervention, considering both individual and group interventions, to teach core social skills. Exposure to typically developing children alone doesn't accomplish enough. If they could instinctively learn from peers, they probably wouldn't have autism.
2. Speech language delay is part of the autism diagnosis.
Regardless of how high-functioning children with autism appear, they have language deficits. It's a defined part of the diagnosis. Some have profound delays in expressive skills and comprehension, but for others the delay is more subtle.
Pragmatic language refers to all the unspoken, nonverbal aspects of human communication. Pragmatic language delays are inherently part of having autism, so children require ongoing speech-language therapy. Importantly, pragmatics are impossible to quantify, so we cannot rely on test scores to define needed services. As long as social awkwardness, lack of awareness, or communication concerns persist, skillful language intervention has a role.
3. Daily repetition is needed to learn social skills.
If the absolute most important thing in the world was for your child to become a concert pianist by age 16, she would have to practice multiple hours almost every day to get there.
Similarly, for children with autistic spectrum disorders the development of social and communication skills is the absolute most important thing in the world. Their educational plan, considering what happens both in and out of school, should include daily reinforcement through a variety of services. As children catch up, or for those with very mild impairment, the intensity can be decreased.
4. Monitor the need for related services.
Occupational therapy addresses fine motor, handwriting and sensory concerns when present, all of which are common with autism. Physical therapy addresses primarily gross motor concerns. Psychoeducational testing should look for these types of impairments, with an emphasis on daily living and adaptive life skills.
5. Monitor for other academic difficulties.
Children with autism frequently have symptoms of attention deficit/hyperactivity disorder (ADHD). They also can have learning disabilities. Obsessive, rigid thinking may affect classroom performance. On a more subtle level, pragmatic difficulties impact their ability to understand and interpret reading assignments, social studies, and other work. This means they likely will need ongoing intervention to address a broad range of educational difficulties.
6. Many children with autism need more support during unstructured time than structured time.
The social rules in a classroom are simple: Sit down. Be quiet. Raise your hand when you want to speak. On the playground, in the lunchroom, and during recess social rules are constantly in flux. A recent study suggested half of children with autism become victims of bullies, which is much more likely during unmonitored time. Planning should address this unstructured, often unsupervised time of the day.
August 28, 2012
ADHD School Planning in 300 Words or Less
A 2011 study from the journal Pediatrics found that near 60 percent of children with ADHD have an associated writing disability. Beyond the effects of distractibility, rushing through assignments, impulsivity and all the rest of ADHD, these children have a neurologically-based deficit around writing. The ability to effectively gather their thoughts, organize them, and get them onto the page is impaired directly, not only by their ADHD. Often overlooked and under-diagnosed, a writing disability impacts not only the specific tasks of producing coherent sentences, paragraphs and essays but also testing and note-taking. Without intervention the added time and stress around writing related tasks affects overall school performance.
One of the most basic principles in supporting a child with ADHD is looking for other conditions that often tag along with it. These are termed 'co-morbid conditions' and common ones include developmental delays (fine motor, language, etc.), various learning disabilities and specific mental health conditions such as anxiety. Nearly two thirds of people with ADHD have at least one of these, and that statistic doesn't even count the far-reaching effects of executive function deficits inherent to daily living with ADHD.
School planning sometimes overlooks these possibilities, many of which are of particular importance in the classroom. Academic motivation depends on a sense of mastery and success and rarely develops when children feel at a loss or lack the tools they require to thrive. For students to enjoy and take ownership of their own academic career, underlying issues affecting school must be addressed first.
Here are suggestions (in fewer than three hundred words) to avoid common pitfalls while planning for the upcoming year ...
• Make sure evaluations have looked for specific learning disabilities, especially when children with ADHD have persistent academic problems.
• Address difficulties with executive functioning at home and school. Children with ADHD require more structure and adult support to manage their work, and more direct instruction in organizational skills than peers. Because of ADHD, they benefit from a scheduled routine instead of open-ended supports that say things like, 'you can visit Ms. Jones if you feel you are falling behind.' Their capacity to identify a problem ('I need help'), create a plan to address it, and then stick to it over time is directly impaired by ADHD. Instead of open-ended solutions, schedule supports into their day: 'Right after fourth period, you have a study session. Would you prefer to meet with Ms. Jones or Mr. Frank?' Similarly, most benefit from a consistent homework plan established at the start of the school year, before their work load increases.
• Implement a structured, reward based behavioral plan proactively. Don't wait for classroom tension to start before focusing on behavioral change.
• Ask for placement with structured teachers who run classrooms that permit fewer distractions in the environment. Classroom set up (e.g., desks facing the teacher when she's teaching and not peers) and management (e.g., clear and consistent rules) matter greatly when children have ADHD.
• Encourage schools to use evidence-based instructional methods for children with ADHD. Today, the most commonly used curriculum rely on learning through exposure to academics without an emphasis on direct teaching of skills. Children with ADHD are less likely than peers to thrive without an emphasis on core skills, repetition and rote instruction.
Educational planning of this kind is one of the three foundations of ADHD care. Integrated with appropriate behavioral supports and judicious use of ADHD medications, children with ADHD can thrive at home and school through the upcoming year and beyond.
One of the most basic principles in supporting a child with ADHD is looking for other conditions that often tag along with it. These are termed 'co-morbid conditions' and common ones include developmental delays (fine motor, language, etc.), various learning disabilities and specific mental health conditions such as anxiety. Nearly two thirds of people with ADHD have at least one of these, and that statistic doesn't even count the far-reaching effects of executive function deficits inherent to daily living with ADHD.
School planning sometimes overlooks these possibilities, many of which are of particular importance in the classroom. Academic motivation depends on a sense of mastery and success and rarely develops when children feel at a loss or lack the tools they require to thrive. For students to enjoy and take ownership of their own academic career, underlying issues affecting school must be addressed first.
Here are suggestions (in fewer than three hundred words) to avoid common pitfalls while planning for the upcoming year ...
• Make sure evaluations have looked for specific learning disabilities, especially when children with ADHD have persistent academic problems.
• Address difficulties with executive functioning at home and school. Children with ADHD require more structure and adult support to manage their work, and more direct instruction in organizational skills than peers. Because of ADHD, they benefit from a scheduled routine instead of open-ended supports that say things like, 'you can visit Ms. Jones if you feel you are falling behind.' Their capacity to identify a problem ('I need help'), create a plan to address it, and then stick to it over time is directly impaired by ADHD. Instead of open-ended solutions, schedule supports into their day: 'Right after fourth period, you have a study session. Would you prefer to meet with Ms. Jones or Mr. Frank?' Similarly, most benefit from a consistent homework plan established at the start of the school year, before their work load increases.
• Implement a structured, reward based behavioral plan proactively. Don't wait for classroom tension to start before focusing on behavioral change.
• Ask for placement with structured teachers who run classrooms that permit fewer distractions in the environment. Classroom set up (e.g., desks facing the teacher when she's teaching and not peers) and management (e.g., clear and consistent rules) matter greatly when children have ADHD.
• Encourage schools to use evidence-based instructional methods for children with ADHD. Today, the most commonly used curriculum rely on learning through exposure to academics without an emphasis on direct teaching of skills. Children with ADHD are less likely than peers to thrive without an emphasis on core skills, repetition and rote instruction.
Educational planning of this kind is one of the three foundations of ADHD care. Integrated with appropriate behavioral supports and judicious use of ADHD medications, children with ADHD can thrive at home and school through the upcoming year and beyond.
August 3, 2012
Adult ADHD: A Little Awareness Goes a Long Way
"I probably have a little bit of ADHD myself -- where do you think my kid got it from?"
It's a frequent comment I hear in conversation, once people know what I do for a living. It also comes up in my medical practice several times a month. Grownups feel that they had attention deficit/hyperactivity disorder (ADHD) as a child or might have it now. Often, this reflection is sparked by having witnessed their own children benefiting from ADHD interventions. And still, most adults shrug off the possibility of ADHD or make a self-effacing joke without apparent thoughts for doing anything concrete about it at all.
A mental shrug can be seen in one way as an admirable acceptance of what actually "is" -- not wrestling with reality. As I heard this week from one parent, "I'm 50 years old, this is who I am." But there is also something trivializing about it, a sense that ADHD is either not worth addressing or maybe not a valid concern to have as an adult. And yet, people may be selling themselves short by not addressing what is in fact a chronic medical condition. Change is possible at any age, and assertively managing ADHD will almost certainly decrease daily stress while increasing both happiness and productivity.
Here's the bottom line: If you have ADHD, by definition you have "impairment" somewhere in life -- it's part of the diagnosis. If you're distractible or a little impulsive and thriving across the board, then you don't have ADHD. The impairment may affect self-esteem, daily stress and relationships or far subtler matters like obesity, a lifetime of late bills, or chronic, disabling procrastination. Seeking a diagnosis isn't a treatment decision but may define the "why" behind a lifetime of struggle. It moves you one huge step toward understanding how best to move forward.
The Bare Facts of Adult ADHD
Adult ADHD affects around 4 percent of the population, although the actual diagnosis rate is far lower. In spite of widespread misperceptions to the contrary, ADHD is a medical condition stemming from decreased activity level in various parts of the brain. The term "ADHD" is also misleading, as the disorder does not involve only inattention, hyperactivity or impulsivity. It instead interferes with a whole host of self-regulatory skills called "executive function" that can affect almost any aspect of daily living. Difficulty with executive function, which acts as a "brain manager" by moderating all our actions and planning, is often the most prominent feature in adult ADHD. Previously seen mostly as a childhood condition, many adult providers are only now learning about ADHD's grown-up implications.
While much can be done to support individuals with ADHD, to address its potential impact we need to know it's there in the first place. Many adults live unaware of what sits behind their chronic struggles with attention, time management, emotional self-regulation, and a host of related facilities that impact family, work, and well-being. They may misattribute the root of various troubles, lagging in self-confidence or inappropriately judging themselves to be lazy, incompetent, or unmotivated.
To identify the frequently-hidden influences of ADHD on family, adults need to at least consider the possibility that they have it. ADHD can have a profound effect on relationships. Symptoms in a spouse or a parent affect the whole family, and parents of children with ADHD can have a significant risk of having this highly-inheritable condition. On top of that, adult ADHD can make it harder to stick to recommended parenting strategies that depend on consistent routines and limit setting, escalating a tough dynamic.
If you're curious about yourself or someone else you care about, the World Health Organization has a free adult ADHD screener. Information about adult ADHD and listings of resources are available through the adult ADHD association (ADDA). And many good books have been published about the effects of ADHD on families and relationships, offering tips for minimizing its effects on you and your loved ones. Finding the time to take care of yourself as a parent with ADHD is an often vital part of caring for your family and children... which may include proactively addressing the impact of your own ADHD on family life.
For more by Mark Bertin, M.D., click here.
For more on ADHD, click here.
It's a frequent comment I hear in conversation, once people know what I do for a living. It also comes up in my medical practice several times a month. Grownups feel that they had attention deficit/hyperactivity disorder (ADHD) as a child or might have it now. Often, this reflection is sparked by having witnessed their own children benefiting from ADHD interventions. And still, most adults shrug off the possibility of ADHD or make a self-effacing joke without apparent thoughts for doing anything concrete about it at all.
A mental shrug can be seen in one way as an admirable acceptance of what actually "is" -- not wrestling with reality. As I heard this week from one parent, "I'm 50 years old, this is who I am." But there is also something trivializing about it, a sense that ADHD is either not worth addressing or maybe not a valid concern to have as an adult. And yet, people may be selling themselves short by not addressing what is in fact a chronic medical condition. Change is possible at any age, and assertively managing ADHD will almost certainly decrease daily stress while increasing both happiness and productivity.
Here's the bottom line: If you have ADHD, by definition you have "impairment" somewhere in life -- it's part of the diagnosis. If you're distractible or a little impulsive and thriving across the board, then you don't have ADHD. The impairment may affect self-esteem, daily stress and relationships or far subtler matters like obesity, a lifetime of late bills, or chronic, disabling procrastination. Seeking a diagnosis isn't a treatment decision but may define the "why" behind a lifetime of struggle. It moves you one huge step toward understanding how best to move forward.
The Bare Facts of Adult ADHD
Adult ADHD affects around 4 percent of the population, although the actual diagnosis rate is far lower. In spite of widespread misperceptions to the contrary, ADHD is a medical condition stemming from decreased activity level in various parts of the brain. The term "ADHD" is also misleading, as the disorder does not involve only inattention, hyperactivity or impulsivity. It instead interferes with a whole host of self-regulatory skills called "executive function" that can affect almost any aspect of daily living. Difficulty with executive function, which acts as a "brain manager" by moderating all our actions and planning, is often the most prominent feature in adult ADHD. Previously seen mostly as a childhood condition, many adult providers are only now learning about ADHD's grown-up implications.
While much can be done to support individuals with ADHD, to address its potential impact we need to know it's there in the first place. Many adults live unaware of what sits behind their chronic struggles with attention, time management, emotional self-regulation, and a host of related facilities that impact family, work, and well-being. They may misattribute the root of various troubles, lagging in self-confidence or inappropriately judging themselves to be lazy, incompetent, or unmotivated.
To identify the frequently-hidden influences of ADHD on family, adults need to at least consider the possibility that they have it. ADHD can have a profound effect on relationships. Symptoms in a spouse or a parent affect the whole family, and parents of children with ADHD can have a significant risk of having this highly-inheritable condition. On top of that, adult ADHD can make it harder to stick to recommended parenting strategies that depend on consistent routines and limit setting, escalating a tough dynamic.
If you're curious about yourself or someone else you care about, the World Health Organization has a free adult ADHD screener. Information about adult ADHD and listings of resources are available through the adult ADHD association (ADDA). And many good books have been published about the effects of ADHD on families and relationships, offering tips for minimizing its effects on you and your loved ones. Finding the time to take care of yourself as a parent with ADHD is an often vital part of caring for your family and children... which may include proactively addressing the impact of your own ADHD on family life.
For more by Mark Bertin, M.D., click here.
For more on ADHD, click here.
July 17, 2012
Getting from Point A to Point C with ADHD
According to professional organizer Judith Kolberg, anything we plan in life has three parts, one of which we often forget. First, we need to prepare (A). Second, we need to act (B). And then third, we need to complete what we started (C). Often on a busy day we leave off the last step. We get through, or partially through, the middle and move on with our lives.
Tonight, I need to get dinner on the table. For starters, I need to find a recipe and shop. Then I need to cook the meal and eat it with my family. And then lastly I (or we) need to clear the table and clean the dishes. If I skip the last step, the dishes will be crusted and dry and waiting in the morning.
The same goes for my son. To complete homework he needs to write down the assignments at school and get his books home. Once there, he needs to focus and complete the work. Finally, he needs to return his materials to his backpack and remember to hand it to the teacher the next day. Otherwise, he gets no credit and he gets in trouble with his teacher.
The Lost Step in ADHD
Having ADHD may mean missing the third step even more often than the rest of the world. Over and over again, day after day, bills start to get paid.. but not mailed. Meals are thrown together... but not cleaned up. Art projects begin... but end in a pile of partially started canvases. The car keys are on the couch, the mail is under the wet umbrella on the kitchen table, the milk is out from the morning and that report is now a week overdue. The house is a mess, nothing has been actually completed and it's time for bed. It's exhausting, stressful and strains families. It keeps people from thriving.
As is frequently true, recognizing the pattern is the first step towards change. Someone with ADHD will often find themselves in the middle of one activity and mentally involved in the next. We all have that tendency, and yet with ADHD it becomes even more intense. The pressure mounts because all of a sudden it's the end of the day and you remember... uh-oh, the bills aren't done, the kitchen is a mess, the mail is drenched, the milk is turning and what was it I was in the middle of right now? There is distracted attention paid to what's immediate and not so much left for reaching an intentional end to any particular task.
Creating a new habit may seem difficult or impossible at first, but it isn't when you borrow a tool from the original mindfulness-based stress reduction program. The goal is to create a habitual pause that brings us back and helps us nail the landing. It may take weeks or even months, but you can learn it to the point where it becomes instinct. I'm paying bills, oh wait I need to mow the lawn, let's see, where's the mower, and... pausing, you return your attention, place the stamp on the envelope and into the mail it goes. Only then do you move on.
Learning to STOP
To create this pause, practice the acronym 'STOP' with each transition. Before getting up from the table, leaving your desk or shifting your activity at any time during the day:
• Stop what you're doing.
• Take a few breaths.
• Observe what's going on for you, internally and externally.
• Pick what would be best to do next.
Having paused and checked in, what would it take to finish what you started? With children, you might even review the three steps before beginning a task. Take out the milk and a glass. Pour and drink the milk. And then... step three, put milk in the fridge and the glass in the dishwasher. Check the assignment pad, finish the homework. And then... put it in the backpack. Create reminders to STOP over and over again through the day. Eventually, this pause in transitioning becomes a habit, consistently getting you and your child from point A to point C -- a complete and well-considered conclusion.
Tonight, I need to get dinner on the table. For starters, I need to find a recipe and shop. Then I need to cook the meal and eat it with my family. And then lastly I (or we) need to clear the table and clean the dishes. If I skip the last step, the dishes will be crusted and dry and waiting in the morning.
The same goes for my son. To complete homework he needs to write down the assignments at school and get his books home. Once there, he needs to focus and complete the work. Finally, he needs to return his materials to his backpack and remember to hand it to the teacher the next day. Otherwise, he gets no credit and he gets in trouble with his teacher.
The Lost Step in ADHD
Having ADHD may mean missing the third step even more often than the rest of the world. Over and over again, day after day, bills start to get paid.. but not mailed. Meals are thrown together... but not cleaned up. Art projects begin... but end in a pile of partially started canvases. The car keys are on the couch, the mail is under the wet umbrella on the kitchen table, the milk is out from the morning and that report is now a week overdue. The house is a mess, nothing has been actually completed and it's time for bed. It's exhausting, stressful and strains families. It keeps people from thriving.
As is frequently true, recognizing the pattern is the first step towards change. Someone with ADHD will often find themselves in the middle of one activity and mentally involved in the next. We all have that tendency, and yet with ADHD it becomes even more intense. The pressure mounts because all of a sudden it's the end of the day and you remember... uh-oh, the bills aren't done, the kitchen is a mess, the mail is drenched, the milk is turning and what was it I was in the middle of right now? There is distracted attention paid to what's immediate and not so much left for reaching an intentional end to any particular task.
Creating a new habit may seem difficult or impossible at first, but it isn't when you borrow a tool from the original mindfulness-based stress reduction program. The goal is to create a habitual pause that brings us back and helps us nail the landing. It may take weeks or even months, but you can learn it to the point where it becomes instinct. I'm paying bills, oh wait I need to mow the lawn, let's see, where's the mower, and... pausing, you return your attention, place the stamp on the envelope and into the mail it goes. Only then do you move on.
Learning to STOP
To create this pause, practice the acronym 'STOP' with each transition. Before getting up from the table, leaving your desk or shifting your activity at any time during the day:
• Stop what you're doing.
• Take a few breaths.
• Observe what's going on for you, internally and externally.
• Pick what would be best to do next.
Having paused and checked in, what would it take to finish what you started? With children, you might even review the three steps before beginning a task. Take out the milk and a glass. Pour and drink the milk. And then... step three, put milk in the fridge and the glass in the dishwasher. Check the assignment pad, finish the homework. And then... put it in the backpack. Create reminders to STOP over and over again through the day. Eventually, this pause in transitioning becomes a habit, consistently getting you and your child from point A to point C -- a complete and well-considered conclusion.
