Another Place to Look for Information

For a number of years, your blogger has written an "Ask the Experts" column for ADDitude Magazine, a print and online publication that is focused on issues of interest to adults and children who are dealing with attention and related disorders. 

As a new series of Questions and Answers began posting today (with additional posts to be added each Wednesday for the next three weeks), we thought it might be useful to look back at some of the questions we have addressed that might be relevant to the readers of this blog. This new series of Q&A's covers issues faced by older students - transition, SAT accommodations, and managing independently. But other columns have dealt with a broad array of topics, including:

• Workplace protections for employees with ADHD

• Legal and safety issues with medication in college

• An extended article on selecting the right school for your child

• What can a parent do if a school refuses to evaluate their child?

• Services for twice-exceptional students

• Another longer piece on discipline, restraint, and seclusion of students with behavior issues 

You can search under "Susan Yellin" for the full list of articles, shorter Q&A's and links to webinars, some dating back several years. We hope you will find them helpful.

In the meantime, have a Safe and Happy Halloween!

Therapy Dogs and ADHD

We've written numerous times about the benefits of dogs as pets. We've shared research that found that children with dogs at home had fewer respiratory or ear infections and needed fewer courses of antibiotics than children who had no exposure to dogs.

We've looked at how using dogs as reading companions can help struggling readers gain skills and confidence. And we've shared how psychotherapists are using dogs in their therapy practices to help their young patients.

Now, a new randomized controlled study (the "gold standard" of how research is conducted) has found that children with ADHD who received Canine-Assisted Interventions (CAI) with a certified therapy dog significantly improved attention and social skills and exhibited fewer behavior problems after only eight weeks. Of note, hyperactivity and impulsivity were not affected. The study, from researchers at the University of California, Irvine, involved 88 children ages 7-9, none of whom had taken medication to treat their attention difficulties. Both the CAI group and the control group received standard behavioral interventions for their ADHD and the control group did improve with these (as did the CAI group), but the children in the CAI group did better and improved more quickly (eight weeks vs. 12 weeks) than those without canine support.

While it is not a cure-all, families whose children have ADHD might consider a certified therapy dog in conjunction with more standard behavioral interventions for their children.

Photo by Andy Omvik on Unsplash

Some of Our Favorite Resources

There are some "go to" resources that we turn to time and again for information about schools and other subjects. You may already use them, but in case you don't and in the hope you find them as helpful as we do, we thought we'd bring a few of them to your attention.

The terrific website InsideSchools.org has reorganized its resources, making it easier to find information on such topics as free programs for students and families, a wide variety of publications on subjects such as how to find elementary, middle, and high schools, and tools for such important topics as How to Change Schools, Special Education, and English Language Learners.

Inside Schools is always a helpful resource for information about specific New York City Public Schools, with search options popping up right on the home page. But it isn't always up to date, since it depends on school visits to each of the schools it reviews. Parents should also take a look at the NYC Department of Education website, where more recent information (without the narrative discussion that makes InsideSchool's reviews so helpful) can often be found. 

In fact, the major limitation of InsideSchools is that it only deals with New York City Public Schools. Families who live outside of New York City can often find guidance on the website GreatSchools.org., which is a national nonprofit with information on both public and private schools nationwide. 

Another resource we like is the steady stream of emails from the A.D.D. Resource Center, headed by Harold Meyer, a founder of CHADD of New York City (Children & Adults with Attention-Deficit/Hyperactivity Disorder), the national volunteer-based organization. This resource isn't for those who are protective of their inbox - Hal Meyer is prolific and can send a half dozen or more emails each day about topics relating to attention and learning. But most of his emails are interesting and some are really excellent. You can sign up for his e-list from his website. 

The State of Learning Disabilities

If you are a parent trying to better understand the issues involved in in your child's learning challenges, an advocate or professional in need of data about learning disabilities or special education, or an educator who is concerned about how schools deal with students who learn differently -- or some combination of these roles -- you will likely find valuable information in a report recently released by The National Center for Learning Disabilities (NCLD), The State of Learning Disabilities: Understanding the 1 in 5. The title refers to the fact that one out of five children in the U.S. has learning and/or attention issues.

The report uses data from the 2015–2016 school year and takes a wide-ranging look at the landscape of learning and attention issues in school age children. It includes information about new findings in neuroscience that look at brain structure and function. It looks at policy issues, such as the increased rate at which students of color and students from low-income families are identified as having learning challenges. And it has extensive data on topics like emotional and behavioral issues.

Whether you prefer to review the "Executive Summary" of several pages or the longer report, which includes videos, charts, and personal perspectives of those dealing with learning challenges, this is a resource to bookmark, download, and use again and again.

Targeting Environmental Risks to Children

Parents of children with learning and other challenges often wonder if environmental factors could have caused or been a factor in their child's difficulties. As noted in a recent issue of Pediatrics, this question was behind the 2015 founding of Project TENDR (Targeting Environmental Neuro-Developmental Risks) by scientists, physicians, other health professionals, and advocates. Project TENDR's mission is to raise awareness of the risk from toxic chemicals to the development of brain-based disorders in children, including intellectual and learning disabilities, autism, and ADHD.

In July 2016, TENDR issued a Consensus Statement, intended to be a Call to Action ...

"to reduce exposures to toxic chemicals that can contribute to the prevalence of neurodevelopmental disabilities in America’s children. The TENDR authors agree that widespread exposures to toxic chemicals in our air, water, food, soil, and consumer products can increase the risks for cognitive, behavioral, or social impairment, as well as specific neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder (ADHD) (Di Renzo et al. 2015; Gore et al. 2015; Lanphear 2015; Council on Environmental Health 2011). This preventable threat results from a failure of our industrial and consumer markets and regulatory systems to protect the developing brain from toxic chemicals. To lower children’s risks for developing neurodevelopmental disorders, policies and actions are urgently needed to eliminate or significantly reduce exposures to these chemicals. Further, if we are to protect children, we must overhaul how government agencies and business assess risks to human health from chemical exposures, how chemicals in commerce are regulated, and how scientific evidence informs decision making by government and the private sector."

The Consensus Statement coincided with the June 2016 signing of amendments to the Toxic Substances Control Act (TSCA), the Nation’s primary chemicals management law, but the authors of the Consensus Statement note that this legislation, while "an important step," provides "too little action at too slow a pace."

The Consensus Statement sets out frightening information about the vulnerability of developing fetuses and children to environmental toxins. So what can parents do to avoid exposing their children to these poisons?

The American Academy of Pediatrics (AAP) Healthy Children initiative has a comprehensive list of steps parents can take to reduce the exposure of their children to pesticides, including links to information about organic foods. The AAP site has similar helpful information about numerous other risks, such as lead and mosquito spraying. Scroll through the list of topics to find those you want to review and take the recommended actions to reduce the risks to your family.

US DOE Guidance on Section 504 and ADHD

K-12 students who struggle with attention may be entitled to support and accommodations under either the Individuals with Disabilities Education Act (IDEA) or Section 504 (of the Rehabilitation Act of 1973).  For those students whose ADHD (which we will use here to include students with attention difficulties, whether or not they include hyperactivity) has a significant impact on their academic performance, or for whom attention difficulties occur together with learning or related challenges, the IDEA is often the best way to receive what they need to be successful in school.

The IDEA generally provides more extensive services, permits more parental input, and is available to students in both public and private schools. However, not all students meet the criteria for receiving IDEA services, which include having a specific category of disability (attention generally falls under "other health impaired"), and being in need of "special education and related services." For students with ADHD who do not meet the IDEA requirements and who are in public schools, Section 504 can provide what these students need to be successful in school despite their attention difficulties.

Earlier this year, the Office for Civil Rights (OCR) of the U.S. Department of Education, which administers Section 504, issued a letter to offer guidance to states and school districts about problems with the way in which Section 504 was being applied to students with ADHD. These problems included:

• Failing to identify students who may have ADHD;
• Failing to properly evaluate students suspected of having ADHD;
• Inappropriate decisions about the education, services, and setting that may be required by students who had been properly identified and evaluated; and
• Failure to let the appropriate school personnel (especially teachers) know about the 504 Plan so it could be properly implemented. 

In addition to the extensive guidance letter (42 pages), the OCR created a brief, clear, two page document titled Know Your Rights: Students with ADHD. One point mentioned in this document, which often is raised by schools when they decline to consider a student with attention difficulties for a 504 Plan, is "Regardless of how well he or she performs in school, a student who has trouble concentrating, reading, thinking, organizing or prioritizing projects, among other important tasks, because of ADHD may have a disability and be protected under Section 504." We frequently find that schools use the excuse "but she gets good grades" or "but he is doing well on tests" when parents know that their child is struggling with attention and could learn and perform better with the accommodations and supports available under Section 504. We hope that seeing this issue set forth in black and white might help schools better understand their obligations to students with ADHD.

Study Looks at Impact of ADHD on Homework

It should come as no surprise to parents and teachers that researchers have found that students who struggle with attention and executive functions are less likely to complete and submit homework assignments. A study earlier this year in the Journal of School Psychology looked at this phenomenon over a period of 18 months in 104 middle school students who had definitive diagnoses of ADHD.

The researchers looked at all the steps that students had to complete to be successful with homework, something they called the “completion cycle.” These include:

• Accurately recording assignments with sufficient detail

• Bringing home the materials needed for the assignment

• Planning ahead to complete the work (ie: not procrastinating)

• Staying focused and completing the work correctly

• Bringing the completed work back to school and handing it in.

Even where teachers or parents provided some homework support, most of these responsibilities fell upon students to meet.

Multiple teachers were questioned about assignment completion and their reports about each student were highly consistent across classes, with teachers reporting that students with ADHD were turning in an average of 12 percent fewer assignments than their classmates.

Furthermore, there was a strong correlation between the percentage of assignments turned in at the beginning of the study and students’ school grades some 18 months later, even when controlling for numerous academic and socio-economic factors that could affect grades. Poor homework completion was associated with low grades and low grades were associated with lower future homework completion rates. The study also found that students whose parents rated their “homework material management” as problematic at the inception of the study were likely to be reported by teachers as having a lower percentage of assignments turned in as the study came to an end.

The researchers note that homework assignment completion problems are persistent across time and can be an important intervention target for teens with ADHD. For parents (and teachers) dealing with students who seem scattered and disorganized in numerous areas of their lives, a focus on homework may be a good first step towards improving their school performance.

Reward, Punishment, and ADHD

The effects of reward and punishment have long been under examination by research psychologists. From Pavlov’s dogs to Skinner’s rats to the continually evolving theory of behaviorism, we have gained much knowledge about how positive and negative reinforcement can impact our daily lives. While general principles have become fairly well understood, we know less about how reward and punishment may differentially impact particular groups. A recent study by a team of researchers from Japan and New Zealand set out to explore how reward and punishment may specifically affect children with Attention-Deficit/Hyperactivity Disorder (ADHD).

Groups of children with and without ADHD were presented with a choice of two computer games to play. In both games, a win would result in points and an animation; a loss would result in a point-deduction and a laughing sound. The latter (punishing) condition occurred more often in one game than the other, even though the frequency of point-awarding and animations were the same in both. While both groups of children indicated a preference for the less-punishing game, this preference was significantly more pronounced for the children with ADHD.

The implications of these results could extend to parents and educators developing behavior plans. An emphasis on positive, versus negative, reinforcement is already a widely-accepted tenet of good practice. However, a particular sensitivity to punishment in students with ADHD may warrant special consideration in developing plans that encourage, rather than discourage, efforts toward success.

Studies Look at ADHD in Adults

A new study, led by a team of British researchers, looked at young adults with ADHD and found that a significant number of these individuals did not exhibit symptoms in childhood as required by the definition of ADHD in the The Diagnostic and Statistical Manual of Mental Disorders, (DSM-V), from the American Psychiatric Association. 

The DSM-V definition of ADHD requires that the individual have:

Six or more persistent symptoms of inattention and/or hyperactivity-impulsivity, several of which were present prior to 12 years of age, that interferes with functioning or development, which are present in two or more settings (eg. at home and at school or at work), and which interfere with social, academic, or occupational functioning.

The researchers looked at a subset of more than 2,000 individuals as part of a study of twins, and found that adults with ADHD included both those who had "childhood onset" ADHD that persisted into adulthood and those who did not meet the DSM requirements for ADHD in childhood but who met them (absent the age of onset) in adulthood. Specifically, they found that, "among 166 individuals with adult ADHD, 112 (67.5%) did not meet criteria for ADHD at any assessment in childhood." 

The British researchers noted differences between the childhood and adult onset groups in areas such as severity of symptoms and comorbid mental health conditions and suggested that more research is needed to determine the relationship between these two types of ADHD and whether they are really the same disorder.

A second study, this one led by Brazilian scientists and published in the same journal as the British study, led researchers to conclude that their findings did " not support the assumption that adulthood ADHD is necessarily a continuation of childhood ADHD. Rather, they suggest the existence of 2 syndromes that have distinct developmental trajectories."

As the British research team noted, "the extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implications for genetic studies and treatment of ADHD."

ADHD Treatments for Young Children - A New Study

A new study just released by the Centers for Disease Control and Prevention (CDC) finds that while more than 75% of young children (ages 2-5) with attention-deficit/hyperactivity disorder (ADHD) are prescribed medication, only about half receive behavior therapy* to address their attention difficulties.

 

This preference for medicating young children runs counter to the clinical guidelines established by the American Academy of Pediatrics, which in 2011 recommended:

"For preschool-aged children (4–5 years of age), the primary care clinician should prescribe evidence-based … behavior therapy as the first line of treatment and may prescribe [medication] if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child's function."

The AAP guidelines go on to caution that, “…in areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment.” The AAP noted that even students whose attention difficulties do not rise to the diagnostic criteria of ADHD may benefit from a behavioral approach to their attention issues.

The CDC study observed that approximately 6.4 million U.S. children ages 4-17 years had a diagnosis of ADHD in 2011-12, which was an increase of 42% increase compared to 2003. The study used insurance claims for psychological services (which includes behavior therapy) and ADHD medication from both Medicaid and private insurance to determine the frequency with which each approach was utilized. 

The CDC reported that the strength of evidence for behavior therapy exceeds that for ADHD medications. It noted that behavior therapy might require more time to impact child behavior and might require more resources but that the impact lasts longer relative to ADHD medication and does not have the side effects associated with these medications. Most of these side effects are minor but they are experienced by approximately 30% of children aged 3–5 years who take ADHD medications and more than 10 % of the children in this group stopped medication treatment because of such side effects.

Here at The Yellin Center we always recommend behavioral strategies for school and home when dealing with attention issues. When appropriate, we can also provide consultation and ongoing prescription management for medications, but we strongly believe that medication should only be considered in the context of a student's overall educational plan, and never thought of as a "quick fix" for school difficulties.

*Behavior therapy in this context includes any psychological interventions that are designed to change problem behaviors, including ADHD symptoms, by modifying the physical or social contexts in which the behavior occurs and can be delivered to the child by a therapist, teacher, parent, or other provider.

Study: Physical Movement Helps Some Kids Focus

Parents and teachers are often distressed when they see young people squirming in class or during homework time. If a child is tapping his foot, clicking a pen, or wiggling in his seat, he can’t possibly be focusing, can he?

At the Yellin Center, we often tell parents that there are two kinds of fidgeting: the kind that distracts a student, and the kind that actually helps him to concentrate. The key is to figure out what kind of fidgeter their child is. A new study indicates that our advice is on target.

In the experiment, students were asked to perform a task that required concentration while sitting in a swivel chair. The ones who had been diagnosed with attention difficulties did better the more they moved. The typically developing kids, on the other hand, performed more poorly when they spun in the chair while working. The movement, it seemed distracted them.

We explain it like this: Moving one’s body is like recharging one’s “battery.” If a child with attention difficulties is forced to sit still, her battery drains, leaving her little mental energy to work with. Instead of devoting her mental resources to thinking, she’s using them up in her efforts to keep her body still. Dustin Sarver, lead author of the study, offers a similar theory: “We think that part of the reason is that when they’re moving more, they’re increasing their alertness.”

If movement seems to help your child concentrate, it’s important to figure out ways that he can move in class without distracting others. (Supportive as we are of fidgeting, we agree that pen-clicking has no place in a classroom.) Perhaps he can do his work standing at a counter or tall table so he can move his feet. When listening to his teacher, maybe he can squeeze a stress ball, sketch, or roll a wooden dowel under his feet on a carpeted floor. Sit discs and swivel chairs are also helpful to many kids. Here at the Yellin Center, our assessment rooms have a variety of chairs, including stationery and swiveling, to accommodate the needs and  preferences of all the students we see.

Remember, though, that the object is to help him focus. If he becomes so fixated on his swivel chair, stress ball, or sketch that he stops listening, perhaps it’s time to try another technique.

New Study Looks at Social Difficulties in Children with ADHD

A new research study from Japan finds evidence of differences in the brains of children with ADHD which may be the basis of social difficulties which these children frequently encounter.

Children with ADHD often struggle with inattention, impulsivity, and hyperactivity, behaviors which can impair their interaction with peers. As one student we know with ADHD described efforts to arrange a social activity with other students who had similar difficulties, "It wasn't pretty. One kid wasn't paying attention and didn't realize we were trying to get together. Another decided at the last minute to do something else. And still another guy wanted to come, but had to stay after school since he was acting out in class." But scientists have questioned whether there is more to the social difficulties that children with ADHD encounter, beyond these behaviors.

In the present study, researchers used  non-invasive near-infrared spectroscopy to measure changing blood flow in the brain to uncover the neural basis for the recognition of facial expressions. Being able to pick up on facial cues is an important skill that helps children get along with one another and understand social cues and expectations. The researchers found that while their typically developing control group had changes in blood flow to theirs brains when they saw either happy or angry facial expressions, the children with ADHD only showed changes in blood flow -- and thus response to -- happy expressions. They did not respond to angry expressions.

This was a small study (with only 13 subjects and 13 controls) and much more investigation remains to be done. Still, it gives some sense of the neural basis for the social struggles some children with ADHD experience; if you can't tell if your friend is angry with you, you won't be able to respond appropriately and social relations may suffer as a result.

photo and graphics provided under CC license

New Study Shows That Brains of Children with ADHD Mature More Slowly

Attention Deficit Hyperactivity Disorder is one of the most commonly diagnosed psychiatric disorders among children. Increasingly, practitioners are able to recognize its symptoms; its cause, however, has been a bit murkier. Past imaging has revealed that brain maturation seems to occur later among children with ADHD than in those who do not have difficulty with attention. Now, a recent study published in the Proceedings of the National Academy of Sciences has added further data to the late maturation observation: researchers found that brain connections that help with focus don’t develop at the same time in the brains of children with ADHD as in the brains of their peers.

A key finding was the interaction between two networks, the default mode network (DMN) and the task positive network (TPN). On default mode, when the DMN is in control, the brain falls into daydreaming or stream-of-consciousness thinking. The DMN is activated in even typically-developing brains when a person is between tasks or fatigued. Among children with ADHD, however, the DMN interrupts the brain’s productive TPN. These kids seem less able to turn off their default modes at will, causing them to shift into daydreaming mode. Instead of using his TPN to focus on what he’s doing or plan for what comes next, a child may tune out.

Saad Faruque via Flickr CC

Happily, thanks to neuroplasticity, brains can be rewired throughout our lives; even the neurons in adults’ brains can change in response to experience. Teaching children who suffer from ADHD to recognize those moments when their default mode network fails to switch off and giving them strategies to get focused could help many kids to “outgrow” ADHD.

Putting Advice to Work

Several months ago, your blogger was featured in a webinar from ADDitude (the magazine folks who also have an informative website) on "Determining if Your ADHD/LD Child Needs an IEP or a 504 Plan and How To Go About Getting It." Like any presentation, especially those not in front of a live audience, it wasn't clear to whether the information provided would actually be put to use by parents.

So, it was good to receive an email last week from a mom who wrote,

"I wanted to take a minute to thank you. I have an 8th grader finishing up middle school and heading to high school next year. He has been struggling since elementary school. In 7th grade I was finally able to establish a 504 plan for him. Two years later, his grades continue to slide and he goes up and down. They give him extra help in reading, then he does well and they pull him out of the extra help classes. It’s a vicious cycle. I have been pushing for reading and writing help since September.

"In October I listened to your Attitude Webinar on IEP and 504 and what to ask for. I stuck to my basic points: ADHD qualifies a student for an IEP [an Individualized Education Program] under OHI [the category of Other Health Impaired]. After several meetings and finally getting the school board involved, they tested him again and agreed that his reading and writing were seriously deficient. The school has agreed to the IEP and he started in the facilitated reading and writing classes the day following our meeting...

"It was that key piece of lingo …“IEP qualifies under OHI” discussion you talked about in the webinar that I needed. I followed your advice to stay calm, listen, be nice, state what you want and stick to a few key points. It’s interesting, I do this all day in my “day” job, but when it comes to your kids, your emotions get in the way. I decided I was going to strategically approach it like I would negotiate anything else and it worked! THANK YOU."

This mom was right on target that we need to take the skills we use in the workplace and other aspects of our lives and put them to use with our children. It is very difficult to stay calm and focused when dealing with your child's school and the more your child is struggling, the more difficult it is to use your skills to help

them. That is why the respected special education attorney Pete Wright, who runs the Wrightslaw website with his wife Pam, titled his basic primer for parents, From Emotions to Advocacy. This is why I always suggest a few key points to parents attending an IEP or other significant meeting about their child:

• Don't go in alone. Bring at least one person with you who will stay calm and focused and help you to do the same. You have the right to bring anyone you want with you - a spouse, a friend, an advocate, but if you plan to bring an attorney you should let the school know so they have the choice of having their attorney present. Otherwise, they may require the meeting to be rescheduled so their attorney can attend. This is one reason why most attorneys don't generally attend IEP meetings.
• Take notes. If you can't focus or participate while taking notes, have someone with you (who can be the person mentioned above) who can do this for you. 
• For formal meetings, like those of the IEP team, ask for a copy of the attendance sheet that will passed around. Chances are you won't use it for anything, but it sends a signal that you are making a formal record of the meeting in case you need to appeal the decisions reached. 
• Come in with a list of the issues you want to address. Just like the most effective shopping trips start with a good list, you will be shopping for services and supports for your child. While you might learn things or hear ideas that will change your mind about items on your list, at least you won't forget to raise important points.
• Don't be pressured to agree to anything or to sign anything at the meeting. While services under an IEP will not begin until you sign off on them, taking a few days to consider things is perfectly reasonable and will allow you time to think about what your child really needs. 

And, as the mom who wrote the note mentioned, "stay calm, be nice, state what you want and stick to a few key points." 

Benefits of Demystification for Teens with ADHD

A small but interesting study from a team of Canadian researchers sheds light on the benefits of demystification -- "the act of putting into plain words what an individual's strengths and weaknesses are, without the use of judgment or labels" -- on teenagers with ADHD.

The researchers built on earlier studies that demonstrated that parents who participated in training programs that provided information about their children's ADHD had improved decision making and knowledge, and their children had improved adherence to both medication and non-medication interventions. Similarly, elementary school children with ADHD who attended demystification workshops gained both knowledge about ADHD and had more favorable opinions of medication and other methods of treating this condition.

The study's focus on teens was prompted by data showing that less than half of teens with diagnosed ADHD who have been prescribed medication stick to their medication regimes, even when their symptoms continue to cause distress. Furthermore, the decision to stop medication is most often made by the teens themselves, whether or not their parents support this decision. The researchers in the present study wanted to see what would result from having teens participate in a two-hour workshop which addressed the following topics: "characteristics of ADHD, evidence-based treatments, strengths and weaknesses associated with ADHD, the connection between ADHD and the brain, how ADHD in adolescence is different from childhood ADHD, what to expect in the future, and important steps to self-advocacy, such as knowing when, who, and how to ask for special accommodations in school."

The study results were strongest when looking at improved self-advocacy information; students who participated in the demystification workshop had a significant and lasting improvement in recognizing which adults could help them with their ADHD and in recognizing ways they could take steps on their own to manage their ADHD. The researchers found an unexpected level of concern among the participants as to the safety of ADHD medications, including questions about combining these medications with alcohol or "recreational" drugs. The researchers note that more investigation is needed to determine how to best transmit information to teens with ADHD, but concluded, "A key strength of the demystification workshop was the notable change in adolescents' individual self-advocacy knowledge." They note that this will "allow adolescents to take more initiative in recognizing when support is required, seeking support from others, and knowing what steps they might take to help manage their ADHD symptoms."

IEP and 504 - What Parents Ask

Your blogger presented a webinar earlier today for ADDitude Magazine, for which she writes the "Your Legal Rights" column.  The topic was "IEP vs. 504 Plans: Which Does Your ADHD/LD Child Need and How to Go About Getting It." Hundreds of parents listened in and many of them had questions, some of which are no doubt shared by most parents who deal with these two laws. There is a link to hear the complete webinar but in the meantime, some of the most common questions -- and their answers -- were:

Can a student have both a 504 Plan and an IEP at the same time?

No. Section 504 (of the Rehabilitation Act of 1973) specifically states that having an IEP (an Individualized Education Program under the Individuals with Disabilities Education Act -- IDEA) satisfies the requirements of Section 504. So, if a student would qualify for services under both laws, the student should get an IEP.

Which law would apply to a student with ADHD? 

It depends on the extent to which the student requires special education or related services because of his ADHD. If the student's attention problem is so significant that it seriously impacted his ability to learn, or if the student also has a specific learning disability, he would qualify for an IEP under the category of Other Health Impaired or Specific Learning Disability. [IDEA requires that a student fall within one of ten categories of disability in order to receive services.] If the student has ADHD but the impact is less significant and doesn't rise to the level of his needing special education services because of it, he would generally not qualify for an IEP but would be eligible to receive services under Section 504.

How do I start the process of getting my child an IEP or a 504 Plan?

First, parents should have met with their child's teacher and discussed how things are going in school. Once they have done so, if they believe that their child needs a 504 Plan they should make a written request to their school's 504 Team. Most schools have specific forms for this and you can obtain them from the school office or even the school website. Complete the form, along with any documentation you may have, and submit it to the 504 Team. You may be invited to their meeting, but the law does not require this and the procedure varies from place to place. The 504 Team will decide if more information is needed (and any evaluations they require will be at school expense) and will decide upon a plan for your child. 

To begin the IEP process, parents need to advise the school -- the guidance office or principal is generally the point of contact -- that they believe that their child requires special education services and sign a consent for their child to be evaluated. The evaluation process must be completed within 60 days of the consent and is followed by a meeting which includes the parents, to decide whether the student qualifies for IDEA services and to create the IEP, which must be in writing.

We have a written a number of blogs, linked below, which deal with some of these topics, including:

• Section 504 Q and A
• Special Education Terminology
• Getting Services in Private Schools
• Preparing for IEP Meetings
• Changing an IEP
• IEP Tips and More Tips

Fans of Percy Jackson: Meet Author Rick Riordan!

Fans of Percy Jackson will be thrilled to learn that on October 9th, author Rick Riordan will be visiting Symphony Space on the Upper West Side of Manhattan to discuss his latest book, The House of Hades, which is the latest addition to his series Heroes of Olympus! Tickets are extremely limited, so don't delay!

To those who haven’t yet discovered Percy Jackson and the Olympians, the first of Riordan’s series about Greek gods and their modern counterparts, we say: What on earth are you waiting for? We love the Olympians series, not only for its humor and action-packed plot but also for what it teaches kids about learning differences and Greek mythology.

Readers are introduced to Percy in the first book of the Olympians series, The Lightning Thief. Twelve-year-old Percy has been kicked out of every school he’s ever attended. He struggles with his work because of his dyslexia, and his ADHD makes it tough to focus. His dad isn’t around either; Percy has never met him. Things begin to get strange when one of Percy’s teachers turns into a Fury and attacks him on a class field trip. Percy learns that he is a half-blood: that is, half-human and half-god. His absentee father is actually Poseidon, god of the sea. His dyslexia? A result of the fact that he’s wired to read ancient Greek, not English. And his ADHD? An important hyper-awareness he’s developed to help him stay alive on the battlefield, of course. Monsters are fond of going after the half-children of gods and goddesses, so it’s best to be on one’s toes. It seems that although Percy wasn’t suited to sit in a classroom, he’s got a lot of qualities that make him outstanding in other arenas. Just as Percy is coming to terms with his identity at Camp Half-Blood, he’s sent on a quest to recover Zeus’s stolen lightning bolt with sidekicks Annabeth, daughter of Athena, and Grover, a satyr.

Percy and his pals grapple with the likes of Medusa and Hades, meet centaurs, consult with an oracle, swallow ambrosia and nectar when they’re injured, and duel Ares, and that’s just in the first book of this five-part series! The Lightning Thief and Sea of Monsters, its sequel, have been released as movies as well.

Once he’d completed the Percy Jackson series, Riordan began work on a second series, The Heroes of Olympus, which turns its focus to Roman mythology. The House of Hades, which he will discuss at Symphony Space on October 9th, is the fourth installment in the series.

A trip to see Rick Riordan speak will make for one enjoyable evening. But hooking kids on his dynamic, exciting books will provide them with enriching entertainment for months to come.

Free Back-to-School Workshops for Parents and Educators

The Yellin Center for Mind, Brain, and Education will present a series of free back-to-school workshops for parents and educators at our Center on West 29th Street in Manhattan in the coming weeks.

Jeremy Koren

First up: on Tuesday, September 24, Paul B. Yellin, MD, FAAP,, Associate Professor of Pediatrics at New York University School of Medicine and Director of The Yellin Center will discuss ADHD, Attention, and Learning. Special emphasis will be placed on the topics of common symptoms, the process of diagnosis (and what labels like "ADHD" really mean), some recommended treatments, and how to deploy individualized strategies to best support weak attention and executive-function controls in learners at every grade level, from elementary school through college.

On the following evening,Wednesday, September 25, Susan Yellin, Esq. will present College 101: What Students with Learning Issues (and Their Parents) Should Know. Mrs. Yellin will focus on matters of import to students and parents who are in various stages of the process of transitioning from high school to the more independent setting associated with colleges and universities, including admissions, student support services, choosing a school, SAT/ACT testing issues, disability disclosure considerations, and more. Parents of students from middle school through 12th grade should find this presentation highly informative.

Finally, on Thursday, October 17, Dr. Yellin will present a special discussion on Memory and Learning. In this conversation, Dr. Yellin will aim to provide parents with a new understanding of how variation in the brain functions which control memory can impact a student's performance in school.

All of these events are free, but advance registration is required and space will be limited. Doors open at 4:30 p.m.. Events will begin promptly at 5 p.m. and conclude by 6 p.m. each night.

Register online here, or call The Yellin Center at (646) 775-6646. Please tell a friend to join you! We hope to see you there.

Download printable fliers for the events here and tack them up on your local community or school bulletin board.


-Jeremy Koren

Learning Links: Recent News

Photo: monkeyatlarge

• Do Kids Really Have ‘Summer Learning Loss’? (Time Ideas)
• US Graduation Gain for Students with Learning Disabilities, but Challenges Remain (Southern California Public Radio)
• Fewer Minority Kids Diagnosed with ADHD (Reuters/Yahoo)
• Rate for Subsidized Stafford Loans Doubles (Alaska Public Media)

Thinking about ADHD

An article in last week’s New York Times, "A.D.H.D.Seen in 11% of U.S. Children as Diagnoses Rise," raises some important issues. The article concerns data from a CDC study which interviewed more than 76,000 parents between February 2011 and June 2012 as part of a wide-ranging look at children’s health issues. The CDC has not yet published its findings, but the Times used the raw data as the basis of the article.

According to the Times, diagnoses of ADHD in the U.S. have risen some 41% in the past decade, and 11% of school-age children have received a diagnosis of ADHD. It also reported that about two-thirds of those diagnosed received a prescription for stimulant medication. 

The article continued by noting that the criteria for ADHD -- a checklist of symptoms occurring across situations (for instance both at home and at school) over a period of time -- was due to be expanded in the new Fifth Edition of the DSM, due out this May. This is expected to add to the numbers of teens and adults who are diagnosed with ADHD. 

So, what does this mean for you, for your child, and for clinicians? 

First, parents need to understand that just because a child has difficulties with attention does not mean that he has ADHD. There can be many reasons for attention issues and children can fidget for many reasons. Thoughtful clinicians need to apply the time tested medical approach of “differential diagnosis” when they look at the symptoms commonly associated with ADHD. "Why," they should always ask, "are these behaviors present?" Does this student have a language difficulty, so that she has trouble understanding what is going on in class? It can be hard to pay attention when you can’t follow the classroom discourse. Does he have a problem with memory, so that he jumps and shouts out so that the teacher will call on him before he forgets what he wants to say? Or, perhaps, does she have a true deficit of attention which may or may not be accompanied by hyperactivity?

Even when children have ADHD, we must be thoughtful about what the best strategies may be to deal with this problem. There are many interventions that can and should be tried before using medication. In fact, medications are NEVER sufficient alone. They must always be prescribed in the context of a comprehensive educational plan that includes strategies students, educators, and parents can implement on a daily basis.

Building self-awareness must also be part of the treatment. A child can have ADHD without being ADHD. They must learn about their strengths, and understand that attention weakness exists within the context of their strengths, and perhaps other weaknesses. Attention is a multi-faceted function that appears to involve at least three different parts of a child’s brain. A child needs to know what parts of attention are the sources of their difficulty, and perhaps what parts of attention are working well for them. Attention problems rarely exist in isolation. We owe it to our children to ask, “What else might be contributing to their difficulty?” 

We understand that medication can be enormously helpful for many children for whom the benefits greatly exceed the risks. However, as is the case with every medical treatment, the risks and benefits must be considered on a case-by-case basis. I believe our role as clinicians is to provide parents with the best information that we can and with our best judgment. However, I worry when I hear that parents had their child “tested for ADHD.” I am not saying that the possibility of an ADHD diagnosis shouldn't be considered. What I am saying is that it must be considered in the context of thoughtful consideration of all of the possible causes of a child’s symptoms. And once a diagnosis has been made, medication must be examined in the context of all of the potential interventions.

Illustration: Life Mental Health