Building a Better IEP or 504 Plan

Yesterday, Dr. and Mrs. Yellin were the featured speakers in a webinar from ADDitude Magazine, where Mrs. Yellin is a regular columnist, writing on "Your Legal Rights." For this event, they jointly presented information on how parents can make sure that their child's IEP or Section 504 Plan will properly provide what is needed for their child to succeed in school.

As they explained to their live audience of close to 2,000 listeners, the first step in creating an effective IEP or 504 Plan is to fully understand the issues with which your child is dealing by having a thorough evaluation, one that looks beyond labels or diagnoses. They noted that it's important to keep in mind that these plans need to be individualized, and that administering a standard battery of tests may not be sufficient to get to the source of your child's problems.

The assessment that begins the IEP or 504 process needs to delve deeply into the specific areas of breakdown. It needs to look not just at a child's challenges, but also look at strengths, since these can be leveraged to help to bypass challenges. Likewise, areas of interest or affinities should be identified, since these can help your child become involved in their academics. Presenting a sports obsessed struggling reader a book about baseball or football is more likely to keep his or her interest than having that same student read about travel or music.

Another key point of the webinar was the importance of goals. Having appropriate goals is critical to a successful plan. Goals set out in an IEP or 504 Plan should be:

• Specific, objective, and quantifiable
• Should include standardized measures
• Must contain a clear understanding of:
• Who is responsible for implementation
• The frequency of assessment
• The mechanism for reporting to parents
• A clear understanding, upfront, of what constitutes sufficient progress. 

You can listen to the webinar in its entirety on the ADDitude website, or watch it on YouTube, below. 

Ancient Brains in a High-Tech World

Last year, we wrote about research supporting a way to manage emails while managing stress. Tending to our internal needs while interacting with the external world has become a particularly challenging and important task as technology has increasingly saturated our daily realities. With smartphones vibrating in our pockets, lighting up next to our beds, and dinging at us from our desks, it can be easy to feel as if we are owned by technology rather than vice versa.

With so many distractors competing for our attention, and with attention being so vital for completing the tasks consistent with our goals and desires, we find ourselves in a historically unique predicament. Of course, while there wasn’t Facebook to check or text messages to respond to in the past, distraction was always a part of life. For example, one of our oldest ancestors might have been foraging for food when suddenly there was a rustle in the trees signaling a nearby predator. This would trigger a shift in focus away from the original goal (finding food) to a more pressing need for survival (escaping the predator). Illustrated in this example is that distractibility can actually be adaptive, which is precisely the reason it evolved. It is therefore important to remember that the key to optimal attention is not to avoid or somehow rid of distractibility, but to modulate our focus in the best way.

Authors Adam Gazzaley and Larry D. Rosen emphasize this in their book The Distracted Mind: Ancient Brains in a High-Tech World. They present a wealth of interesting research regarding the brain, its cognitive feats and limitations when it comes to attention, our behaviors as they relate to focus and distractibility, and the impact of constantly shifting our attention as technology beckons. Finally, they suggest ways to take control and maximize your productivity and general well-being in the face of so much technological buzzing.

We appreciate and recommend this book, not just as professionals who work with many students struggling with attention, but as imperfect, self-reflective people who are always looking to understand ourselves better and improve the allocation of our own attentional resources. Perhaps you can challenge yourself to put the smartphone down and give it a read!

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.

New Attention Being Paid to Attention

When might a student’s focus be more likely to drift to the window rather than stay with the task at hand? Would it be when the material is easy or when it is difficult? A new study set out to explore and build on past research regarding this question.

Psychologists at the University of Illinois presented subjects with math problems to solve while pictures of neutral scenes, as potential distractors, flashed on a computer screen. As indicated by eye-tracking devices, participants who were given only easy problems to solve (Group A) were more likely to look at the distractors. In contrast, participants who were given only challenging problems (Group B) were less likely to look at the distractors. Financial incentives were incorporated into a variation of the experiment, but they seemed to have little impact. The more challenge that the participants encountered when working on the problems, the less likely they were to be distracted, regardless of financial incentive. 

Some participants were presented with a mix of easy and hard tasks. How distractible they were at any given time did not correlate with the difficulty level of the particular problem they were working on then. In other words, it seemed to be participants’ overall level of engagement with the task, rather than the difficulty level of any particular item, that accounted for the differences in distractibility between Group A and Group B.

The results suggest the importance of making sure that students are cognitively engaged. It is not enough to identify and assist students who may be struggling with coursework; it is also important to identify, and find ways to stimulate, students who may be bored with material that is not challenging them enough.

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.

Teaching Children Mindfulness

At The Yellin Center we often work with students who struggle with attention and self-regulation. There is a large body of research to underpin the value of systematically teaching mindfulness to children. Not only can mindfulness training help children learn to self-soothe and monitor their behavior, but it also can develop intrinsic qualities like compassion, kindness, thoughtfulness, and caring.

There are several thoughtful, structured approaches to help develop a child’s awareness of the world around them and grow their emotional intelligence. Taking part in activities that promote mind-body awareness, such as martial arts, yoga, or dance, can be valuable for students who struggle to regulate their impulses. Mindfulness exercises are another great way for children to improve their ability to sustain focus, regulate their emotional responses, and make better decisions.

Some of our favorite resources are:

I am Yoga  by  Susan Verde and Peter H. Reynolds

We have written in previous blogs about children’s author and illustrator Peter H. Reynolds. This time he has teamed up with certified yoga instructor Susan Verde to create a book that encourages children to explore the relaxing world of yoga. The intention of the book is to foster creativity and self-expression in young people in a playful, engaging manner. The narration of the book encourages students to get moving as they are read to, and the back of the book houses a detailed explanation of all 16 poses they will be guided through.

A Handful of Quiet: Happiness in Four Pebbles by Thich Nhat Hanh and Wietske Vriezen

A Handful of Quiet describes Pebble Meditation as a “unique technique to introduce children to the calming practice of meditation.” Pebble Meditation was developed by author Thich Nhat Hanh, who is a Buddhist monk and poet. He was nominated  for the Nobel Peace Prize in 1967 by Dr. Martin Luther King Jr. for his work in mindful living. The book guides students through a hands-on mindfulness practice that helps relieve stress, increase concentration, and develop gratitude.

Planting Seeds: Practicing Mindfulness with Children  by Thich Nhat Hanh, Chan Chau Nghiem and Wietske Vriezen

Mr. Thich Nhat Hanh and Ms. Wietske Vriezen bring forth another exceptional resource for developing mindfulness in children. Planting Seeds offers concrete activities and a detailed curriculum for parents and teachers to help children improve communication, grow confidence, and deal with difficult emotions. Techniques in the book and the accompanying CD include deep relaxation, conflict resolution, ethical guidelines for children, and mindful breathing.

I wonder…  by Annaka Harris and John Rowe

I Wonder... is a beautifully illustrated picture book written for children age one and above. The story follows a little girl as she confronts several questions about the world around her. Through the process she learns that it is okay to not know all the answers but rather that curiosity and awareness of the world is what matters. The story offers lessons in emotional intelligence and aims to build children’s confidence in themselves.

 

What Does It Mean to be Present? By Rana DiOrio and Eliza Wheeler

The award winning children’s book What Does it Mean to be Present? encourages students to be mindful by equipping them with practical ways to be present. It teaches students how to listen to themselves and others, as well has how to slow down and focus on what is going on in the world around them. This book is one of several in the What Does It Mean To Be …? series. So if you like this story, you may also enjoy author Rana DiOrio's books on developing kindness or a global mindset.

New Study Looks at How Brains Multi-Task

Scientists at NYU Langone Medical Center have just announced new research findings that may help explain how our brains focus attention on specific tasks and filter out distracting or unimportant information, a process often referred to as "saliency determination."

As reported by NYU Langone, senior study investigator and neuroscientist Michael Halassa, MD, PhD. noted, 

“Our latest research findings support a newly emerging model of how the brain focuses attention on a particular task, using neurons in the thalamic reticular nucleus as a switchboard to control the amount of information the brain receives, limiting and filtering out sensory information that we don’t want to pay attention to. Filtering out distracting or irrelevant information is a vital function. People need to be able to focus on one thing and suppress other distractions to perform everyday functions such as driving, talking on the phone, and socializing.”

The researchers also noted the interaction of the thalamic reticular nucleus and the prefrontal cortex of the brain in controlling how the brain multi-tasks. The prefrontal cortex has long been known to control executive functions - organization, focus, and other behaviors that impact day to day functioning. The study looked at how mice were able to respond to stimuli when their prefrontal cortex was inactivated, which disrupted TRN neural signaling. When this occurred, the mice were not able to block out distracting stimuli and find a reward of milk.

Certainly, this research has a way to go before it fully explains how this process works in humans. But it may be a huge next step in explaining the brain issues underlying attention deficit and executive function disorders.

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.

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

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

Eye to Eye: A Mentoring Program By and For Kids with Learning Differences

Children with learning differences or difficulty with attention may feel like no one really “gets” them. Wouldn't it be fantastic if each one of these kids could work with an older mentor who not only provides good company and advice but who actually shares their learning difference? Eye to Eye, a fascinating organization for empowering students with learning differences, makes this fantasy a reality.

This outstanding program began in 1998, when five students from Brown University with learning disabilities (LD) and/or attention deficit/hyperactivity disorder (ADHD) began a public service project. Christening their idea Project Eye-to-Eye, they targeted a group of elementary school children who’d been given labels similar to theirs. Their goal was not to tutor these kids, per se; they say they simply wanted to give them hope. So they worked on art projects together, hoping the kids would find art an accessible medium to express their feelings and showcase their talents. Founding member David Flink graduated and went on to work as an admissions officer at Brown, but he kept getting requests from students at Brown and other universities for information on how to continue the program. So he changed tacks, recruiting employees and traveled the country to set up similar experiences for both LD/ADHD mentors and mentees around the country. The goal is to empower “at risk” kids by giving them membership in a community that accepts and supports them.

Today, Eye to Eye pairs highly trained high school and college mentors with LD/ADHD with younger students who have similar learning challenges. The pair meets weekly to work on art projects, talk, laugh, and learn about each other and themselves. We are especially impressed by Eye to Eye’s commitment to helping kids develop metacognition  This important skill allows kids to understand themselves from the inside out, recognizing their strong and weak areas and determining how to overcome challenges using their unique talents. One of Eye to Eye’s core principles is that self-esteem, self-awareness, and self-determination are critical for resilience, and so they strive to help students feel good about who they are, learn about themselves, and become self-advocates. Additionally, mentors help students develop concrete academic study skills and personalized goals that students can propose during IEP or 504 meetings or parent-teacher conferences.

Interested in getting involved with Eye to Eye? Visit their website to learn more. The FAQ page contains instructions for contacting Eye to Eye if you are interested in finding a mentor or mentee for a child in your life; currently, fifty-one chapters are spread across nineteen states. Information is available for those wishing to start chapters in their areas if one does not already exist. Also, those in the New York, New Hampshire, and San Francisco areas may be interested in the outstanding, week-long Camp Vision, where kids learn to celebrate their different strengths through a variety of fun and enriching activities.

Recommended Reads: Joey Pigza Swallowed the Key

We love books! So, from time to time we will be sharing some of the wonderful books for children and young adults that your family may have overlooked in a new series called "Recommended Reads." We'd love to hear from you about your family's favorite reads and suggestions for books you would like us to review in the future. Today's pick features a boy who struggles to control his attention.

---

Joey Pigza Swallowed the Key by Jack Gantos

Originally published by Farrar, Straus and Giroux  (1998)

Ages: 5th grade and up

Awards: Finalist for the National Book Award for Young People’s Literature in 1998, Notable Children’s Book in 1999

Plot: Joey Pigza is in the care of his grandmother when his mom comes to the rescue. Joey’s grandma doesn't take good care of him, so he’s thrilled when his mother returns after being gone for as long as he can remember. His life immediately improves – in some ways. But he still can’t sit still in class and is constantly in trouble at school. No matter how hard he tries, Joey can’t seem to control himself. He likens himself to a Tasmanian devil – he simply can’t sit still, and the “dud meds,” all his mother can afford, often fail to work. Despite his good intentions, he sticks his finger into a pencil sharpener on an impulse to give himself a sharp nail like Dracula and has to be sent to the nurse. He ruins a class trip by jumping from a rafter and spraining his ankle. And, of course, he swallows his house key. Joey always means well, and he knows that he’s a “good kid,” but things seem to be going from bad to worse for him. Eventually, he is sent to the special education classroom from time to time. The teacher there is more knowledgeable about Joey’s difficulties, but she has her hands full and can’t really give him the help he needs. When he runs across the classroom with scissors, producing disastrous results, Joey is sent to a center downtown. He dreads going, but instead of punishment finds a team of experts who put him on the right track at last. It will still be an uphill battle for Joey, but in the end he, his mother, and his teachers are feeling hopeful, and rightfully so, that things will work out for him after all.

Adult Themes: Joey’s mother alludes to her own former problems with alcohol several times and tells him that he’d have to look in bars if he wanted to find his absent father. She drinks a single cocktail after work in several scenes though she is never shown to be intoxicated or negligent. Joey’s grandmother, who disappears early on, is not a suitable caregiver, and while she is not physically abusive to Joey, she is certainly emotionally abusive.

Our Take: While we try to focus on kids’ reactions when we review books, we were blown away by the way the author put us so vividly in the shoes a child who suffers from uncontrollable attention difficulties. The first-person narrative allows readers to get right into Joey’s head, and it made us understand the obstacles children face when they struggle to control their attention on a different level. This book is alternately funny and heart-wrenching, and often both at the same time. It’s clear from the beginning that Joey is an immensely likable, good-hearted boy, but adult readers will find themselves wondering how on earth they would ever be able to manage him if they were his teacher or parent. Younger readers will be taken with Joey’s good nature and sense of humor, and some may even relate to him personally, or be able to see a classmate in Joey. Children often report that they find Joey’s shenanigans humorous, though adult readers may find the book more poignant than funny. Through much of the book, Joey tries to improve and fails again and again because he lacks the right resources. This can be hard to read, especially for older readers, and it comes as a huge relief when Joey finally meets people who can help him, and his mother, get their lives together.

Some parents may want to read this book before giving it to their children so that they can be prepared to discuss some of the difficult issues it raises. While there’s no question that Joey’s mother loves him very much, she is not an ideal parent, and kids will also be confronted with the emotional abuse Joey suffers at the hands of his grandmother (this part is brief), inadequate support from his school, and both learning and physical disabilities. These realities are not written gratuitously; in fact, Joey serves as a caring and tender narrator, but some kids may fare best with parental support.

Children who struggle with attention themselves would particularly benefit from this book, and will be pleased to know that there are three other books in the series: Joey Pigza Loses Control (a Newbery Honor Book in 2001), What Would Joey Do?, and I Am Not Joey Pigza. 

Scholarships for Students with ADHD

We are often asked about college scholarships for students with learning or attention issues, and find it frustrating when we have to answer that such scholarships are rare indeed. So, with the deadline approaching for one such program, and several others coming up, we thought it would be a good time to take a look at this topic.

The Anne Ford Scholarship and Allegra Ford Thomas Scholarship both have an application deadline of December 31, 2012. These scholarships were established by Anne Ford, former Chairman of the Board of the National Center for Learning Disabilities and her daughter, Allegra, whose challenges with learning and related issues were chronicled in the book Laughing Allegra. The Anne Ford scholarship is an annual $2,500 award for each of  four years for a student with a documented learning disability who will be pursuing a full-time bachelor's degree. The Allegra Ford Thomas scholarship provides a one-time $2,500 award for a student who will be enrolled in a two-year community college, a vocational or technical training program, or a specialized program for students with learning disabilities.

Shire, a pharmaceutical company that manufactures medications for ADHD, will offer a $2,000 scholarship and a year of coaching to fifty students who will be attending a college, university, technical school, or vocational school. Applications are due by March 27, 2013.

Learning Ally (formerly Recording for the Blind and Dyslexic) offers the Marion Huber Learning Through Listening (LTL) awards, which provide six scholarships for students with specific learning disabilities. Applicants must be a member of Learning Ally. The awards for the three top winners are $6,000 each and three special honors winners receive $2,000 each. The deadline for the next awards is March 15, 2013.

A helpful resource for scholarships and other financial aspects of college is available on the website of the College Board. Students and parents should also become familiar with FAFSA, the Free Application for Federal Student Aid.

Photo: CC by Tax Credits

Early Skills Can Predict College Success

A study by a team at Oregon State University led by Dr. Megan McClelland and published in Early Childhood Research Quarterly found that children who had greater attention spans at age four had an almost 50% higher likelihood of completing college by age 25. The researchers looked at 430 children and, after controlling for such variables as family background, gender, and early academic achievement levels, found that strong early attention abilities also predicted math and reading achievement at age 21.

That's all well and good, but if attention spans in young children are so important, can anything be done to build such skills in children who lack them?

The answer may lie in the games some of us remember from childhood -- games like Simon Says and Red Light, Green Light. An earlier study of 65 preschoolers found that when children who had low levels of focus played games similar to these they demonstrated improvements in both early language skills and self-regulation.

A review of this topic by New York Times writer Tara Parker-Pope notes that the most effective way to to use games to build skills in young children is to begin with games with simple rules and to make them increasingly complex. For example, the games used in the Oregon research included a variation of Simon Says that started with copying the leader's movements but then required the children to do the opposite of what the leader did --such as touching toes when the leader touched her head. Other games that were found to build attention and executive function skills were singing in rounds and playing "Red Light, Green Light" using red for "go" and green for "stop." Try these. They are harder than you would expect.

The Impact of Clothing on Academic Performance

Any parent of a teenager knows that wearing the “right” clothes is an important part of fitting into – or standing apart from – particular social groups. Adults, too, know that the clothing they wear to their jobs or on social occasions sends a message to the people around them. What we wear can also impact how we feel about ourselves. As noted in research from a team at Northwestern University, it turns out that what we wear can also impact how well we do on academic tasks, specifically on tasks related to attention.

The researchers coined the term “enclothed cognition” to describe the impact of two influences occurring together -- the symbolic meaning of the clothes to the subjects and the physical experience of wearing them. The scientists begin their study by discussing some previously documented findings about the impact of wearing particular clothing on the behavior of individuals. They note that prior studies have demonstrated that wearing a bikini has the effect of making a woman eat less and perform worse on mathematical tasks. They refer to other research that finds that sports teams that wear black are more aggressive than sports teams wearing other colored uniforms.

The subject in this study were college undergraduates who were asked to wear white lab coats while performing certain attention tasks. Some of the subjects were told that the coat was a doctor’s lab coat, while others were told that the coat was a painter’s coat. When subjects wore a coat that they believed to be a doctor’s coat they scored better on measurements of attention than when they wore a coat that they believed to be a painter’s coat – or when they simply viewed a doctor’s coat and were asked to think about what it represented to them.

The authors present their findings in a particularly clear way and discuss numerous examples of earlier studies and questions that need to be addressed in future studies. If you have the time, it is well worth reading the original publication.

Photo: Vivien Rolfe / Creative Commons

Study Links Early Snoring to Behavior Problems

A sleeping toddler snoring away may seem cute to parents and other observers, but a new study in the journal Pediatrics raises concerns about the impact of sleep-disordered breathing (SDB) -- loud, persistent snoring -- on the future development and behavior of children.

Researchers enrolled 149 child/mother pairs in a prospective study that tracked snoring through the child's third year and categorized the children as non-snorers, transient snorers (who snored at age two or age three but not both) and persistent snorers.The choice of the age group of two to three years was based upon the fact that SDB is known to peak during this period.

The study found that there was a significant increase in behavior problems in the group with persistent SDB even when adjusting for such factors as gender, race, and socioeconomic status. These behavior problems included hyperactivity, depression, and attention. The findings of this study are consistent with findings of studies looking at older children and which hypothesize that the interruption in sleep caused by SDB can interfere with neurological development.

Two other significant findings in this study were that children who were breast fed were less likely to have SDB and that a low socioeconomic level made it more likely that a child would have transient or persistent sleep disordered breathing. None of the children who were fed breast milk for more than a year developed SDB but one-quarter of those who never were fed breast milk or who were fed it for less than one month developed SDB.

The study authors note that interventions to treat snoring have been shown to be helpful and urge that children be screened for sleep disordered breathing. They also stress the positive impact of breast feeding and urge that parents consider this protective factor when making feeding decisions.

Photo: Elizabeth / Creative Commons (modified)

ADHD Medications and Teenage Drivers

We are frequently asked whether it is really necessary to take attention medications every day. Some students feel that they only need their meds when they have a major project, important test, or heavy workload. Many parents like to give their children a “break” over the weekend or during vacations. I believe that deciding whether and how to take medications is a personal decision best made in consultation with the prescribing physician. But making a wise decision requires the best information so each of us can weigh the potential benefits and risks in the context of our own lives. With that in mind, I think it is important to share interesting research that was published in the April 2012 edition of the Journal of Clinical Psychopharmacology in a study called "Long-Acting Methylphenidate Reduces Collision Rates of Young Adult Drivers With Attention-Deficit/Hyperactivity Disorder" (by Cox, Daniel J. PhD; Davis, Margaret BA; Mikami, Amori Yee PhD; Singh, Harsimran PhD; Merkel, Richard L. MD, PhD; and Burket, Roger MD). 
    
The investigators studied adolescents diagnosed with ADHD who had previously responded to medication, were not routinely taking medication, and were active drivers with more than one collision or citation in the past two years. Half of the participants received long-acting stimulants; the other half did not. Their driving was monitored for three months with in-car video cameras. (You are probably wondering how you can get a hold of one for your own adolescent driver). Compared to the untreated group, the group receiving medications had fewer video-documented collisions and “problematic driving events.” So, when making decisions about risks and benefits of attention medications, bear in mind that academic performance may not be the highest priority.

Photo by Dominic Alves via Flickr/Creative Commons

3 Keys to Fostering Resilience in Children with LD and ADHD

Dr. Yellin recently contributed an article about a favorite topic of conversation here at The Yellin Center, resilience, to the newsletter of Smart Kids with Learning Disabilities, a Connecticut-based non-profit organization dedicated to empowering the parents of children with learning disabilities and attention-deficit disorder.

Paul B. Yellin, MD, FAAP

In the article, Dr. Yellin writes: "So many of the children I see in my practice are their own harshest critics, exaggerating their weaknesses and diminishing their strengths. Helping children appreciate their strengths and talents is often the first step to resilient thinking."

Read 3 Keys to Fostering Resilience in Children with LD and ADHD here.