After the Storm

It's been quite a week here in New York, and we hope you are reading this blog in your warm home, with lights on and family around you. The Yellin Center was closed at the height of the hurricane, but has been open and busy since Wednesday. We aren't sure how, but our building on West 29th Street somehow escaped the mandate that all power would be turned off south of 34th Street (and remains off for most downtown areas as of Friday afternoon).

Most of our staff, including Dr. Yellin, still have no power in their homes, and getting to the office has required patience and creativity. We've got folks sleeping in cold apartments, in the homes of friends who have electricity, and with relatives.

Still, we have no complaints. We are all safe, our homes are intact (if cold), and we know that things will be better for us soon. We know that is not the case for many of our patients, friends, and colleagues and we are deeply concerned about them. We know that this blog is read by folks all over the country, so we wanted to let you know that we are up and running -- and to share our concern about those who have lost their homes, their businesses and, most tragically, their loved ones.

Photo: MTAPhotos / Creative Commons

Online Productivity Monitors Can Help Find Lost Time

Do you ever wonder where your time goes? Two productivity monitors that track your online activities, Slife and Rescue Time, can tell you exactly.

Both function similarly, sitting quietly in the background and keeping track of every site you visit and how much time you spend there. But each can take a more active role if you choose, limiting the time you spend in particular areas such as news, email, and games. (You can categorize sites yourself.) You can generate reports for your own activity and for the time your family members -- including your children -- spend online. These reports can plot the data by hour, day, and week. You can set time goals (i.e. I will spend a minimum of three hours doing online research each day,” or “I will spend no more than 15 minutes answering email,”) or, in cases of extreme addiction, completely block distracting sites from your family members or from yourself.

Each service can be downloaded for a small fee, but if time really is money, the cost may be worth it.

Photo: Gary Cycles / Creative Commons

Children, Football, and Concussions

As a parent, pediatrician, and lifelong football fan, I was naturally drawn to the article on the first page of yesterday’s New York Times, “A 5-Concussion Pee Wee Game Leads To Penalties for the Adults.” The article was particularly timely as we embark on a major initiative at The Yellin Center to better understand and address how concussions affect academic performance. As I read the Times article, I followed the narrative as the litany of concussions in this single football game in Massachusetts unfolded. As Chris Nowinski, president of the Sports Legacy Institute aptly noted, there were undoubtedly many more concussions than those that were diagnosed. While I do believe that adults need to be held accountable for their decisions when they are responsible for children’s safety, I think we are fooling ourselves if we believe that this alone is an effective way to address this problem.

As a former Chief Medical Officer of a hospital, this football game is what we would call a “sentinel event.” Like the canary in the coal mine, sentinel events often tell us that there are big problems that need to be confronted. In almost every case, individual errors in judgment can be identified. However, when one looks closely through a process called a “root cause analysis” one usually finds that these kinds of errors in judgment are often more widespread and that the sentinel event represents a “perfect storm” of causes. Taking an immediate punitive approach often short-circuits the root cause analysis and discourages people from coming forward in the future to report minor problems before they become major ones.

It’s clear that concussions are not only a problem for the youngest players. A follow-up article in today’s paper about concussions in high school football refers to a study from the Pediatric Brain Trauma Lab at Massachusetts General Hospital that found that 486,000 combined head impacts had been recorded over a five-year period among players from the football teams at Brown, Dartmouth and Virginia Tech, as well as two men’s and two women’s hockey teams.

Was I the only one that was stunned when I read that based on the rules of “safety” the weight limit for 10 year olds in the Pee Wee game was 120 pounds? 120 pounds is more than 20 pounds above the 95th percentile for 10 year olds! Furthermore, as the Times notes, “rules are only as effective as the adults charged with enforcing them. Four of the five injured boys have resumed playing football…”

So, I think that we all have some serious work ahead of us in examining the safety of contact sports for young children. We need to begin with a root cause analysis of the Massachusetts sentinel event. And we have to seriously entertain the question about whether it is ever possible to make these contact sports safe enough for young children.

Photo: woodleywonderworks / Creative Commons (modified)

Games to Build Visual Skills

Visual perception is critical to academic success in many areas. Reading, geography, math, art and art history, foreign language literacy, and the sciences are just some of the subjects that rely heavily on visual discernment. Below, we've described some games that are so much fun, kids will have no idea they’re actually building their visual skills!

On the Dot

When reading aloud, it is common for students to substitute a visually similar word (for example, “from” instead of “form”). This can happen to inattentive readers or to readers with poor sequencing skills. Another possibility is that the student needs to build his/her visual acuity.

Visual perception is clearly an important skill in reading, and it is not necessarily related to the quality of a student’s eyesight. A child with 20/20 vision may still have difficulty perceiving clusters of letters accurately, which suggests that s/he needs to strengthen cognitive skills like visual acuity and spatial reasoning. Luckily, a simple board game can help.

On the Dot is recommended by expert reading instructor Al Moore to help students strengthen both visual acuity and spatial reasoning in a fun way. Play is simple: After looking at a card with a configuration of dots on it, players stack a series of transparent cards, each printed with their own dots, to recreate what they see on the card. The first to accurately copy the pattern on the card is the winner. Single players may time themselves to determine how many patterns they can replicate in five or ten minutes.

Guess Who?

Fluent readers rely on their visual memories to read words, and most of us use the same memory function to check our spelling. To improve this cognitive skill, as well as to give any student, regardless of learning style, a serious higher-order thinking workout, try playing Guess Who?.

This old favorite seems to have fallen by the wayside, but it deserves a resurgence. In this two-player game, each player privately selects one of 20 characters. Then players take turns trying to guess the identity of their partner’s character through a series of yes/no questions designed to eliminate possibilities. Though most people would hardly call this game educational, in fact it is great for developing important cognitive skills used in reading. To play, one must look at a variety of visual stimuli and determine what is similar about them and how they differ, the same way a proficient reader can identify a word at a glance because of its visual characteristics. It also reinforces listening comprehension, particularly at the sentence level, and short-term and active working memory.

Guess Who? provides both the medicine - a hefty dose of cognitive strengthening - and the spoonful of sugar to help it go down.

Seeing Stars

Seeing Stars – not your average board game – is designed specifically for reading instruction. Its price tag is considerable, and your family is unlikely to play this game around the kitchen table on a Saturday night. Still, it is enjoyable for children and has been demonstrated to be effective in helping them improve the cognitive areas critical to reading.

Seeing Stars, a game developed by the famous reading program Lindamood-Bell, encourages children to latch on to the reading process in a non-traditional way. The programs at Lindamood-Bell are heavily visual, guiding children to learn the shapes of words and the letters within them rather than processing words letter by letter. This is an effective approach for children who struggle with phonemic awareness and phonology. Consequently, Seeing Stars is all about mental imagery. In this game, a student is asked to visualize a real or nonsense word, then alter it by transposing, removing, adding, or substituting letters to form new words. For students who must memorize orthographic patterns in order to spell - in other words, students who cannot “sound out” words in order to spell them - this process helps students form a strong, mental image of words that can easily be recalled later during reading and writing tasks.

Seeing Stars may not replace Monopoly as a family favorite, but its value goes far beyond entertainment.

A Week to Focus on ADHD

A coalition of national organizations, including CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) and the Attention Deficit Disorder Association (ADDA), have declared this to be ADHD Awareness Week, and we thought that this would be a good time to look at the facts about ADHD to help parents, educators, and students better understand this condition.

The CDC notes that ADHD is one of the most commonly diagnosed behavioral disorders of childhood, with 9.5 % of children being diagnosed with ADHD at some point. Boys are two to three times more likely to be diagnosed with ADHD than are girls. Some of that difference may stem from the fact that there is more than one kind of ADHD; the National Institutes of Mental Health notes that there are three different types of ADHD:

• Predominantly hyperactive-impulsive
• Predominantly inattentive
• Combined hyperactive-impulsive and inattentive

A girl who seems to daydream in class may not be as likely to be diagnosed as a boy who can't sit still and is disruptive, but both students may have ADHD and may need treatment and strategies to get the most out of what is going on in their classrooms.

Research is clear that ADHD has a real, brain-based cause and also has a genetic component. It is not caused by parenting styles or food allergies, although environmental toxins may be a factor in its occurrence. Co-morbidities, conditions that are often diagnosed in individuals with ADHD, include anxiety, depression, and learning disabilities. 

While diagnosis of ADHD is generally made by looking at the how many symptoms occur in various settings -- such as both at home and at school -- it is important to take a nuanced look at what is going in an individual before deciding on a diagnosis and before determining the appropriate treatment. For example, a student who is struggling to process what is going on in his classroom because of a language disability may appear to be inattentive, when the difficulty is actually a learning problem, not ADHD. Only by addressing the language processing difficulty will this student be able to attend properly in his classroom. 

What about treatment? This needs to be an individualized decision, especially for children. There are many medications that can be effective in helping with ADHD symptoms, and the National Institutes of Mental Health has a good explanation of what these are. But these medications can have side effects and parents may want to consider behavioral strategies before they decide whether medication is the best choice for their child. It is crucial that parents work with a physician with experience with these medications to make the right decision for their child.

Related articles from The Yellin Center Blog about ADHD

Planning to Protect Your Children's Future

This week is National Estate Planning Awareness Week. It's a good time for all parents, especially parents of children with learning and other challenges, to think about whether they have taken the steps necessary to ensure their children's future -- financial and otherwise.

It helps to understand what happens when parents don't have wills. In the event that both parents die by an untimely accident or illness that leaves behind minor children, a court will award custody of the children based on "the best interests of the child." The preference of the parents for one family member over another, for example, won't be clearly known to the court that makes this decision. In addition, any funds left behind by the parents (savings, investments, life insurance, or proceeds of a "wrongful death" lawsuit) will be placed in a trust by the court, to be administered according to state law and to be released in full to the child when he or she attains majority, usually at age 18. Only children with the most significant disabilities will have their funds placed in a trust that is administered by a court-appointed trustee. A child with significant special needs who may be receiving benefits from a state or federal agency will lose those benefits that are income based, at least so long as the money left behind by the parent lasts.

In contrast, parents who have sat down and thought about their children's future and who have put in place a plan for what will happen after they are no longer around can take important steps to protect their children and make sure they will have access to their legacy in the most effective and helpful ways.

First, parents can name a guardian for their minor children and for children with significant disabilities who will be in need of guardianship as adults. While this instruction from parents is not controlling on the court administering the parent's estate (see the "best interests of the child" standard mentioned above), it can go a long way to influencing the naming of a guardian, particularly when parents set forth their reason for their decision.

Second, parents can create trusts to hold the assets which will be available to help support their children. These trusts can be set up during the parents' lifetime or, more commonly, in their wills. They can specify how assets are to be spent, at what age(s) their children will receive some or all of the principal of the trust, and who will control the trust purse strings and make necessary financial decisions during the term of the trust.

Most children will reach an age -- 21, 25, 30 -- when they have sufficient judgment and maturity to manage the assets in their trust. But other children will be unable to handle their own finances in any way, especially the significant sums that may have been left to them in a trust. This situation can arise when a child has significant physical or cognitive disabilities, emotional difficulties that impair judgment, or is addicted to drugs, alcohol or gambling. The situation will be different for each family, but parents will know which children fall into this category. For these children, a trust may need to last through their lifetime. And, for children with special needs who are receiving government benefits, parents need to work with a skilled financial planner or special needs attorney who can help set up a trust, generally called a Special or Supplemental Needs Trust, that will ensure that their child can continue to receive their benefits, while being able to supplement the limited categories of items that such benefits cover by providing funds for such items as housing, travel, and education.

After years of legal practice, your blogger has learned not to be surprised at how many parents of young children don't have wills. Often writing a will is something they plan to do, but just haven't gotten around to yet. Sometimes, they can't agree on who should be named as a guardian of their minor children and put off this contentious decision by avoiding writing a will. Planning for the future by writing a will is something that all parents, particularly parents of children with special needs, need to make a priority.

Photo: Jeremy Koren

Newsday Webinar on "Selecting the Right College"

Susan Yellin, Esq., the Director of Advocacy and Transition Services at The Yellin Center for Mind, Brain, and Education (and frequent contributor to this blog) has been invited to serve as a panelist for a free webinar on "Selecting the Right College."

The Newsday College PrepTalk webinar will take place on Monday, October 22, at 8:00 PM (Eastern).

Topics that will be discussed include: Student Life, Academic Reputation, Campus Size and Faculty, Special Circumstances, and Students with Disabilities.

The free event is sponsored by Hofstra University.

Register for the event here.


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For more information about upcoming Yellin Center events, please visit our Events page.