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
Epilepsy brain

Diagnosing and Treating Epilepsy

 

 

Epilepsy is diagnosed when the child experiences two or more seizures with no known cause (e.g. no significant illness, no known fever, or no known physical hit to the head).  Epilepsy is fairly common and it is estimated that 1 in 26 individuals will develop epilepsy over their lifetime (Epilepsy Foundation of America, 2014).

Seizure activity is typically identified by characteristics of an electroencephalogram (EEG).  An EEG is when the individual has several electrodes placed on their head which measures electrical activity.  Seizures are identified by having sudden changes in electrical activity in either the entire brain or specific regions.

There are two main types of seizures with several subtypes underneath them.  Generalized seizures are when there are abnormal
findings on an EEG in all parts of the brain at the same time.  Children who exhibit generalized seizures will lose consciousness.  Partial seizures are when there is limited EEG findings to only one single area in the brain.  Children with partial seizures typically do not lose consciousness.

Epilepsy brainThe usual front line treatment of epilepsy is pharmacological intervention.  Some children do not respond to the anti-epileptic medications and may require surgery to help address seizure activity.

There are numerous cognitive and academic concerns associated with epilepsy.  There is some indication that IQ can be effected by seizure activity.  It is hard to classify specifically what effect there might be with IQ as research has indicated that seizure location as well as age of onset of seizure activity have a major impact on changes in IQ.  Studies have indicated that memory, attention, and executive functioning are often impacted by seizures.  Research has also indicated that children with epilepsy have a much higher rate of special education services for learning issues in the school setting.

It is important that if a child has epilepsy, a comprehensive evaluation be conducted in order to monitor IQ, academic achievement, attention, executive functioning, and memory in order to ensure that he or she is receiving the most efficacious interventions in the classroom setting.
Yeates, Ris, Taylor, & Pennington (2010), Pediatric Neuropsychology: research, theory, and practice

Hunter & Donders (2007), Pediatric Neuropsychology Intervention

Emotional boy

Getting Help For Your Child’s Emotional and Behavioral Needs

As a parent you may have difficulty deciding at what point you may need to seek therapeutic intervention for your child’s emotional and behavioral needs. When a child goes through the different stages of development, they can often experience conflict and challenges as they achieve new milestones, confront new situations and encounter new demands. It can be common for children to have emotional ups and downs and feelings of anger, sadness and disappointment in response to these new experiences and significant life events.  A child’s reaction to these different circumstances can range from mild and short lived to severe and long lasting. When your child’s problems and emotional/behavioral concerns do not resolve themselves and they appear to be affecting your child’s everyday functioning at home, school or with peers, it is time to seek outside help. It is also important to know that significant life events like losing a parent, the loss of a pet, moving to a new area, experiencing a trauma or going through divorce can trigger concerns that may be indications that therapeutic support is needed.

Ask yourself the following questions:Emotional boy

How is my child functioning at school, at home or with peers?

How often does this behavior occur and how long does it last?

Has there been a recent change or a new stressor in my child’s life?

Do I or my family find that we are walking on “eggshells” all the time when we are around my child?

Is my child meeting developmental milestones? (See our infographics and resources to learn more)

Look for warning signs:

  • Extreme difficulty separating from primary caregiver
  • Withdraws from primary caregivers
  • Ignores other children or isolates self from group
  • Does not initiate or participate in activities
  • Difficulty with transitions from activities on a regular basis
  • Difficulty expressing a wide range of emotions
  • Excessive fears of being alone
  • Difficulty with transitions between activities
  • Overly aggressive behavior, i.e. biting, hitting, kicking
  • Excessive crying and difficulty self-soothing
  • Problems sleeping, i.e. refusing to go to sleep, nightmares
  • Behavioral problems, i.e. refusal to obey adults (will not follow rules or listen to directions) and poor self-control

If you feel like your child exhibits some of the above behaviors and these behaviors are impacting their ability to function and be successful at home, school or with their peers make sure to talk to your pediatrician or a local mental health provider for support. If your child has expressed a desire to harm himself/herself or another person your child may need more serious interventions and should contact 911 or take them to the nearest emergency room to be assessed for mental health services.

 

More helpful resources include:

Center for Disease Control and Prevention:  Learn the Signs. Act Early

        PBS Parents- Child Development Tracker 

Autism ribbon

The Diagnostic Transformation of Autism

 

 

 

The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V) brought about many changes in psychiatric diagnosis.  Among them, the criteria used to diagnose Autism underwent a number of alterations.  To begin, the previous manual (DSM-IV TR) outlined three Autism diagnoses: Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.  With the most recent edition, there now exists only one Autism diagnosis: Autism Spectrum Disorder.  The “spectrum” has certainly widened and is supposed to be used to describe those who are nonverbal to those with only mild Autism ribbonsymptoms.

Now more than ever, a thorough and careful evaluation is needed to determine whether a child meets criteria.  This begins with an extensive interview including the child’s history (medical, developmental, social, language, play, and behavior), a detailed description of current concerns, observations across a minimum of two sessions, and a collection of objective data (testing, parent questionnaires, teacher surveys).  Consideration of alternative explanations for a child’s presenting concerns is also done, including cultural and social factors.

A year after its inception, the consequences of the diagnostic changes are still taking shape.  From a personal clinical experience, the new criteria makes diagnosis more specific.  Where before, criteria may have been liable to greater subjectivity, attempts to resolve this in the new edition have been made and we are defining Autism with ever greater clarity.

 

Autism graphic

Intervention For Autism Spectrum Disorder

After a child has been diagnosed with Autism Spectrum Disorder, parents are often at a loss as to where to go or what to do next.  It is important that parents are informed about treatment choices and utilize empirically supported interventions in order to provide the child with the best possible outcome. Applied Behavior Analysis (ABA) therapy is a research-supported approach to intervention that focuses on improving positive behaviors while extinguishing negative behaviors.

Autism graphicThere has been bad press regarding ABA therapy such as that the focus of the therapy is solely on punishment.  In reality, ABA therapy focuses on positive reinforcement of behaviors with a minimal use of punishment.  Punishment of any kind should only be implemented in specific situations in which the child is in danger of hurting himself for someone else. The amount of ABA therapy varies and is completely dependent upon the child’s needs.

Therapy is often implemented in the home, school, and clinic settings. Oftentimes children with a diagnosis of Autism Spectrum Disorder present with language concerns; either expressive language (ability to express themselves) and/or pragmatic language (which is their social language).  These children often benefit from speech and language therapy in order to develop these skill sets. It is also quite common for children with a diagnosis of Autism Spectrum Disorder to present sensory concerns; either they avoid certain sensory modalities or actively seek out various sensory inputs.  Occupational Therapy can often help provide strategies for children, parents, and academic staff as to how to better deal and cope with these sensory concerns.

The treatment of Autism Spectrum Disorder cannot be done in isolation.  The majority of children with such a diagnosis would require a multidisciplinary treatment approach.  It is vital that all care providers are on the same page and meet routinely to ensure that the child is making progress.

Girl leaving for college

Navigating College with Autism

More than ever before, higher numbers of teens with Autism are attending college.  Reasons for this increase are related to enhanced recognition of the condition (and therefore diagnosis) as well as greater access to early intervention services which we know creates better outcomes later in life.  Autism or not, the transition to college can be challenging.  Leaving home for the first time and adjusting to a completely new environment is nothing short of overwhelming.  Despite the expected challenges, students with Autism are finding success in college and beyond, with just a little extra attention to their needs.

The following tips will help this transition:

  1. Girl leaving for collegeWhen selecting a university, it is important to consider a number of criteria about the university itself, including: campus living options (single room or double), campus and student population size, class size, community supports, technology, transportation, and learning center resources.  Schedule a visit to see the campus and get your questions answered.  The right fit between a student and school can make all the difference.
  2. Develop life skills needed to live on campus: reading maps and navigating directions, accessing public transportation, managing money, doing laundry, organizing time, and making or purchasing healthy meals.
  3. Work with a tutor to help create a good study schedule and habits.
  4. Work with a counselor to help manage anxieties and depression, to provide encouragement in building social supports, and assistance in maintaining a balanced, healthy, and fun lifestyle.
  5. Know yourself and how to self-advocate.   For example, request that bright lights in your room be replaced, wear headphones to block out noise, avoid larger-class sizes, and do not overwhelm yourself with an excessively rigorous schedule.
  6. Ask for help.  Do not be afraid to reach out in times of need.  Rather, know your supports and use them.
Child being told to be quiet

Working With Parents Regarding Behaviors at Home

One of the major stressors that parents have to deal with on a daily basis is negative behaviors.  Negative behaviors can take the form of  non-compliance, physical aggression, and/or verbal aggression.  Behavioral management focuses on increasing on-task behaviors (e.g. behaviors parents want the child to engage in) while extinguishing off-task behaviors (the negative behavior).   Below are some bullet points that are important for parents to realize about behavioral management.

  • Child being told to be quietNegative behaviors always increase in intensity when being modified or extinguished.
  • Focus should almost always be on positive reinforcement of appropriate behaviors
  • Punishment only utilized when behavior is dangerous to the child or others
  • Reasons for failure of reinforcement systems

o   Too confusing; if we as adults do not understand them, then the child of course will not

o   The wrong behavior is being addressed

  • Goals need to be attainable

o   Child and parent have to see that the system will work

o   Slowly increase demands

  • Never take away a reinforcement that a child earned
  • The reinforcer will constantly change

o   What is rewarding today for the child will likely be different in the near future

Behavior almost always can be modified.  It is important for parents and professionals that are working with the child to understand that, in order for a behavioral reinforcement system to work, there needs to be consistency with the approach.   The idea is to set realistic and measurable goals and constantly identify how much improvement is exhibited.

Messy room

Time-Out Gone Wrong: My Child Destroyed Their Room!

For some children, especially older ones, their bedroom is the most logical place to spend a time-out.  Careful that it is not overly reinforcing with a computer, videogame devices, phone, etc.  And what happens if they trash their room?  First, no emotion from you.  Bite your tongue, walk away, do whatever you need to do to not show your absolute fury.  And then?  Let them live with their mess.  Give them a few days and talk to them about what happened (when you are both calm) and offer to help get things back in order.  Yes, you did not have a part in its destruction but children, even older ones, have a difficult time initiating this job because they do not know where to start and have not yet developed the organization skills. Messy room

If the thought of standing by while your child trashes their room makes your skin crawl, try these alternative consequences to a time-out:

  1. Early bedtime
  2. Removal of a privilege (phone, TV, videogame, having a friend over).  Make it as immediate as possible for optimal effectiveness.
  3. Give an unpleasant chore to be completed that day or evening

Time-outs and privilege losses are not meant to be punishing in and of themselves.  While your children may not realize it in the moment, they are learning an important lesson in emotional regulation and how to cope with real-life situations.

 

Phelan, Thomas. (2010). 1-2-3 Magic: Effective discipline for children 2-12. Glen Ellyn, IL: ParentMagic, Inc.

 

Child misbehaving in school

Behavior In The Classroom

Many times children with behavioral concerns, attention issues, emotional concerns, or learning disorders will exhibit negative behaviors within the classroom setting.  Behaviors, by nature, are reasonable and driven by some factor.  The majority of the time, there is a purpose and a reason as to why a child engages in a negative behavior. What this indicates is that it is vital to figure out what the driving force of the behavior was as well as what the consequences of the behavior are.

If a parent or teacher has significant concerns about a child’s behavior, it is truly important to figure out what is going on.  Many times in these situations a Functional Behavioral Analysis (FBA) is required.  An FBAis when some behavioral specialist with the school will go and observe the child over several days and several times during the days.  The individual will first identify the percentage of time the child is off task in comparison to a few peers.  It is always important to have the percentage of off task behavior with several other children in the classroom.  This way there is anecdotal data indicating that child ‘X’ was off task xx% while the other children on average were off task only xx% which could indicate that the child in question actually is off task more than peers.

Child misbehaving in schoolOnce off-task time is established the focus is then on identifying the antecedents and consequences of the behaviors at hand.  There almost always is a driving force (the antecedent) which causes the behavior.  In addition, there usually is a reaction, either positive or negative (consequence), which results in increasing the likelihood of the behavior in the future.

Once the FBA has concluded and information has been disseminated to the team, the next step is to create an action plan to decrease negative behaviors while increasing positive, on-task behaviors.  This is when a functional intervention plan is created.  This plan utilizes the data created by the FBA to set up reinforcement of on-task behaviors, identify triggers and situations that might increase the negative behavior, and set up manageable goals.  A goal must be manageable and attainable.  For example, if a child is off task on average 80% of the day, a goal of being off task 10% of the day would be unrealistic.  What might be established is that with reinforcement and behavioral management, the goal for the first few weeks would be that the child is off task only 70% of the day, then slowly decrease it until the goal is consistent with the amount of time that the rest of the class is off task.

The take home message about behavior in school is that in order to change behavior we have to first identify what the behavior we want to change is, how often it occurs, and why it occurs (what triggers it and what does the child get out of it).