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Accomodations No. 4: Fidgets

Dec 7, 2018

Fidgets are an important part of managing or physical restlessness. But, they have to be "respectful" fidgets. Check out Fidget to Focus. It will give you many great ideas. But the short version is that your kids (of your) fidget needs to be something that isn't visually or auditorily distracting to everyone else. I would love to click a pen all day, but that would drive the rest of the world nuts. Something simple like a squeeze ball or a piece of putty are great. Even a paperclip or a piece of string can work. I would suggest having a variety of things in the school bag to rotate through so your fidgety-ness doesn't bet bored. 

For artistic kids, doodling can be a great option. I think I've mentioned this in a post before, but that won't stop me. I have a client who's in middle school who is quite the artist. We used to meet in person and I always let her doodle while we were meeting. She would be staring down at her paper, not making eye contact. But I could tell she was paying attention. And, I don't think I ever asked her a question and she wasn't present with the conversation. Many teachers, parents, and neurotypical people find this rather disconcerting. I would suggest they got over it. If an artistic kid focuses better while drawing, let 'em do it. 

Lastly, when doing homework on one's own fidgets can be a little less respectful and on a larger scale. I had an instructor at my coaching school who told us that he never finished a book in his adult life until he realized how kinesthetic his learning style was. He realized that he could read if he was actively rocking in a rocking chair. Now he blows through books and enjoys them.

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Accomodations No. 3: Preferential seating

Nov 30, 18

Preferential seating is often offered, but in  very specific sense. Usually it meas front row center. This is great in some respects, but other options are better for other types of kids. For example, those of us who benefit from movement, might be better off on the side of the room with the understanding that it would help us to stand up at certain time during the class. I always liked to be up front but by the side so I could go for a walk without feeling like I was disrupting class. When I take classes, go to conferences, check out lectures at this point in my life, I prefer to grab a seat in the back and end up either standing up for much of the session or even sitting on the ground in the back to afford me the most possibility of moving around. 

My point is that most kids could benefit from targeted seating, but that might not be the same for every kid with ADHD. It may even vary from class to class. And, it may be somewhat depending on who else in in the class and how long it is. Think it through with your kids. They might have an insight into this that you wouldn't have thought they'd have.



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Accomodations No. 2: Extended time for assignments, not just tests

Nov 23, 2018

Pretty much everyone gets extended time for tests as a standard accommodation. But there are some nuances to think about. 

First, many systems require the student, even young students, to ask ahead of time for extended time. Why? I don't know. I always had access to extended time. I couldn't tell you how often I used it but it wasn't all the time. So how was I supposed to know? This also puts a lot of pressure on kids who are reticent to be open about their accommodations to ask the teacher in front of the class for the extra time. It also puts pressure on kids who are somewhat conflicted about the idea of accommodations to take their time. Maybe they can finish but only if they rush? Lastly, I think it's important to make sure the how and where of finishing is ideal for the student. Some teachers are worried about the integrity of the test. I guess that's reasonable. But I have yet to meet a criminal mastermind who's using the accommodations to game the system. 

I guess I'll throw this in while we're on the subject of test taking. A quiet supervised environment outside the classroom might be best. Allowing the student to wear noise canceling headphone, and maybe even listen to music. 

But the real crux of this post is that ADHD kids will often need extended time in on assignments, not just tests. On one level, this is important because the ADHD kid is usually fighting through organizational and other EF challenges just to get to the place where they can complete the work. It is also important because most of us take longer to complete much of our work due to attentional challenges and/or slower processing speed. But, fundamentally, the challenge is the sheer quantity of work most students face. There is always an issue with the allocation of resources. whenever I do a speaking engagement I ask the parents how many of them have 6 different bosses who assign them work independently, without consulting each other? No one ever raises their hand. My brother-in-law is the closest. As a lawyer he is always juggling many cases, but rarely more than a few at a time. The point being that it just may not be possible for an ADHD student to get everything done on time even if time and attention are managed optimally. I spent most of my school vacations catching up on papers. I never took advantage of it and seem to have turned out fine.



Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.


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Accomodations No. 1: Competency based grading

Nov 15, 2018

After my epic, cathartic, and very personal post from last week, I'm going to do a few weeks of quick tips around the holidays. I'll start with a few on standard and not so standard accommodations for students with ADHD. The first is my favorite, though not so standard: Competency based grading. 

For someone who processes slowly, has limited attention, and who's kryptonite is boredom, doing 30 math problems every night is a problem. Especially since I was an English/History kind of kid, math also wasn't my priority once I got to high school. My theory was always that I shouldn't have to be tortured by all those problems if I knew the material already. (Of course that's the key, knowing the material.) I figured if I could do the last five questions or the last one in each section, I probably knew my stuff. As it turned out, my performance on tests bore that out. Therefore I wouldn't be graded down for only doing a part of the homework if I demonstrated reasonably mastery of the material. 

No system that I'm aware of offers this and they usually fight it. They really cling to the idea of homework being integral to the learning process though many studies demonstrate the opposite. The have some idea that as ADHD kids we are trying to get away with something, like it's not fair if we do less homework. Frankly, I think it's unfair that my homework takes me twice as long as my intellectual peer sitting next to me. The school doesn't seem to have a problem with that though. Anyway, ask for it if your kids need it. It can make a big difference.



Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.


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Protecting our most vulnerable

Nov 9, 2018

This is a pretty personal thought... not that my blog is usually clinical and objective... I mentioned a few posts ago that my 4 1/2 year-old was diagnosed with Bipolar disorder and started medication. I'm sure someday she'll be mortified that I have put these thoughts on the internet for eternity. But that's how important I think this discussion is. So here goes.

When I say that my daughter's behavior was tearing our family apart, it is only a slight exaggeration. I was constantly on edge and yelling way more than I wanted to. My wife ended many a day in tears. And, my son, God bless him, was not getting the attention that he needed and had to walk on eggshells in a way that a nine-year-old shouldn't. This had been going on for at least a year. 

But there was no one symptom/behavior that you could point to and say, "that's not right." All kids have tantrums. All kids are unreasonable sometimes. Many kids have sleep issues. Many kids have separation issues with their Moms. Lots of kids struggle with eating real food. Some kids struggle following the rules at school. And, some kids are stubborn and defiant. But when you put all of those things together in one kid....? But what's the deal?

So as part of my continuing education in to ADHD for my career, I attend a three day conference every two years through MGH psychiatric academy called ADHD through the lifespan. The March 2017 conference had tremendous session sessions on ADHD and accompanying conditions. I learned a tremendous amount about dyslexia, tourettes, and bipolar—particularly pediatric bipolar. I had had this presentation in the back of my mind for a year-plus in regards to my daughter. But whenever I mentioned it, which wasn't often, everyone thought I was nuts because she was only 4. But I knew there was something wrong. 

We started out very conservatively. We were in contact with her wonderful pediatrician .We had her evaluated at a the Think Kids program at MGH. We got her a neuropsych. I read most of The Explosive Child. She does therapy once a week at school. And, we tried just about everything we could think of while maintaining a positive parenting mindset. And through the course of a year or so, nothing really worked. I finally decided it was time to take her to see my doctor. It just so happens that I have a world class doctor who I've been seeing for 30 years. Back then he was the one who was aggressive and adept with my medication. He got me the help that I needed when it was perhaps beyond the cutting edge to give a 10 year-old the amount of stimulants that I needed. He is already managing my son's ADHD and anxiety very effectively. 

In advance of our intake I had to fill out the standard questionnaires which amounted to 45 minutes to an hour of filling in computerized bubbles about her behavior. But, I reflected on those bubbles for the many weeks until our appointment date. I just didn't feel like they were asking the right questions to evaluate my daughter. Like I said, it was about the "constellation" of her symptoms/behaviours. It was actually hard to articulate. I just didn't feel like anyone other than my wife and my daughter's teachers really grasped the enormity of her issues. If I didn't have the knowledge that I had from that conference and the determination of a junkyard dog, it would have been easy to believe that I was going crazy or blowing it all out of proportion. Luckily, I'm a persistent son of a gun. So, one night when my wife had the kids at an event that I didn't need to go to, I sat down to write a quick bullet point email to Dr. B. about what I saw as the issues.

1,400 words later I had an email that was so thorough I was actually embarrassed to send it. But I did. To make a long story short, I saw Dr. B. a week or so later for myself and he said that everything I wrote was, "textbook bipolar." This was a tremendous relief to me. Not only did it validate my thinking and pretty much prove that I wasn't crazy; It was an answer! I like answers. I like having a thing that I can attack. Of course everyone else in my life freaked out. My wife cried. My dad swore. My mom consoled me. But I felt better already.

Fast forward to a few months later. My daughter had her intake. She started a liquid form of an atypical antipsychotic med the next day. (Antipsychotic is a scary word. But Abilify is approved to treat several mood disorders.) It is safe, has a low side effect profile, and is pretty effective. And, it works very quickly, unlike, say and SSRI. She was on .5 mg for two weeks and now has been on 1mg for almost a week. Almost immediately she is like a new kids. She generally only has one tantrum a day. She recovers much quicker. She is, all of a sudden, a model kid at school. She randomly tells me that she loves me. She falls asleep at her bed time. And, she is often fun to be around. 

My props to you if you are still reading this. And, I hope you are because this is the point of the whole post. I have two important takeaways from this process. Or maybe they are the same takeaway viewed from different angles. It was not that long ago that the psychiatric community refused acknowledge that pediatric bipolar was even a legitimate diagnosis. It took a real maverick to diagnose a kid at all, let alone a 4-year-old. In fact there aren't actually any studies on Abilify in anyone under six. I am tremendously grateful for the second time in my life to have access to Dr. B. It is a shame that not everyone has access to such talented psychiatric support.

But I think there is a fundamental question that we need to ask ourselves as a society. What are we doing to protect the most vulnerable members among us? The establishment errs on the side of not treating children. Now, I don't necessarily disagree with that approach. We have to be very careful about medicating our kids. We need to be very cautious about how young they are when we address their issues pharmacologically. But, in certain cases, we do more harm by not treating kids just because they are kids. My daughter was in pain. She was wildly out of control. It was affecting her academically, socially, in her family, and in terms of her self esteem. After reading my letter and talking to me and my wife Dr. B. said, "it would be irresponsible of me to tell you to go home and come back in six month." 

I don't know what the answer is. There is no cut and dry way to look at psychiatric treatment of kids. But I know that my daughter needed help and I could not be more grateful to have access to a doctor who understood that and wasn't afraid to act. 



Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.



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More schedules!

Nov 2, 2018

If you are among the small cadre of people who read my blog regularly, you may be sick of my schedules... or maybe not. But I try to post one every few months so that everyone has something to refer to when I talk about scheduling. Since this is not groundbreakingly new stuff, I'll be brief. 

This was a Saturday when were were having people over for dinner. We were going apple picking in the morning, stopping at a farmers market on the way home and doing our food shopping. The plan was to get a workout in before I had to start cooking for the dinner party. As I've said in the past, I don't make a schedule every day. At this point, I'm pretty good at rolling through my day without writing it down. (Years of practice my padawans.)But on this particular day, there were lots of moving parts, many transitions, and I had to actually write it down to see if/how it would all fit.

The schedule was tight but it looked like it all fit... barely. In fact everything moved just a bit slower than anticipated and I forgot to account for putting the groceries and the apples away. Ultimately, I decided not to work out. (A decision that I rarely make. But in this case I prioritized having the meal mostly done when company arrived so that I could take full advantage of a chance at social interaction, which is also a priority for me.) I'm posting this particular schedule because it is very simple and straightforward. Maybe you wouldn't think a day with this few things would need a schedule. I needed one!



Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.

More schedules!

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