mastering morning routines

Mastering Morning Routines

 

 

 

Many parents report the most anxiety prone time of the day is the weekday mornings. There is much going on in a very limited time. Parents often need to ensure that they are ready for work and have their children ready for school. This time of day is difficult for most children; however, children with attention problems or executive functioning weaknesses are much more prone to exhibit significant weakness with regard to their ability to follow routines and get out the door on time. Although it is difficult, it is not impossible for these children to be ready to go on time! Mastering the morning routine is the best way to get the family out the door, happily, each day.

Steps to Master the Morning Routine:

The main recommendation is to keep the mornings as structured and consistent as possible. Have the schedule planned and written out. Think about all daily routines from waking up, brushing teeth, getting dressed, to leaving the house. Think about not only the tasks that are expected of the child but also a reasonable amount of time to complete each task. It may come down to it that the list of expectations placed on the child’s morning is not realistic (today) and there might have to be some modifications.

Once it has been established that the tasks in the morning are reasonable, create a chart with picture cues for each task. Also, have the time expected for each task written down next to that item.

The first few days or weeks will require a significant amount of adult assistance to help ensure the child is finishing the tasks in the appropriate order within the required time allotments. Use strategies such as reinforcing completed tasks, timers, and praise.

Morning routines can be hectic but do not have to be impossible. With structure, organization support, and use of reinforcement, many children with attention concerns and executive functioning weaknesses are able to stay to the routine and get out the door in time.




504 or IEP

504 Plan or IEP: Which Is the Best Vehicle for Your Child?

 

 

Today’s guest blog by Pam Labellarte, Special Education Advocate,  explains how to navigate accommodations plans when your child receives a diagnosis.

Before we can even address the question of whether a 504 plan or an IEP is the best vehicle for your child, we need to unravel the process required to get your child identified as a student with educational needs that cannot be addressed through the general curriculum, without support of additional accommodations and/or services.

Your Child Has a Diagnosis, Now What?

You get the news from your child’s teacher, your pediatrician or after your child has been evaluated by a neuropsychologist…your child has a disability. Maybe it’s a Learning Disability, Attention Deficit Hyperactivity Disorder (ADHD), or any one of several other disabilities that is limiting your child’s academic progress. Your first inclination is to ensure your child is provided whatever supports are necessary to maximize his potential. But, you are at a loss as where to begin. If your child’s teacher has not taken any further action, the first step is to connect with your school district’s Special Education Director/Coordinator. The initial request for consideration for services should be a letter hand delivered, sent certified mail or an email with a letter attached.

The “Special Education Maze”:

You are now about to enter what is often called “the Special Education Maze”. Understand, Special Education is NOT a PLACE. Special education services are driven by the needs of the individual child. Therefore they are delivered in a variety of places, sometimes within the classroom and other times outside the classroom in a smaller setting. It is critical that the initial and any future contact with the school district be documented in writing. This means documenting any important verbal conversations that occur between you and the school district staff, with an email confirming the conversation. By law, once a school district receives written requests from a parent regarding special education, they are required to respond within specific timelines, hence, the importance of written documentation.

Important Steps to Take to Receive Special Education Services:

Upon receipt of your written request for consideration of special education services for your child, the school district is required to respond to you in writing within 14 school days whether they believe your child should be evaluated. If they agree, a meeting will be scheduled to identify specific areas to be evaluated. Often referred to as the “Domain Meeting”, it the place where the school team and the parents review the major areas or “domains” to be evaluated, such as achievement, cognitive, communication, etc. The Domain Meeting is one of the most important meetings you in which you will ever participate, because you and the school team will determine which areas need to be evaluated and how (formal evaluations, informal assessments, observation, review of records, etc.). In order for the process to continue you have to provide “informed consent”, agreeing to allow the specific evaluations/observations to be conducted only after you understand what information they will provide. If a critical area is not addressed it may negatively impact the services provided to your child.

Developing the IEP:

Once you have provided consent, the school staff has 60 school days to complete all evaluations and observations, publish their findings and conduct an eligibility meeting. Most parents do not realize they can request that the draft reports be provided in advance of the eligibility meeting (three school days prior is sufficient time). If you wait to review the reports at the meeting, how can you hear the information (much of it foreign to you), digest what you have heard and then make “informed” decisions about your child’s programming? Once your child is found eligible the school district has 30 days to develop and implement an Individual Education Plan (IEP).

IEP or 504 Plan?

What if your school district has responded to your request in writing that they do not believe that your child has a disability requiring special education services provided under the Individuals with Disabilities Education Act (IDEA). But, they are willing to consider developing a 504 Plan to provide accommodations to your child. Would a 504 Plan be appropriate? How do they differ? Which would provide your child the most appropriate support?

Click here for a Section 504 and IDEA Comparison Chart (obtained from the National Center for Learning Disabilities) that provides details regarding the differences in the two laws. Don’t make any quick decisions until you understand the basic difference between the two educational programs.

Click here to view the webinar: Getting the Best IEP for Your Child!

diabetes

Neuropsychological Aspects of Diabetes

 

 

 

Diabetes is an autoimmune disorder associated with an inability of the affected person’s/child’s pancreas to secrete insulin. There are two types of diabetes (type I and type II). Read on to understand the neuropsychological aspects of Diabetes.

Type I Diabetes:

Type I diabetes is considered to be insulin dependent in which the child must take insulin injections, as there is a complete inability for the body to produce insulin. Type I Diabetes is associated with unusual thirst, excessive urination, rapid unexplained weight loss, and overwhelming fatigue. This is one of the most prevalent chronic childhood diseases with approximately 29,000 new cases diagnosed each year. The peak incidence rate of type diabetes is between 10 and 14 years of age.

Type II Diabetes:

Type II diabetes is considered to be non-insulin dependent and is rarely signaled by a clinically obvious medical crisis. Type II is most common in individuals who are over forty years old and whose body mass index is greater than 25 (considered overweight). This is a fairly common condition in that there are approximately 600,000 new cases identified each year.

Neuropsychological Aspects of Diabetes:

Research has indicated that age of onset of diabetes is a critical factor in secondary cognitive impact. What this means is that children who have been diagnosed with diabetes in the first four to six years of age are more prone to significantly lower cognitive scores. This is also found to be true with concerns with attentional regulation. In general, children and adolescents with a diagnosis of diabetes are not more prone for a diagnosis of ADHD; however, if the child had been diagnosed with diabetes early in life, they are more likely to exhibit symptoms of ADHD.

Children and adolescents with late onset diagnosis of diabetes are more prone to concerns with verbal cognitive functioning and academic achievement in comparison to a control group of non-diabetic children and adolescents.
Overall, diabetes can be a pretty well-controlled disorder. If children and adolescents control their insulin levels, they tend to not demonstrate more neurocognitive concerns than their non-diabetic peers.

Click here to learn more about our Neuropsychology Diagnostic and Testing Center!

medication for mental health in kids

When is it Appropriate to Seek Medication Management for Mental Health Symptom Reduction in Children?

 

 

 

For many families, the conversation about medication management to reduce mental health symptoms in children is off the table before the realities of this intervention can be explored. Medication can be a beneficial intervention, in tandem with therapy, to translate the skill development from the clinical setting into positive behavioral changes in the natural environment.

When is medication recommended to manage mental health symptoms in children?

Medication might be recommended as a therapeutic approach early on in treatment depending on the severity of the presented concerns and the impact of these symptoms on the child’s overall quality of life. For instance, if the child struggling with impulsivity and reduced focus/attention is doing poorly in school, if he has challenges reading social cues in peer relationships, and is he is internalizing negative feelings of self as the result, medication may be recommended sooner rather than later to improve client’s overall level of functioning.

The goal of social work intervention is to address the socio-emotional concerns through teaching client awareness into the triggers that precipitate the maladaptive behaviors (i.e. distracting thoughts/stimuli that reduce focus, decisions that elicit anger that snowballs into a meltdown, etc.) and the skills to modify their behavior. In some cases, the client can demonstrate and prove comprehension of the skills presented but in practice, have a hard time implementing the learned coping strategies in real-life scenarios. If the child’s quality of life and overall functioning remain to be negatively impacted despite intellectualization of how to handle their emotions or redirect their behavior, medication might serve as the glue to carry these compensatory strategies into reality.

To decide if a medication consultation is right for you, use this checklist:

  • Does my child struggle with implementing the therapeutic skills they learn in treatment?
  • Despite involvement in therapy, is my child’s quality of life negatively impacted socially, academically, personally?
  • Has there been an increase in the frequency and duration of symptoms (i.e. more meltdowns per week, more redirections to re-regulate body to remain calm, etc.)?
  • Does my (the parent) and my family’s quality of life continue to be negatively impacted with frequent impulsive reactions, mood dysregulation, or hyperactive nature of the child?

Consult with your pediatrician and therapist if you have any questions about if medication would be a right fit for your child. And remember, just because you may decide to try medication does not mean that it is a magic bullet fix or that it has to be a life sentence. Ongoing therapeutic intervention in addition to medication can be the right course of treatment for some children.


mental illness in children

The Rise of Mental Illness in Children

 

 

The Journal of Pediatrics published a recent article that childhood developmental conditions including ADHD and Autism are increasing at a rate of 16% from 2001 to 2011 (Read a review of this article on the CNN blog, The Chart, here). Although this might sound astounding and like this should be an area of concern, the researchers have posited that this actually might be a positive.

In all likelihood, these rates were probably the same. What we have now is an increased awareness of a variety of developmental disabilities as well as increased acceptance of such conditions. Having increased acceptance is extremely positive in that now we are able to provide support and services to help these children that otherwise would not be available.

Here are some tips for parents for children who might have a neurodevelopmental condition like ADHD or Autism:

  1. Seek out a good, comprehensive evaluation in order to first help identify the specific condition that the child might present with.
  2. Identify your treatment team. Your team will consist of multiple individuals including teachers, therapists, administration, and special education teachers. Make sure the team is all on the same page and aware of the specifics that the child presents with.
  3. Seek out resources and information to help support you and your family. There are multiple, empirically supported organizations that provide parents and family members with not only support but also resources to help the child out.

Although the rates of a variety of neurodevelopmental conditions are on the rise, it is likely that these conditions have always been as prevalent as they are today. The social stigma associated with the conditions is no longer as strong, and these children are now able to receive specific services and interventions that would be beneficial for them.




set up a routine for homework success

Set-Up a Routine for Homework Happiness

 

 

 

Children with attentional problems or issues with executive functioning often have difficulties with homework completion. Several issues associated with executive functioning lead to concerns with the ability to complete daily work including the following:

  • Initiation on work
  • Organization concerns
  • Time management
  • Difficulty transitioning

When is the best time for my child to do homework?

Oftentimes children will want to have a break from school work when they come home. They want to play for a while before doing work. I would actually recommend that the child immediately start homework when he gets home. Research has indicated that children with attentional problems and poor executive functioning have difficulty transitioning between tasks. The child is still in the school mindset when he arrives home. Having the child take a break and then later transition back to homework likely will prove difficult. Instead, I would recommend that the child have a light snack and then immediately start the work.

How should I structure the homework space?

Organization, or lack thereof, is a hallmark feature of poor executive functioning. With that in mind, I would highly recommend that the homework environment in which the child is working be as organized and structured as possible. Have a specific desk or table where work is to be done. Keep the table as clean as possible with a minimal amount of distractions in the room. Oftentimes, having the child complete homework in his room proves to be a disaster. There are too many distractions that keep the child’s interest away from the homework assignment. It may prove best to select a quiet room away from family members with the fewest distractions possible.  Click here to watch a Pediatric TV Episode on setting up a homework station.

How do I work on time management with my child?

Parents often state that the child has no idea about time management or how long tasks should last. I often recommend that parents have the child provide an estimate of how long he perceives a task should last. Time the child and then provide the difference as to how long he thought the work would last and how long it actually lasted. Then the next day, have the child again provide an estimate as to how long the task will last. If the child is way off with the estimate, pull out the data from the night before and ask if he wants to revise his estimate. Keep this going until the child starts to develop an actual idea of how long tasks should last.

These are just a few tips to keep homework as structured as possible. Help the child start homework right away as it will help with initiation on tasks as well as ensuring a smooth transition between demands. Keep the room and desk as organized as possible to limit distractions and off-task behaviors. Provide some guidance with time management by helping identify how long tasks and assignments should last.

Read here for 8 more tips to ease homework time stress!







extra-curricular success for children with special needs

Ensure Extra-Curricular Success for Children with Special Needs

Often parents of children with special needs are worried and fearful about the ability of their child to succeed in extra-curricular activities such as sports, boy scouts, dance, art class, etc. Parents often fear the worst and are afraid of how the child will behave or act in such circumstances.  I would recommend that parents utilize several tips in order to help ensure success with each out-of-school activity, as these activities have many proven benefits for a child’s self-esteem.

Tips for Working with Coaches to Ensure Success for Children with Special Needs in Extra-Curricular Activities:

1. Be frank with the coach or director of the activity. Inform him or her about the child’s concerns. These are often individuals who volunteer to help children and more times than naught have the child’s best interest in mind.

2. Let the individual know what types of behaviors the child has exhibited in the past. What happened in school when parents were away, etc?

3. Create a list of accommodations that have proven to be beneficial for the child. Let the coach or instructor in on some of the modifications that have been helpful in the academic setting, as he may be able to apply the modification to the activity setting.

4. Be present, or within immediate reach, for the first few sessions.

5. Have the child go and see the building and room will the activity will occur. If possible, meet the instructor to form a relationship in advance.

Ultimately the main goal of after school activities is to increase socialization while teaching a skill, activity, or sport. The above tips should help provide some strategies to ensure the maximum success for children who have special needs in such situations.





 

prep your child's teacher to help your child with ADHD

How to Prep Your Child’s Teacher to Work with an ADHD Diagnosis

To start the school year out right for your child with and ADHD (or other) diagnosis, it is important to establish a close collaboration between you, your child’s teacher, any professionals of the treatment team, and your child!  Here is how you can prepare your child’s teacher to best understand your child’s needs to get off to a great start this academic year.

10 tips to prepare your child’s teacher to best help your child with an ADHD diagnosis:

1. Request to set up a meeting at the start of school year.

2. Get an idea of what your child’s teacher knows about ADHD and his general attitude towards ADHD. Some teachers may be more or less informed about ADHD, as research and diagnostic criteria has changed quite a bit over the years.
3. Inform the teacher of your child’s ADHD diagnosis (or other diagnosis), if he is on any medication or if you chose an alternative treatment method.

4. Find out what the culture of the classroom is like:

  • Structure: Is the daily schedule posted?  Does the teacher request frequent “brain breaks” during the day?
  • How does she describe her teaching style?
  • Rules & Expectations: Are there visual reminders posted around the room? What is the reward system? Incentives? Token System?  Nature of the homework assignments? Seating arrangements?
  • Can your child sit facing the front and close to the teacher?

5. Discuss the best way to contact one another (i.e. via phone or email).
6. Discuss if any notes home or behavioral report cards are necessary or how often?
7. Pass along any recommendations to your child’s teacher that she can implement that you have found helpful  for your child.

Examples:

  • “Jake does well when given one command at a time versus following multiple steps at once.”
  • “At home, we have found that having Jessica repeat back directions or rules, helps her to be more accountable.”
  •  “We use the token system at home and Sam seems to do well with it when we are consistent.”

8. Be supportive and open.

  • Assist the teacher in any way by being supportive and open to suggestions he or she may have.
  • Let the teacher know you want to work as team to make it a successful year for everyone.

9. Offer Praise and appreciation: A positive attitude with your child’s teacher creates a stronger relationship with all involved!

10. Request to set up a follow-up meeting to check-in : This could be half-way through the school year or sooner depending on the needs of your child.

Click here to read about self-regulating strategies to help children with ADHD.







ADHD in boys and girls

ADHD in Girls v. Boys

 

 

 

 

Although there are many features of ADHD that may overlap between genders, studies have shown there to be characteristics that differ among boys and girls. Neither of these characteristics are exclusive to the gender, but these are generally the characteristics seen in girls and boys with an ADHD diagnosis:

 ADHD Features in GIRLS:

  • Tend to show more symptoms of inattentiveness vs. hyperactivity
  • Are more likely to be diagnosed later in their academic career
  • Some adult women are not diagnosed until their child goes through the process and is diagnosed themselves!
  • Have a higher likelihood of being under-identified and under-treated
  • Display more symptoms of inattention, daydreaming, and memory problems
  • May be initially misdiagnosed
  • Tend to go under the radar during early school years
  • Tend to be slower learners and less motivated
  • Are at-risk for self-esteem issues, mood issues, and substance abuse
  • Adolescent-aged girls have lower self-efficacy and coping skills
  • Have a higher tendency to internalize problems
  • Are easily overwhelmed
  • Have difficulty with time management

 ADHD Features in BOYS:

  • Have a 2:1 ratio diagnosis of boys to girls
  • Are more likely to be detected and diagnosed early on in the school–age years
  • Show more symptoms of hyperactivity and behavioral problems
  • Have higher rates of impulsivity
  • Have Higher incidents of externalizing problems associated with ADHD symptoms (i.e. aggression, trouble getting along with peers)
  • Have trouble sitting still or disruptive in the classroom

Girl Day dreaming

Self-Regulation Strategies For Kids With ADHD

Symptoms related to ADHD can manifest differently from child to child. Redirecting hyperactive, impulsive, and/or inattentive behaviors can be achieved through following these strategies:

Engagement In Whole Body Listening

Educate your child that listening does not just include opening your ears to the sound of words, but that it in fact means that the entire body is calm, engaged, and focused. The child’s body should be directed toward the speaker or the task at hand, with feet still on the floor, hands still in their lap or on the desk, eyes looking at the task or person speaking, ears listening to the spoken content, and with their brain focused on the current material.

If your child is too hyperactive and is having trouble regaining whole body listening, encourage them to engage in muscle relaxation activities such as squeezing hands/fists/body into a ball tightly for 10 seconds and then releasing. They can do these reps about 5 times or until they are able to extinguish the extra energy causing them to become hyperactive.

On-topic vs. Off-topic Thinking

Help your child gain awareness about what their brain is processing. Chances are, if your child is thinking about Minecraft, a fun science experiment that he did in school, or what he will have for dinner that night, he is NOT listening to what you are saying. If your child appears inattentive, ask them what they are thinking about. If they reply in alignment with the message you have presented, they are using “on-topic” thinking which fosters enhanced focus/attention. If they reply that they were thinking about unrelated material, educate them that this is “off-topic” and they can shelve this idea until after their work is over or after the directive is completed.Girl Day dreaming

Stop-Sign Technique

Help your child reverse their acting and thinking processes. Impulsivity occurs at times when we are absently thinking and as a result, behave quickly. When we react before we think, we do not think about the potential ramifications of our actions and therefore can make poor choices. If you notice your child acting quickly and in the process of engaging in a non-preferred or unexpected behavior, shout out “stop” and/or hold your hand out to signal stop. Have your child cease whatever they were engaging in and have them evaluate the potential consequences if they continue doing what they are doing. Having the child assess the outcome of their action will help them reconfigure more compliant behaviors. You can help your child problem-solve in this process and model for them the appropriate steps for formulating the best choices through thinking before acting.

These strategies can be interactive and process-oriented between child and parent in the hope that the child can then internalize these strategies and autonomously utilize them. Don’t be afraid to help redirect your child, but also encourage them to utilize these skills independently.