I may have more accomodation posts, but I wanted to talk about the importance of a medication journal today. What, you may ask, is a medication journal? It is just a record of medications, dosages, changes, and symptoms. Finding the right medication is usually a process of trial and error. I think this is especially the case with ADHD meds. Or, perhaps I should say that the changes and effects happen so rapidly and there are so many options that the number of changes in a short period of time can be extensive.  I’ve been on the same stimulant regimen for almost 20 years. So there isn’t an issue there. My current antidepressant gets adjusted from time to time, but that’s only one variable and the effects are pretty obvious and rapid. My son’s meds are also pretty straightforward. So I’ve never really needed to keep track of them in a detailed matter. My daughter is a whole ‘nother story. I won’t get into detail about her journal, as it’s kinda personal. But it did prompt me to write this. So let’s start with the macro. Especially with our kids, who are constantly growing and changing during the period of time when we are responsible for their meds, it is extremely important to keep track of what meds, what dosages, what age/size, when, and for how long. Often parents will tell me, “he took Stimulant A when he was in 3rd grade but I don’t remember how much and I’m not sure why we stopped that one.” This is not meant to criticize those parents. In the moment things seem so obvious and memorable, but six years later when that kids is in 9th grade, how likely is anyone to remember all the details. Specifically, one reason this is important is that…

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…

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.

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…

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…

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…

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.…

I was going to write about something else today but while going through my mail I finally read an article my dad sent me from the Boston Globe magazine from August 12th. (That about puts into perspective how busy I am.) Turns out it was great. It is entitled “A field guide to happier parenting” by KJ Dell’Antonia AUGUST 07, 2018. I would suggest reading the article before you read my commentary. Happier Parenting Article I like to think that I do most of this stuff and encourage my wife to do the same. After all, I am a life coach. The catch is that parenting kids with issues raises the degree of difficulty considerably. I’m sure, if you are a regular reader of my blog, you know that my now nine-year-old son has ADHD just like his Dad. But, where as Dad was a classic hyperactive boy, he is the absent minded professor — very much off on his on planet, especially when his meds aren’t on board. So, morning routine and evening routine is always going to be more challenging in our household than in many others. But, he’s a kid who just loves school. (He gets that from his Mom!) So homework has never been an issue for him. Now, my four-and-a-half-year-old is another story all together. Between you, me, and the other eight people who subscribe to my blog, she was just diagnosed with bipolar disorder. So, all the great parenting in the world has not helped with her titanic emotional dysregulation in many cases. In the grand scheme of things all the principles of happy parenting apply, but it is much harder to put them into action. There is only so much you can do to facilitate independence in a child who has a morning-altering tantrum 43% of the…

I feel that I have to preface this by saying that I have not read much of Dr. Ned Hallowell’s stuff. But I do have experience with many people who have had negative experiences with his Hallowell Center in Sudbury, MA. And, I’m reasonably familiar with the fact that he’s been touting ADHD as a blessing for many years now. Frankly, I think that’s bull shit. (Pardon my language.) So when the following came in my email I had mixed feelings. From Shame and Stigma to Pride and Truth: It’s Time to Celebrate ADHD Differenceswith Ned Hallowell, M.D., and William Dodson, M.D.Wednesday, October 31, 2018 @ 1pm ET I’m certainly a big believer that ADHD shouldn’t carry the stigma that it does. Things have gotten a lot better from when I was a kid. I don’t think anyone has told me that they don’t believe in ADHD in about a decade. That’s progress. But to say that ADHD is a blessing is such an unbelievable stretch as to be insulting.  I understand the desire to make ADHD into a thing that isn’t only negative. But, I’m curious how one can even define what the “benefits” are. ADHD is a neurobiological disorder that exists on a spectrum. It, likewise, negatively affects functioning on a spectrum. It can be diagnosed and is, thus, subject to standards. I don’t read the DSM V as having any positives listed in the diagnostic criteria for ADHD.  I like to think that the things I like about me are about me, not about my ADHD. Or at the very least that I can separate those two things. Here’s how I always put it: If a genie had come out of a lamp when I was, say, 15 and told me I could change one thing about me,…

I grew up in Newton. One of the best school systems in the state. I got a tremendous, well rounded liberal arts education in high school. As I look back, one of the few failings of the Newton School System was that no one ever encouraged me to really think about what I wanted to do for a career or have me reflect on how my passions and my talents might converge to allow me to make a living.  We were solidly middle class. My Dad was a high school english teacher and administrator. My mom took a bunch of years of but was a graphic designer. My Dad went to Brown and my mom went to RISD. (That’s where they met.) All my friends parents were doctors, lawyers, therapists, engineers, professors, judges, or the like. All very traditional career paths that involved college and mostly grad school. But I never really thought about how one gets there. I just put my head down and tried to make the best of my high school education, all the while hoping things would get more interesting and relevant in college. They didn’t.  I don’t necessarily have any regrets. I’m happy with my life. But it was a grind to get here. I wonder what life would have been like if I’d done culinary right out of high school. What if I’d learned to be a carpenter and owned my own contracting business. What if I’d been exposed to other white collar jobs that were more specialized. I have a friend in logistics. His job is to get stuff from one place to another all over the county. I think I’d be great at that. But who knew that was a thing?  I don’t expect a high school sophomore to know what they want to do for…

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So, you are wondering why I’m writing a blog post about a ballot question. Fair enough. Here’s why: As an advocate for mental health care and affordable healthcare and medication, this ballot question is extreme important. I would ask that you please read this and consider my points.  First, I come by this information because of my involvement in the Mass General Hospital Patient and Family Advisory Council. I would not have know enough about this question and now that I do, I’m desperate to spread the word. I will attempt to be concise but thorough.  What the deal with Question No. 1? This is a piece of legislation that the MA Nurses Association has been trying to push through the legislature for 20 years. But has had so little support that it has never even gotten out of committee or been sponsored as a bill.  So the went the ballot question route.  Who are the MA Nurses Association? The are the nurses union in MA. Unfortunately the represent less than 1/3 of all nurses. And many of their members are against the ballot question anyway.  Why is this an issue? There are some hospitals, mostly rural hospitals, that are asking their nurses to to too much. In a small number of locations, there is a problem with understaffing of nurses. However, this is not a pervasive problem in MA.  What are some of the details of this bill that make it a problem? These staffing regulations do not take into account day of the week, time of day, needs of a particular floor, the experience level of nurses, or any other real world considerations of staffing.  This law would require implementation over the course of just 37 business days. In some cases MGH spends 6 months “onboarding” new nursing staff.  There is already a…