Child having trouble reading

Learning Disabilities or ADHD: Which Is It?

My child is disorganized, has trouble during homework time and following directions, and doesn’t seem to be reading like other kids his age…Is it ADHD or maybe a learning issue?

ADHD and learning disabilities often co-occur. In fact, about 1/3 of children with ADHD also have an additional learning disability. Sometimes parents might wonder if the ADHD is causing the learning disability or if the learning disability causing the inattention. The fact is that they are two discrete disorders with their own set of symptoms. It is true that some of the symptoms may be common to both disorders including:

–          Poor executive functioning
–          Lack of organizational skills
–          Inefficient use of strategies (mnemonic tricks, imagery, rhymes)
–          Behavior problems
–          Low self-esteem

Learning and attention problems are on a continuum ranging from mild to severe.  With the various overlapping symptoms and the fact that behaviors, that may be a result of a learning disorder, can look like ADHD, it can be difficult to distinguish between the two. Although they are both neurologically based, they are assessed and treated differently. A learning disorder (i.e. dyslexia, reading, writing, math) can affect the way that information is stored and relayed back causing a breakdown in information and learning.

Intervention for learning disorders may include the following:

–          Academic skills tutoring
–          Development of compensatory strategies
–          Self-advocacy skills
–          Implementation of an Individualized Education Plan (IEP) or other school accommodations

Although ADHD can interfere with a child’s ability for learning, it is often treated with the following:

–          Behavioral modifications
–          Family counseling and parent training
–          Modifications to the learning environment
–          Implementation of medication
–          Classroom accommodations
–          Executive functioning tutoring

Whether your child struggles with a learning disability, ADHD or both, parent support and education are important to help your child succeed. CHADD.org  is a great website that offers resources such as training and classes that help with parenting and discipline concerns.

Child scared of the dark

How To Deal With Nighttime Anxiety

Try these steps to reduce nighttime anxiety and improve compliance with evening time routine.

At the end of a long and exhausting day, how do you effectively transition your kids from the stimulation of the day to the peace and quiet of the night? Now, combine that tall order with nighttime anxiety. It would appear as though this would be more difficult, but there are simple strategies to integrate into the nighttime routine to reduce anxiety and increase overall compliance with this tricky transition.

1. During non-triggering times, talk with your child about what causes them to feel nervous or anxious with regards to bedtime. Are they afraid of the dark? A monster under their bed? A zombie in the closet? Identify with them what they are afraid of and then problem-solve with them ways to reduce their fear. If they are afraid of the dark, offer to keep their door open with a hall light on in addition to a nightlight. If they are spooked out about creatures living in their room, add an additional step before lights out to go through their room with them and search for these alleged monsters. When they see they are non-existent prior to bedtime and with support of their parent, they can feel more at ease going to sleep. Set up a plan with your child to eradicate irrational thoughts to facilitate more restful nights.

2. Begin the transition to bed earlier. If it takes a long time for your child to “unplug” and transition to bed, starting earlier can be helpful – even if it is just a conversation about starting the routine soon. If a child has anxiety about nighttime, the more advanced preparation and warning they have, the better. They can begin their thought-process and, in turn, anxiety-reduction process sooner to aid in a smoother transition. Create positive, self-coping talk that you can model for your child about bedtime such as “Sleep is important because it recharges us for the day,” or, “Bedtime is a chance for us to reflect on our high points from the day and set positive goals for the next day,” and, “Everybody sleeps.”

3. Integrate the use of a “worry doll” or “worry journal” that the child can externalize their fears and worries prior to bed to reduce rumination of irrational thoughts or fears. The worry doll can be a doll or figure that can hold the child’s worries while they are asleep. The child can tell the doll what it is worried about and clear their mind before bed. This can also present an opportunity for the parent to listen and hear what is concerning the child. If it is not appropriate for the child to have a doll (i.e. older child or male), encourage the use of a worry journal to either draw or write out concerns prior to bed. The journal will house the worries so the child can clear their mind and focus on positive, coping self-talk prior to bed.





Dyslexia

A Reading List for your Child or Teen with Dyslexia

 Many times, children with dyslexia are misunderstood. Dyslexia has nothing to do with intelligence, but when grades are low and reading skills are poor, the lines become blurred. This can often make kids feel insecure about their abilities. Dyslexia is quite common, so you and your child are not alone, although it may feel like it at times.

Here is a list of recommended books for children and teens from the Illinois Branch of The International Dyslexia Association:

“Books are the quietest and most constant of friends; they are the most accessible and wisest of counselors, and the most patient of teachers.” ― Charles William Eliot

Bauer, James. (1992). The Runaway Learning Machine: Growing Up Dyslexic.  Minneapolis, MN: Educational Media Corporation.

Barrie, Barbara. (1994). Adam Zigzag . New York, NY: Delacorte Press. (young teens)

Betancourt, Jeanne. (1993). My Name is Brain/Brian . New York, NY: Scholastic, Inc.

Blue, Rose. (1979). Me and Einstein . New York, NY: Human Sciences Press. (young teens)

Dwyer, Kathleen M. (1991). What Do You Mean I Have a Learning Disability?  New York, NY: Walker & Co. (elementary)

Fisher, Gary & Cummings, Rhonda (1991). The School Survival Guide for Kids with LD.  Minneapolis, MN:Free Spirit Publishing, Inc. (young teens)

Gehret, Jeanne. (1990). The Don’t Give Up Kid and Learning Disabilities . Minneapolis, MN: Raising Readers. (elementary to young teens)

Griffith, Joe. (1998). How Dyslexic Benny Became A Star.  Dallas, TX: Yorktown Press. (young teens)

Hayes, Marnell L. (1994). The Turned In, Turned On Book . Novato, CA: High Noon Books. (teens)

Janover, Caroline. (1995). The Worst Speller In Jr. High , Minneapolis, MN: Free Spirit Publishing. (teens)

Levine, M.D., Mel. (2001) Jarvis Clutch – Social Spy . Cambridge, MA: Educators Publishing Service. (elementary to teens)

Polacco, P. (1998). Thank You Mr. Falker . New York, NY: Putnam Publishing Group. (elementary)

Richards, Regina G. (2000) Eli: The Boy Who Hated to Write – Understanding Dysgraphia . Riverside, CA:RET Center Press.

Stern, M.A., Judith and Ben-Ami, Ph.D., Uzi. (1996). Many Ways to Learn: Young People’s Guide to

Learning Disabilities . New York, NY: Magination. (elementary to early teens) [audiotape also available.]

If you would like to have general information on any of the books listed here, you can search The National Library Service at www.loc.gov/nls. Click on “Search the Catalog:” and type in the book title orthe author’s name to do a search for a short description of the book. Many of these authors have published multiple books on Dyslexia and Learning Disabilities.

Child getting tutored

What Makes A Good Tutor?

It is quite common for a child in elementary school and junior high school to have an academic tutor. Parents often ask us what we recommend for a tutor. What characteristics, what training is needed, etc. It is impossible to give a patented answer for these questions. The characteristics and qualities of the tutor really must be dependent upon the concerns presented by the child.

If a child presents with a learning disability such as dyslexia, it is vital that the tutor have specialized training in an intervention for that issue. Remedial support to keep the child ‘afloat’ in class simply will not cut it. If the tutor indicates that they utilize a specialized approach to tutoring, parents should always ask the individual if they are certified in that approach. The certification will at least provide the bare minimum standards that the individual received quality training.

If the child does not present a learning disability but is struggling with learning concepts and material in the classroom, it would be recommended that he or she work with a tutor that actually knows the curricula. The first place the parents should turn is the school. Many times teachers within the school provide outside tutoring or at least the school can provide a list of tutors that they would recommend.

If the main concern is a nightly battle between the parents and the child, I have made the recommendation of hiring a high school student to come and spend an hour or so a day with the child to help with homework. This way the stress of battling with your child is taken away.

Packed tutoring programs may be beneficial for retention of skill sets. These might prove best to be implemented over the summer.

Overall, the type of tutoring and amount of intervention needed truly depends on the child as well as what the concern and need for intervention is.








What a Diagnosis of Cerebral Palsy Means for Your Child

For new parents whose children are diagnosed with Cerebral Palsy (CP) and parents whose children with CP are nearing school age, understanding the diagnosis, prognosis, and the interventions available is often their top priority.  Being a first-time parent is challenging enough, and for many parents looking for answers, a medical diagnosis provided by a doctor often leads to more questions.

What having Cerebral Palsy means for your child:

Cerebral Palsy is a broad term used to describe a neurological condition that impacts physical functioning in children. The presentation of CP in individuals affected is highly varied in terms of severity, symptoms, and deviation from typical development.  The condition itself is explained by a brain lesion that occurred in utero or around the time of birth (such as an in-utero stroke, brief oxygen deprivation before birth, or a birth trauma to the young brain).   The neuromuscular system is affected, leading to motor impairments that hinder a child’s voluntary muscle control. Put simply, a child’s ability to control his trunk and move his body parts become limited.

Muscles and our brain’s ability to control them are a huge part of our physical function, from our vision and speech, to our sense of balance. This impaired control and coordination of voluntary muscles affects children in a variety of ways, depending on the location, timing, and severity of the brain lesion.  Much like a brain injury can affect a mature individual’s ability to control his limbs, a lesion in the immature brain often leads to decreased postural control and delayed physical development.  The lack of motor control is not always, but is often correlated with cognitive delays and learning disabilities, speech delays, visual or auditory impairments, and seizure disorders.

There are many misconceptions in the general community about children with CP.  Many people think CP is associated with mental delays and poor independent functioning. This is simply not the case for everyone with cerebral palsy.  Cerebral Palsy is often classified in different ways based on the movement disorder (stiffness, rigidity, low tone, uncontrollable movement, etc) observed. No matter the diagnosis or presentation, a team of healthcare professionals is absolutely essential to improve the lives of children and families affected with cerebral palsy.  It is important to begin a treatment program as early as possible to ensure a child develops to his or her full potential.  Sometimes, a child with CP may need surgery, orthotics, assistive technology, early intervention therapy, or medications, to improve their function and independence.

The role of the physical therapist:

One of the first steps to take after receiving a diagnosis of cerebral palsy is to discuss with your pediatrician and your child’s medical team about the interventions currently available and the interventions needed long-term. Often times, physical therapy becomes an indispensable part of a child’s medical care. Physical therapists will develop a plan of care based on the child’s abilities.

Our goal as physical therapists is to improve a child’s independence by doing the following:

  • Teaching him to move and play while protecting his joints from abnormal movements/postures
  •  Helping him strengthen muscles that are weak, keep stiff joints mobile, and stretch out muscles that are tight
  •  Fitting him for special equipment to help him stand, walk, and participate in school and life activities as needed
  •  Working with his family and caregivers on adaptive techniques and changes to their home or school environment, to allow him to interact with other children and participate in daily tasks
  •  Addressing his limitations and movement disorders by improving his posture, walking mechanics, endurance, and pain
  •  Accommodating for his changing needs as he matures and as new challenges arise, and
  •  Providing the child and his family emotional support, healthcare references, and professional insight to help him transition into adulthood.

Every child with cerebral palsy develops differently. The importance of early therapy is to help a child live up to his full potential with this neurological condition.

Reference: Olney SJ, Wright MJ. Cerebral palsy. In: Campbell SK, eds 3. Physical Therapy for Children. Philadelphia, Pa: WB Saunders Co, 2004 :625-664.

How Do I Know if My Child Has a Reading Disability?

Reading Disabilities are estimated to occur at a prevalence rate of 5-10%.  A disability, which is a more chronic struggle with reading without early identification and intervention, must be differentiated from the child who demonstrates a slower process in the normal developmental curve of reading development.  A disability will not resolve with repeated practice, extra attention, or the passage of time.  Below are a few clues to help figure out if there really is a disability.

Clues that Indicate Your Child May Have a Reading Disability:

  • Your child has difficulty with basic rhyming.
  • Your child has always been slow to learn the alphabet and maybe even numbers.
  • Your child struggles with sound-letter associations.
  •  Your child’s writing is illegible.
  • Your child likes to be read to but never wants to read.
  • Sight words, despite repeated practice, are easily forgotten by your child.

At times, differentiating between a disability and other factors (e.g., attention, motivation and interest, or behavior) can make accurate identification difficult.  An evaluation can help tease apart any related factors that may be impacting your child’s success.  If you are concerned with your child’s reading development, you can request an evaluation through our Neuropsychology Diagnostic Clinic.  We have clinicians trained in the diagnosis and assessment of reading disabilities and are able to provide efficacious recommendations to best help your child.
Click here to read about signs of a reading disability across grades.


Turn a Bully Into an Ally

What is one seemingly positive characteristic of a bully?

Great leadership skills. They can gather a group of followers and move in a pack to accomplish a lot.  Most bullies use this skill for negative outcomes, but think of what good could be accomplished if we taught bullies to use this strength for good?

We need to teach bullies that great leaders have certain qualities.  Bullies can be taught that they are great leaders, and great leaders use their leadership skills for good.   The bully can be taught this by the assignment of positive leadership tasks.  For example, assign the bully to a time of day to make sure each and every kid is taken care of.  At lunch, the bully ensures each child has food and is not eating alone. If she is, charge the bully with finding a solution.  At PE, have the bully ensure each girl is picked first on a team at least once and gets to be team captain at least once.

Once the bully feels the power of leading for good, she may just become one of the best leaders and members of the class.  Make strong powered kids into true positive leaders and see more leaders and team players blossom!

For more on handling bullies, read Mean Girls and bullying Boys: How Parents Can Help, and How to Include Bullying In Your Child’s IEP.

The Basics of a Math Disorder

Mathematics is much more than adding and subtracting.  In reality, there are several factors and components that compose a child’s mathematics achievement.  Children’s mathematics skills are found to develop in a hierarchical fashion.

Stages of mathematics development:

  • The first stage of mathematics development is observed in young children and consists of skills such as understanding of one-to-one correspondence, classification, seriation, and conservation.
  • After theses skills are developed, children are able to learn addition, subtraction, multiplication, and division.
  • Finally, after these skills are developed, advanced skills such as algebra and geometry are able to be learned.

Teachers can watch to see if these skills are developing as they should be.

Once teachers have identified a child as struggling with mathematics, one or more of the following factors would likely need to be addressed:

  • Visualspatial skills
  • Linguistic abilities
  • Working memory

Visualspatial skills are necessary for aligning numerals in columns for calculation problems, understanding the base ten system, interpreting maps, and understanding geometry.  Linguistic skills are needed when performing word problems, following procedures of how to carry out operations, understanding math terminology, and knowledge of math facts.  Working memory capabilities are used for the manipulation of numbers and operations.

From here with a plan from the teacher and/or a neuropsychologist, the student can get back on track with his or her math skills.

Click here for more information on Learning Disorders.

What is Co-Treating?

You may have heard your therapist say, “I think a co-treat would be a great option for your child!” But what does that really entail? Will your child still be getting a full treatment session? Will his current and most important goals be worked on? Will he benefit as much as a one-on-one session? When a co-treatment session is appropriate, the answer to all of those questions is…YES!

What is a co-treatment session?

Co-treatment sessions are when two therapists from different disciplines (Speech Therapy (SLP), Occupational Therapy (OT), Physical Therapy (PT), etc.) work together with your child to maximize therapeutic goals and progress.

When is a co-treatment session appropriate?

When the two disciplines share complimentary or similar goals.

EXAMPLE: Maintaining attention to task, executive functioning, pragmatics, etc. Playing a game where the child needs to interact with and attend to multiple people while sitting on a stability ball for balance. [all disciplines]
*When children have difficulty sustaining attention and arousal needed to participate in back-to-back therapy sessions.
EXAMPLE: Working on endurance/strength/coordination while simultaneously addressing language skills. Obstacle courses through the gym while working on verbal sequencing and following directions. [SLP + PT or OT]
*When activities within the co-treatment session can address goals of both disciplines.
EXAMPLE: Art projects can address fine motor functioning as well as language tasks like sequencing, verbal reasoning, and categorizing.
*When a child needs motivations or distractions. [OT + SLP]
EXAMPLE: Research has shown that physical activity increases expressive output. Playing catch while naming items in category or earning “tickets” for the swing by practicing speech sounds.  [PT or OT + SLP]
EXAMPLE: PT’s need distraction for some of their little clients who are working on standing or walking and working on language through play during these activities works well. [PT + SLP]

Why co-treat?

  • Allows therapists to create cohesive treatment plans that work towards both discipline’s goal in a shorter amount of time.
  • Allows for therapists to use similar strategies to encourage participation and good behavior in their one-on-one sessions with the child.
  • Allows for therapists to collaborate and discuss the child’s goals, treatment, and progress throughout the therapy process. Together, they can consistently update and generate plans and goals as the child succeeds.
  • Aids in generalization of skills to different environments, contexts, and communication partners.
  • Allows for problem-solving to take place in the moment. For example, an extra set of hands to teach or demonstrate a skill or utilizing a strategy to address a negative behavior.

Co-treatments sessions can be extremely beneficial for a child. There are endless ways therapists can work together to promote progress and success towards a child’s therapeutic goals.. However, co-treatments may not always be appropriate and are only done when the decision to do so is made collaboratively with the therapists and the parents.

Contact us for more information on the benefits of co-treating in therapy sessions.

Talking to Children about Their Learning Disorders

As we all know, children are very inquisitive and ask questions all the time.  Children with learning disabilities are often pulled out of their main stream classroom, attend after school tutoring, or receive accommodations and interventions within the mainstream setting.  Parents and schools are often quite good at identifying the needs of children; however, at times are at a loss of how to approach the topic to children.

How to talk to a child about his learning disorder:

There really is no easy answer as to how to discuss learning disorders with children.  This depends on the child’s age, maturity, and ability to comprehend and understand information.  If the child starts to ask questions about why he or she is being pulled out of class or receiving work different than his or her peers it is most definitely time to discuss this with the child.  What I would recommend is to focus on the positive.  Indicate that everyone learns differently and everyone has things that they are really good and things that need a little work.

One technique that I have used in my clinical practice to explain services to children is to compare it to other medical/health issues.  (e.g. if I told you that you had a vision problem you probably would go and get glasses; if I told you that you had a hearing problem, you might get a hearing aid; so you have a weakness with learning to read so we are going to find someone to help out with that).

If the child is older I always believe it is best to be proactive and inform the child before services begin.  Let the child know what will be happening with services and accommodations in the school.
Overall, it is always best to keep the child informed about services and accommodations.  Focus on the positive and remind the child that everyone learns differently.

Click here to learn more about learning disabilities.