memory and adhd

Wait… What Did You Say? Memory in the ADHD Student

Making memories is an important part of being human, and our beloved camera phones seem to make the process that much easier! However… our cameras aren’t the only ones doing the work. What about when you have to remember that long 10 digit phone… oh wait… we don’t have to do that anymore either! I suppose a modern day challenge would be to remember all those tedious passwords we have to keep!

But that’s neither here nor there!

Our awesome brains deserve a little credit, too, actually a lot of credit for that (grey) matter (just a little brain joke for ya!)

While memory is a challenge for all of us, it can be an exceptional challenge for a student with ADHD. In order to understand this, we will look at the 3 basic stages of memory.

Three basic stages of memory:

Encoding: Information enters into our memory systemmemory and adhd

Storage:

  • Short-term memory (STM) : 20-30 Seconds: Information that is transferred from the STM enters into the HIPPOCAMPUS! When we repeat information over and over again it’s like sending it through the hippocampus several times!
  • Long-term memory (LTM): Can last a lifetime

Retrieval:

  • How you store depends on how you get those memories back OUT
  • Organization is key here (i.e. using the alphabet to categorize things or remembering numbers in chunks)

Something happens around you that you can see, hear and/or touch. This sensation lingers in our short-term (working) memory for about 20-30 seconds. For example, when you are having a conversation with someone and they are talking, you may be thinking of what to say next (thanks to your working memory).

Kids use their working memory all day in the classroom to follow instructions, remember where they need to be, and to keep track of their belongings and assignments (just to name a few). Kiddos with ADHD tend to struggle more with these tasks, which can make learning difficult, specifically reading comprehension.

Let’s say a teacher says, “Go to your desk, grab your book and a pencil, go the center, and finish the worksheet.” That can be a lot to remember for a child who has a deficit in this area and can be misinterpreted as purely inattention.

“How can you plan ahead if you don’t use working memory to keep your goal in mind, resist distractions and inhibit impulsive choices?” says Matthew Cruger, PhD, neuropsychologist with the Learning and Diagnostics Center at the Child Mind Institute in New York.

Here are 4 ways to help teach ways to integrate learning for kids with ADHD:

  • Teaching mnemonic devices: “Never Eat Soggy Waffles” : North, East, South,West
  • Creating visuals
  • Use songs or a melody to learn concepts
  • Ask follow-up questions

Sometimes it can be hard to tell whether a child has a memory deficit or if it is a by-product of ADHD or a Learning Disorder. Receiving formal testing can be beneficial to tease them apart or better identify how they influence one another.

the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2)

Understanding Physical Therapy Outcome Measurements: The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)

Previous physical therapy blogs have explained outcome measurements used to assess gross motor development in infants and children up to age 5, including the Peabody Developmental Motor Scale, second edition and the Alberta Infant Motor Scale. When children age out of either the PDMS-2 or the AIMS, one standardized assessment option physical therapists have is the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2). The BOT-2 can be used to evaluate a wide variety of fine and gross motor skills for children, teenagers and young adults 4-21 years of age. This is a test that can also be used by occupational therapists, psychologists, adaptive physical education teachers, special education teachers and educational diagnosticians.

The BOT-2 contains a total of 8 subtests that look at both fine and gross motor functioning. When certain subtests are combined, they can give more specific information regarding the child’s Fine Manual Control, Manual Coordination, Body Coordination, or Strength and Agility. Administering all 8 subtests can allow the physical therapist to obtain a Total Motor Composite looking at the child’s overall performance with fine and gross motor functioning.

Below is a description of the subtests most commonly used by physical therapists in BOT-2 testing:

  • Bilateral Coordination: This section of the BOT-2 looks at a child’s control with tasks requiring movement ofthe Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2) both sides of the body. Tasks in this section will require the child to move his arms and legs from the same and opposite sides of the body together, in sequence, or in opposition.
  • Balance: The balance subtest evaluates the child’s moving and stationary balance. Tasks are completed with a variety of challenges to the balance systems, such as while on one foot, on a balance beam, or with eyes closed.
  • Running Speed and Agility: This section of the test looks at a child’s maximum running speed, running and changing directions, as well as stationary and dynamic hopping and jumping skills.
  • Upper-Limb Coordination: This subtest is used to assess the child’s ability to coordinate arm and hand movements and visual tracking of the task. The child is required to demonstrate skills such as catching, throwing and dribbling a tennis ball with one or both hands.
  • Strength: In the strength section of testing, the child is required to perform tasks designed to evaluate strength in the core, arms and legs. Strength is assessed in both static positions as well as with dynamic movements.

Based on the child’s presenting concerns, a physical therapist may evaluate the child using just a few or all of these subtests. The child’s performance on the BOT-2 will allow the physical therapist to identify areas of strength and areas of need in regards to the child’s gross motor functioning, and can therefore help to guide treatment. Because the BOT-2 has both age and sex-specific normative data, this test will help the physical therapist determine how the child is performing compared to peers his age. The BOT-2 can be re-administered periodically in order to monitor progress in the child’s functioning and performance with gross motor skills.

If you have concerns with your child’s performance in any of the categories listed above, click here to get scheduled with one of our pediatric physical therapists!

References:
Bruininks, Robert H., and Brett D. Bruininks. Bruininks-Oseretsky Test Motor Proficiency. 2nd ed. Minneapolis: Pearson, 2005. Print.

child does not qualify for speech language services

Your Child Doesn’t Qualify for Speech-Language Services-Now What?

 

 

 

The start of the school year brings new school supplies, new teachers, and can bring new evaluations. Children are often flagged by doctors, teachers, or other school staff and subsequently may participate in a speech screening or possible evaluation. Following this evaluation, children may or may not qualify for ongoing speech-language services. If they don’t qualify, what do you do next?

Steps to take if your child does not qualify for needed speech-language services:

  1. If you still feel the child requires services, ask for a second opinion! If the child is told at school that he doesn’t qualify, this could be based on a child’s age or ability level. Often times the severity of a child’s difficulties may impact his qualifying for services, taking in to account age-matched peers.
  2. Watch and wait. If a child doesn’t qualify for services now, he might later! Depending on the child’s specific areas of need, articulation norms are tied to ages, so oftentimes therapists will wait until the child is in the expected age range before targeting a given sound. For example, /r/ is a later developing sound, so typically therapists won’t work on /r/ production until a child is 5 or 6 years old!
  3. Promote speech and language skills at home! Parents and siblings can be a great support for children with speech and language difficulties. Parents can model their own appropriate speech and language skills and recast if a child is struggling. When recasting, for example, parents can expand upon their child’s utterance to increase the length or make it more adult-like. If a child says, “ball,” parents can follow that with, “oh, you want the ball?” Siblings can also be a great help to work on peer interactions, turn taking, direction following and appropriate interaction and play!

Should your child not qualify for services right now – don’t give up! A licensed speech-language pathologist can help. SLPs may provide home programs to help target weak areas, and will often re-screen or even re-evaluate in 6 months or a year.

Click here for more information on our Speech-Language Pathology program.

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.




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
what is an orthotist

What is an Orthotist?

 

 

 

Pediatric physical therapists and physicians often rely on the help of orthotists and prosthetists to help with patients’ mobility needs. Sometimes, children come to physical therapists with gait and postural deviations (toe-walking, in-toeing, scoliosis, etc) and other conditions where exercises and muscle retraining simply are not enough. In those cases, we often ask for the help of an orthotics and prosthetics (O&P) specialist. Braces and artificial limbs are important to facilitate movement and promote independence.

When we refer children to an orthotist, it means we think that some aspect of their movement and growth could be helped out by an external medical device. An orthotist is a critical part of the rehabilitation and therapy process. Orthotics help correct alignment and improve function of childrens’ neuromuscular or musculoskeletal system. Orthotists evaluate what a child’s functional needs are and will design and construct the orthotic devices as needed. An orthotist is a certified healthcare professional who is knowledgeable in human anatomy and physiology, biomechanics, and engineering. As movement specialists, physical therapist rely heavily on the help of orthotists to achieve the mobility goals for our clients.

Some conditions that may require help of an orthotist:

Not sure if your child will have orthotic needs? Come see a physical therapist and we can point you to the right medical professional depending on your needs.

Click here to read our run-down of the best over the counter foot orthotics.

night splints

The Quick Guide to Night Splints for Children

 

 

 

For many children who are idiopathic toe-walkers, physical therapists often take the conservative approach. We have many things in our arsenal to help children improve without undergoing costly and painful surgery. Outside of stretching and strengthening exercises, we might recommend ankle foot orthoses (AFOs) for day time and/or night time wear. Depending on the child’s range of motion measurements, walking mechanics, and underlying pathology, different types of orthotics might be recommended. We often work closely with orthotists (professionals who design medical supportive devices such as braces) to make sure each child receives the individualized care and equipment he needs to gain full function and optimal alignment.

Here are reasons why your physical therapist might have recommended night splints for your child:

  1. The main goals of physical therapy interventions for toe-walkers are to increase ankle dorsiflexion range of motion and to decrease possible contractures that are associated with the condition. Physical therapy exercise programs include stretching the calf muscles, strengthening the trunk muscles, manual therapy, treadmill training, balance training, and ankle mobility training. Sometimes, in stubborn cases of toe-walking, orthotics are needed to maintain the range of motion gained throughout daily exercise sessions.
  2.  If you’ve ever tried to stretch your pre-schooler’s muscles, you know that children can be active and fidgety. They don’t tolerate passive stretches as well as adults and might complain of boredom, pain, or ticklishness. The most effective stretches are those held for a prolonged period of time at a joint’s end range. Night splints allow for increased stretch time at the ankle joint, because the child is sleeping or resting when they are in place.
  3. The best time to gain range is when a child is relaxed. Since children relax more during sleep, even more range can be gained through passive stretching using a night time AFO.
  4. This is where the night-time splint comes in. While the daytime AFO is a rigid orthosis that keeps your child’s ankles from plantarflexing (pointing down) past neutral while he walks, the night time AFO is a much more dynamic system. Night splints can be adjusted as the ankles gain more range into dorsiflexion. They provide a low-load, prolonged-duration stretch that helps with contracture reduction and counters high tone.
  5. In the literature, night splints have been found to be effective for contractures at a variety of joints, and can be useful in brachial plexus injuries, cerebral palsy, and muscular dystrophy.

As pediatric physical therapists, we rarely recommend over-the-counter orthotics for your child’s orthopedic needs. By consulting with an orthotist, we make sure each child is fitted to the most comfortable and developmentally appropriate custom foot wear for his condition. Usually, children who adhere to a strict physical therapy program and who receive the right orthoses can see a complete change to their posture and gait mechanics in as short as 6 months’ time.

Click here to view our gross motor milestones infographic!

References:
Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline for management of idiopathic toe walking in children and young adults ages 2 through 21 years. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2011 Feb 15. 17 p. [49 references]