Seldom do I see a child with ADHD (Attention Deficit Hyperactivity Disorder) who does not have at least one co-exisiting, or comorbid disability or disorder. The population of children with ADHD has a very high rate of difficulty with handwriting. From personal observation, I see everything from forced, heavy handed small print to large, immature, poorly spaced writing. Frequently these children are never comfortable with cursive writing. Even in adulthood, they continue to print when they have the option to do so.

According to evaluations I have seen, there appears to be a high rate of visual perceptual problems in varying degrees. A teacher once told me that if a child is not writing cursive comfortably by the fifth grade, they should be allowed to print. By that time, emphasis should be on content, not a handicapping style of writing. I believe older youngsters should be given the regular use of a computer to produce written work, especially that of creative writing. For many reasons, the computer often bypasses the short circuits in the complicated process of writing for these children. Computer use, (assistive technology), frequently reduces distractibility.

If your child can produce much more acceptable work on the computer, or if you suspect that is the case, you have the right to ask for such technology on a regular basis for your child. If there is an IEP (Individual Education Plan) for your child I highly recommend that specific use of the computer for writing be written into the IEP. Don't leave it to chance that maybe your child will do some writing on a computer. Don't be misled if you are told all the children use the computer. Be sure it is not just keyboard instruction. All children are supposed to have instruction on the computer. Children with difficulty writing need the immediate reinforcement and praise for good content, even if they have to hunt and peck for awhile.

See to it that the team writes in detail when, and how much, and for what purpose your child will be on the computer. Check the IEP as soon as this is supposedly decided. I would say 98% of the time, we see the district has just written in "creative writing" without the words "on the computer". It happens far too often to be coincidence.

If your child needs assistive technology, such as a computer, to bring performance level up to peers, the school district should provide that technology.

Information at this site is not to be construed as legal advice. If you need such advice be sure to contact an attorney who specializes in special education matters.

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The information is this diagnostic section is a composite of information gleaned from diagnosticians, advocates, veteran teachers, and personal experience.

Under each heading, the brown color explains how a low test score impacts a child in the classroom.

WISC Verbal subtests:

Information-

Measures long term memory, child is asked information questions like how many cents are in dime; things that most kids are exposed to, and checks if they can recall them.

Kids who cannot retain information are going to have to review work more often or it will evaporate. And they'll need to study for tests, instead of just walking in and whipping out a written tests as do their friends. They need to use aids to recall information, such as studying with graphic patterns, boxes and circles and triangles, grouping data according to how it fits into the topic. Grid/calc for times tables in grades 4-7, the longest and most boring single piece of memory work.

Similarities-

Measures logical/abstract reasoning. Child has to tell similarities between 2 things, some concrete such as (dog/rat) and some abstract (beautiful, ugly).

These children have trouble with concepts in any subject. You see it right away in grade 2 when doing place value for regrouping. Explaining moving a group of 10, leaves them with a blank stare. And doing integers (negative numbers) in grade 7---forget it. But they can learn the operations even if the concept is missing, by teaching the procedure. Same in language arts, inferences and generalizations will be hard, but plot development and themes and characterizations will be OK. So they have to be walked through inferential work.

Arithmetic-

Measures math reasoning. Child does oral problem solving.

These kids of course have trouble with problem solving. You ask a grade 2 or grade 3 kid--"if the farmer sold 5 cows for $100.00 each, how much money did he make? And the kid looks at you and says, "do ya add or subtract?" They don't have a clue. And the heartbreak is, problem solving is the only reason to teach math! The only way to really help these kids seems to be to use flow charts to organize the known from the unknown.

Vocabulary-

Measures expressive vocabulary. Child is asked for definitions of words.

Their work appears immature and brief, as though a younger kid did it, and some teachers want to hand it back to be redone. But the teachers have to know that they should accept it even if it looks like this, if the child has made a good effort. The kids need help thinking of ways to say things, and the new game Taboo is great for that.

Comprehension-

Measures knowledge of appropriate social behavior and judgment. Child is asked what he would do in certain situations, like "What would you do if you came upon a child lying hurt in the street,"; and why certain things are so.

These children are the ones who are always in trouble for doing the wrong thing, like fighting, because they aren't good at social situations. Or they are "nerds" because they can't learn the cool behavior. They need help dealing with situations, and we find they need an example of how to handle every type of situation, because they don't generalize. The fighters need to be taught how to stay out of trouble. For instance, it is better to call someone a name than to throw a punch. The "nerds" need to learn what to say when a certain thing happens so they don't sound goofy.

Performance Subtests:

Picture Arrangement-

Measures visual sequencing. Child has to put story cards in the correct order to show how a story progresses.

Picture Completion-

Measures alertness to visual essential details. Child is shown a picture with a missing piece and must find the missing element in the picture.

Object Assembly-

Measures visual-spatial organization. Child works puzzles.

Seems to affect mostly representational math like geometry . These children need to memorize the formulas.

Block Design-

Same as Block Design. Child does parquetry, fitting colored blocks together to match a picture.

Coding-

Measures fine-motor speed. Child has to copy designs from a legend into the corresponding number.

These kids are slow to finish written work. They need extra time, and if it's very serious, in the upper grades it is helpful for them to learn to use some abbreviations, and keep several words in their heads when copying. They often become better typists than writers, and for the very severe they often learn shorthand in 2-3 weeks, and then they can write a s fast as the teacher can talk. But if they can't read their shorthand they're cooked, because no one else can read it for them.

Digit Span-

Measures short term memory.

They forget directions, and need them chunked, and later repeated.

IQ

A poor verbal IQ means a general language disability, and a poor performance IQ means a general visual-spatial disability.

Average IQs are 90-110. Gifted is usually over 130. Mentally retarded (DH) is under 50.

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and what are those tests REALLY measuring?

The information in this diagnostic section is a composite of information gleaned from diagnosticians, advocates, veteran teachers, and personal experience.

I was amazed to find out that the labels put on diagnostic tests can be rather misleading. For instance, I thought Comprehension measured a child's reading comprehension. Humm. I wonder where I could ever have gotten that idea? It actually measures, among other things, how well a child comprehends the world he lives in and social interactions. It's always wise to ask your diagnostician, before a meeting, to write down a brief summary of what each test is actually measuring. Otherwise it can seem so clear when it's being explained to you and so garbled when you look at it at home.

I am most grateful to "Bob," whom I met at the bulletin board at LDONLINE for the following definitions, put in parent-friendly language. I searched for 3 years for such understandable definitions, and with his help, I can now put this up for all of us to reference.

Tests for Formal Assessments

Formal assessments are norm-referenced and validated with use on 1,000 plus kids (if the tests are any good) who are the same age, but comprised of different ethnic groups. The "norm" is the absolute middle in grades. Usually that "smack-in-the-middle point" will mean a norm or "mean" of 100. Some have a different mean.

What's important for parents to realize is that when you see 100, you aren't thinking: "100%, gosh that means perfect". That's the usual grading reference we saw when we were in school. In this case, 100 really means: half the kids did better than 100 and half the kids did worse. If your child performed within 15-17 points on either side of 100, that's in the "average" range. So if a child had a 85-115, that would still be average.

15 points either way would be called one "deviation". Two deviations is considered serious enough for concern. Of course, if your child is two deviations ABOVE the mean, it means he/she excels in that area. One example of the 100 mean is the I.Q. test. If your child tests out with a composite score of 100, that is smack-in-the-middle-average. If the score is 85-115, that is still average and our one deviation range of 15 points---get it?

If your child's score is 70 or 130 you are looking at two deviations. Below 70 is considered the retardation range, over 130 is considered the gifted range.

Speaking of composite scores---I do not like them and do not go by them. If you are a marvelous swimmer and make a high score in competition say 95, and a lousy runner who makes a score of 15, how can an average of the two scores, (55) have any possible importance? Always look at each subtest score individually, and get help for the low ones and encourage and enrich and build on those unusually high scores. This is where you discover a child's academic strengths, as well as weaknesses.

Some tests, like a lot of subtests I have seen, have a mean of 10. That means the same as the above. Half did better, half did worse. If your child has more than 3 points off of 10, it can be a cause for concern. They go by "deviations". When the "mean" or "norm" is 10, a standard deviation is 3 points. If a child has 2 deviations in a subtest, it's cause for serious concern.

Criterion Referenced Tests

Measures knowledge against certain criteria--such as knowledge of one area of language. These tests usually have more than one version and the tester will change the versions around with a student, so they won't memorize the questions or tasks. These tests are good for planning instructional strategies and measuring progress.

Curriculum Based Measurements

Some of these tests to measure knowledge in the general education curriculum are published by book manufacturers, some by a state's Department of Education. The Iowa Test of Basic Skills is an example.

Curriculum Based Assessment

This is an assessment without the use of formalized tests. The student is measured against the general curriculum to see if the deviation is enough to qualify for special education.

If this testing method is used exclusively, there's lots of missing information. There are no clues as to why the student is not keeping up, as you would get from WISC-III or other testing data. That's why this method should NOT be used as the only qualification method for learning disabilities. Understanding WHY a student is not keeping up is very important, and this type of assessment does not give that information.

Teacher Assessment

All ways of assessing are important in their own way, even teacher observations. However, too much "teacher observation" assessment leaves nothing to show, or prove, achievement of the goals and objectives. Teacher assessment can be subjective and should be only one part of any assessment. I recommend parents not let progress towards the short term goals on the Individual Education Plan (IEP) be measured by "teacher observation" only. While it's an important component, it shouldn't be the sole means of testing. Objective, measurable testing should always be included and is required by law.

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When I'm called upon to assist a child who is struggling in school, I find the spotlight is invariably focused on a child's weaknesses. This is particularly common for the child with Attention Deficit Hyperactivity Disorder (ADHD), as poor social skills have brought additional negativity into play.

Years of remedial effort have been poured into fixing what's broken, rather than capitalizing on what works. In other words, if a child can't read, hours are spent teaching that child with methods that didn't work in the first place. If there are behavior issues, the same punitive measures are used over-and-over, yet there's no improvement.

When the spotlight shifts onto areas where your child shines, in his/her areas of strengths and personal interest, there are often very dramatic improvements in work effort and negative behaviors often significantly diminish.

Areas of Strength

Child psychologist and recognized authority on ADHD, Dr. Robert Brooks, developed the term "islands of competence" in reference to these areas of strength. I interpret his concept in the following way:

Everyone has strengths, but sometimes they're not obvious. We must find those areas of strength and build on them. Every person must feel they are making a contribution to their environment. If we accept both these concepts, the obvious thing to do is to build upon them.

I've used both concepts in helping a parent obtain services for a child suffering from academic failure and low self-esteem. Every child must feel important and every child must taste success.

Once academic needs are determined and appropriate services are in place, it's extremely important to begin building self-confidence and self-reliance. It's essential to have a concerted effort both at home and at school, with clear communication between the school officials and the parents.

Dr. Brooks likes for each of his young patients to have a special job at school in an area related to the child's interests and needs. It can be something like feeding pets or taking attendance to the office monitor. This can take creativity and ingenuity, but it's essential.

The schools I visit are usually resistant to this effort. After all, many have never tried this positive approach to resolve behavior issues or low self-esteem problems. School personnel look at us like we've lost a few screws. But it works! Inappropriate behaviors diminish, the child walks taller, often begins to show improved self-confidence, and demonstrates reliability. He feels needed and recognized for his efforts.

Sadly, the child with ADHD is often the last picked for helping out with different tasks. In reality, it's one of the single most effective tools to help your child gain self-confidence.

Ways to Help Your Child

The focus of scholastic effort must also be on the child's strengths. Following, are just a few examples and suggestions for compensating effectively for weaknesses and building on strengths.

• If your child has excellent verbal skills and creativity, but writing is a struggle, you might ask for daily use of a computer. If a child demonstrates such a need, (and I see this often in ADHD and learning disabilities), than the school is responsible for providing that assistive technology. Remember your child doesn't have to settle for the broken computer in the corner of the room (which happens all too frequently). Any needed equipment must be in working order and be made available in the regular learning environment. If you're concerned about the condition of equipment, you can stipulate in any 504 plan or IEP (Individualized Education Plan) that the equipment be in working order and located in an area immediately accessible to the student.
• Perhaps your child grasps math concepts, but has difficulty performing the actual calculations on paper. A calculator is a great assistive device for such children. Sometimes there are complaints that the child has to first learn math the "old fashioned way." Practical experience has taught me that if a child can't perform very basic math calculations by, say, the fifth grade, it will probably always be somewhat difficult. Is he/she going to suddenly become proficient in this area when an adult or count fingers? Most likely not. This person will buy a calculator for as little as $5.00 and finally become successful in performing practical arithmetic calculations. Why not start early to help the person with a math disability progress rapidly with the concepts by using a calculator to bypass the disability? This is not to say a child should not continue to work on mastery of calculations as well.
• Or take the fifth-grader who's struggling with second-grade spelling, perhaps spending as much as two hours a night trying to learn a list of twenty words. The most common modification, if any is made at all, is to cut the list in half. What if we let that child spend spelling time becoming computer literate? With the use of a spell checker and word processor program to offset organizational difficulties and spelling difficulties, children suddenly blossom into creative authors.
• A child who is very distractible in the classroom can show dramatic improvement when work is produced on a computer. Many children with ADHD tend to lose the thought somewhere between brain and pencil, but are excellent writers when using a computer. There seems to be an instant direct connection between brain and screen. Organizational skills show improvement. Problem solving skills are also honed on the computer, bypassing faulty circuitry that gets in the way of real learning. In each of these instances weaknesses are diminished by technology that levels the playing field for people with disabilities. The spotlight then shifts from the writing weakness to the content strengths.

When the strengths are brought forth and allowed to flourish, so does the whole child.

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Get details on the largest clinical study of ADHD in children and major findings regarding the most effective ADHD treatments for children with ADHD.

1. What is the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD)? The Multimodal Treatment Study of Children with ADHD (MTA) is an ongoing, multi-site, cooperative agreement treatment study of children conducted by the National Institute of Mental Health. The first major clinical trial in history to focus on a childhood mental disorder, and the largest clinical trial ever conducted by the NIMH, the MTA has examined the leading treatments for ADHD, including various forms of behavior therapy and medications. Te study has included nearly 600 elementary school children, ages 7-9, randomly assigned to one of four treatment modes: (1) medication alone; (2) psychosocial/behavioral treatment alone; (3) a combination of both; or (4) routine community care.

2. Why is this study important? ADHD is a major public health problem of great interest to many parents, teachers, and health care providers. Up-to-date information concerning the long-term safety and comparative effectiveness of its treatments is urgently needed. While previous studies have examined the safety and compared the effectiveness of the two major forms of treatment, medication and behavior therapy, these studies generally have been limited to periods up to 4 months. The MTA study for the first time demonstrates the safety and relative effectiveness of these two treatments (including a behavioral therapy-only group), alone and in combination, for a time period up to 14 months, and compares these treatments to routine community care.

3. What are the major findings of this study? The MTA results indicate that long-term combination treatments as well as ADHD medication-management alone are both significantly superior to intensive behavioral treatments for ADHD and routine community treatments in reducing ADHD symptoms. The longest clinical treatment trial of its kind to date, the study also shows that these differential benefits extend as long as 14 months. In other areas of functioning (specifically anxiety symptoms, academic performance, oppositionality, parent-child relations, and socials skills), the combined treatment approach was consistently superior to routine community care, whereas the single treatments (medication-only or behavioral treatment only) were not. In addition to the advantages proved by the combined treatment for several outcomes, this form of treatment allowed children to be successfully treated over the course of the study with somewhat lower doses of medication, compared to the medication-only group. These same findings were replicated across all six research sites, despite substantial differences among sites in their samples' socio-demographic characteristics. Therefore, the study's overall results appear to be applicable and generalizable to a wide range of children and families in need of treatment services for ADHD.

4. Given the effectiveness of ADHD medication management, what is the role and need for behavioral therapy? As noted in the NIH ADHD Consensus Conference in November 1998, several decades of research have amply demonstrated that behavioral therapies for ADHD in children are quite effective. What the MTA study has demonstrated is that on average, carefully monitored medication management with monthly follow-up is more effective than intensive behavioral treatment for ADHD symptoms, for periods lasting as long as 14 months. All children tended to improve over the course of the study, but they differed in the relative amount of improvement, with the carefully done medication management approaches generally showing the greatest improvement. Nonetheless, children's responses varied enormously, and some children clearly did very well in each of the treatment groups. For some outcomes that are important in the daily functioning of these children (e.g., academic performance, familial relations), the combination of behavioral therapy and ADHD medication was necessary to produce improvements better than community care. Of note, families and teachers reported somewhat higher levels of consumer satisfaction for those treatments that included the behavioral therapy components. Therefore, medication alone is not necessarily the best treatment for every child, and families often need to pursue other treatments, either alone or in combination with medication.

5. Which treatment is right for my ADHD child? This is a critical question that must be answered by each family in consultation with their health care professional. For children with ADHD, no single treatment is the answer for every child; a number of factors appear to be involved in which treatments are best for which children. For example, even if a particular treatment might be effective in a given instance, the child may have unacceptable side effects or other life circumstances that might prevent that particular treatment from being used. Furthermore, findings indicate that children with other accompanying problems, such as co-occurring anxiety or high levels of family stressors, may do best with approaches that combine both treatment components, i.e., medication management and intensive behavioral therapy. In developing suitable treatments for ADHD, each child's needs, personal and medical history, research findings, and other relevant factors need to be carefully considered.

6. Why do many social skills improve with ADHD medication? This question highlights one of the surprise findings of the study: Although it has long been generally assumed that the development of new abilities in children with ADHD (e.g., social skills, enhanced cooperation with parents) often requires the explicit teaching of such skills, the MTA study findings suggest that many children can often acquire these abilities when given the opportunity. Children treated with effective medication management (either alone or in combination with intensive behavioral therapy) manifested substantially greater improvements in social skills and peer relations 14 months later than children in the community comparison group. This important finding indicates that symptoms of ADHD may interfere with their learning of specific social skills. It appears that medication management may benefit many children in areas not previously well known to be salient medication targets, in part by diminishing symptoms that had previously interfered with the child's social development.

7. Why were the MTA medication treatments more effective than community treatments that also usually included medication? There were substantial differences between the study-provided ADHD medication treatments and those provided in the community, differences mostly related to the quality and intensity of the medication management treatment. During the first month of treatment, special care was taken to find an optimal dose of medication for each child receiving the MTA medication treatment. After this period, these children were seen monthly for one-half hour at each visit. During the treatment visits, the MTA prescribing therapist spoke with the parent, met with the child, and sought to determine any concerns that the family might have regarding the medication or the child's ADHD-related difficulties. If the child was experiencing any difficulties, the MTA physician was encouraged to consider adjustments in the child's medication (rather than taking a "wait and see" approach). The goal was always to obtain such substantial benefit that there was "no room for improvement" compared with the functioning of children not suffering from ADHD. Close supervision also fostered early detection and response to any problematic side effects from medication, a process that may have facilitated efforts to help children remain on effective treatment. In addition, the MTA physicians sought input from the teacher on a monthly basis, and used this information to make any necessary adjustments in the child's treatment. While the physicians in the MTA medication-only group did not provide behavioral therapy, they did advise the parents when necessary concerning any problems the child may have been experiencing, and provided reading materials and additional information as requested. Physicians delivering the MTA medication treatments generally used 3 doses per day and somewhat higher doses of stimulant medications. In comparison, the community-treatment physician generally saw the children face-to-face only 1-2 times per year, and for shorter periods of time each visit. Furthermore, they did not have any interaction with the teachers, and prescribed lower doses and twice-daily stimulant medication.

8. How were children selected for this study? In all instances, the child's parents contacted the investigators to learn more about the study, after first hearing about it through local pediatricians, other health care providers, elementary school teachers, or radio/newspaper announcements. Children and parents were then carefully interviewed to learn more about the nature of the child's symptoms, and rule out the presence of other conditions or factors that may have given rise to the child's difficulties. In addition, extensive historical information was gathered and diagnostic interviews were conducted, in order to establish whether or not the child exhibited the long-standing pattern of symptoms characteristic of ADHD across home, school, and peer settings. If children met full criteria for ADHD and study entry (and many did not), informed parental consent with child assent and school permission were received, the children and families were eligible for study entry and randomization. Children who had behavior problems but not ADHD were not eligible for study participation.

9. Where is this study taking place? Research sites include the New York State Psychiatric Institute at Columbia University, New York, N.Y.; Mount Sinai Medical Center, New York, N.Y.; Duke University Medical Center, Durham, N.C.; University of Pittsburgh; Pittsburgh, PA.; Long Island Jewish Medical Center, New Hyde Park, N.Y.; Montreal Children's Hospital, Montreal, Canada; University of California at Berkeley; and University of California at Irvine, CA.

10. How much money has been spent on this study? The study was jointly funded by the NIMH and the Department of Education, with costs totaling just over $11 million dollars.

11. What is Attention Deficit Hyperactivity Disorder (ADHD)? ADHD refers to a family of related chronic neurobiological disorders that interfere with an individual's capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways. The core symptoms of ADHD include an inability to sustain attention and concentration, developmentally inappropriate levels of activity, distractibility, and impulsivity. Children with ADHD have functional impairment across multiple settings including home, school, and peer relationships. ADHD has also been shown to have long-term adverse effects on academic performance, vocational success, and social-emotional development. Children with ADHD experience an inability to sit still and pay attention in class and the negative consequences of such behavior. They experience peer rejection and engage in a broad array of disruptive behaviors. Their academic and social difficulties have far-reaching and long-term consequences. These children have higher injury rates. As they grow older, children with untreated ADHD, in combination with conduct disorders experience drug abuse, antisocial behavior, and injuries of all sorts. For many individuals, the impact of ADHD continues into adulthood.

12. What are the symptoms of ADHD? (a) Inattention. People who are inattentive have a hard time keeping their mind on one thing and may get bored with a task after only a few minutes. Focusing conscious, deliberate attention to organizing and completing routine tasks may be difficult. (b) Hyperactivity. People who are hyperactive always seem to be in motion. They can't sit still; they may dash around or talk incessantly. Sitting still through a lesson can be an impossible task. They may roam around the room, squirm in their seats, wiggle their feet, touch everything, or noisily tap a pencil. They may also feel intensely restless. (c) Impulsivity. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. As a result, they may blurt out answers to questions or inappropriate comments, or run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they are upset.

13. How is ADHD related to ADD? In the early 1980s, DSM-III dubbed the syndrome Attention Deficit Disorder, or ADD, which could be diagnosed with or without hyperactivity. This definition was created to underline the importance of the inattentiveness or attention deficit that is often, but not always, accompanied by hyperactivity. The revised 3^rd edition of DSM-III-R, published in 1987, returned the emphasis back to the inclusion of hyperactivity within the diagnosis, with the official name of ADHD. With the publication of DSM-IV, the name ADHD still stands, but there are different subject types within this classification, to include symptoms of both inattention and hyperactivity-impulsivity, signifying that there are some individuals in whom one or another pattern is predominant (for at least the past 6 months). Thus, the term "ADD" (though no longer current) should be understood to be subsumed under the general family of conditions now called ADHD.

14. How is ADHD diagnosed? The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. Diagnosis is based on history and observable behaviors in the child's usual settings. Ideally, a health care practitioner making a diagnosis should include input from parents and teachers. The key elements include a thorough history covering the presenting symptoms, differential diagnosis, possible comorbid conditions, as well as medical, developmental, school, psychosocial, and family histories. It is helpful to determine what precipitated the request for evaluation and what approaches had been used in the past. As of yet, there is no independent test for ADHD. This is not unique to ADHD, but applies as well to most psychiatric disorders, including other disabling disorders such as schizophrenia and autism.

15. How many children are diagnosed with ADHD? ADHD is the most commonly diagnosed disorder of childhood, estimated to affect 3 to 5 percent of school-age children, and occurring three times more often in boys than in girls. On average, about one child in every classroom in the United States needs help for this disorder.

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(A story for any youngster feeling misunderstood)

Zak bounded into the lounge, his baseball cap all askew and his jumper on back to front. Bouncing into his favorite squashy chair, he looked at his mum with a quizzical expression. "Mum, why am I different?" His mum looked at his flushed little face lovingly. Zak had been dashing about again. His face was red and his hair was plastered clammily to his head.

"Why, what do you mean son?" his mum asked.

"Today, Mrs. Keenoe, my teacher, said that I was hyperactive." Zak replied.

"Well you do have a lot of energy Zak, that is true, but that can sometimes be a good thing."

"She often gets cross with me when I get out of my seat, and she says I can't sit still." he went on.

"Oh Zak, I am sorry your teacher gets cross. She just doesn't understand you. An energetic and lively little boy like you needs lots of stimulation, and that is why you move around a lot in your classroom."

"But Mrs. Keenoe says I've got St Vitas dance," Zak moaned.

His mum took Zak upon her knee. She could feel his heart pounding heavily under his clothes. "Just think what an advantage it is to be always on the move like you are. Not many children can move quickly like you. What if you ever had to run away from trouble? You would be the fastest little runner around. No one would be able to catch you, would they?"

Zak hadn't thought about it like that. He was aware that he did move around more than the other kids, but he had always thought that this was a bad thing. Zak's mum then went on. "When you grow up, you may want to become an athlete or a sportsman. You will have to practice to become stronger and faster. Racing about will then come naturally to you won't it?" Zak smiled at his mum and realised that maybe his need to dash about would come in very useful one day.

Trying to be positive

The next day, Zak ran out of the school gates and scurried up to his mum, nearly knocking her off her feet. His shoe laces were undone and he had one sock up and one sock down. "Boy, am I glad to be out of there! I have been so bored at school today Mum," Zak exclaimed.

"Have you, darling?" she smiled. "I know it is difficult for you to stay on task sometimes. Because you are a lively and bright little boy you needs lots of stimulation to stay interested."

Zak told his mum how he found it very difficult to concentrate in his lessons, especially if the work was too easy for him. She put her arms round him and sighed. "You are a very clever boy," she assured him, "but sometimes it is hard for your teacher to know when you are bored. She has so many other children to look after as well as you. Just do your best and don't be too worried if you get a little bored sometimes."

Zak gave his mum his most beaming smile when she said they could visit the park on the way home. He felt happy that he would have a chance to run around and stretch his legs.

"Yippeeeeee!" he screeched as he ran into the distance, his mum trying hard to keep up with him.

Dealing with the school

Zak's mum was wearing her best outfit. She was sat in the school corridor, along with Zak, awaiting her turn for the parent interviews. Each term, school officials met with every parent to report on how their children were getting along with their work. "Mrs Wilson!," a voice echoed down the corridor. "That's us, love." Zak's mum said as they both got up and went into Flabby Bucktrout's office. (The headmistress wasn't really called "Flabby." Her real name was Ernestine, but Zak always called her by this cheeky nickname because she was a little bit...er, flabby.)

"Mrs Wilson, do you know that Zak is prone to daydreaming in class? He drifts away into his own little dreamland, and then he has little idea of what he is supposed to be doing, when he returns to the land of the living."

Zak's mum calmly responded: "You are right. Zak does tend to daydream sometimes, but he is a very thoughtful boy. He has a lot of information in his head, and sometimes gets absorbed in his own thoughts."

Mrs. Bucktrout looked startled. She wasn't expecting a reply like this. Flabby Bucktrout thought that Zak was a handful of trouble. In school, he was always overactive and often found it difficult to concentrate in class. "But Zak has other problems too," Flabby continued, "he usually strays from what the rest of the class is doing, preferring to go his own way."

"Ah yes, Mrs. Bucktrout," Zak's mum said pointedly, " but you are forgetting that Zak is a very independent and individual child. He is also inquisitive and shows interest in lots of different things. Qualities like this should be encouraged."

When they left the office Zak's mum turned to him, and said kindly "You are one of a kind Zak, and don't you ever forget it. Your qualities make you stand out from the rest. You are a very special person."

"But I sometimes feel like a geek Mum." he said sadly, " I know that I don't think in the same way as my friends and everyone says that I always have to be different."

"Who wants to be the same as all the others anyway?" she asked. "The world needs inventors and leaders, not just workers you know."

Zak thought about this for awhile and soon he felt much better. He thought to himself that maybe he wasn't such a geek after all.

Why can't I do that?

"Mum, Mum! Andy's mother says I don't know how to play properly. She says I'm too bossy." Zak called as he crashed in through the door and threw himself face down onto the couch, sobbing his heart out.

"Come here sweetheart," his mum cooed, "it's alright now."

She wondered why others couldn't be more understanding about Zak's special difficulties. It's hard enough for children like him, she thought, without people adding to his problems by saying unkind things. She put her arms around the little boy and cuddled him close to her body. He felt safe and loved. "You do come across as being a bit boisterous you know Zak," she explained, "and sometimes other children are even frightened of you. If you could just put the brakes on a little, things would be easier, but it is part of your character not to be able to do that."

Zak looked into her eyes questioningly, "but why aren't I able to do that?" he said.

"Because your brain is special and works differently than most other children's brains," she explained, "and this is what makes you different. When you grow up though, you will be able to put this difference to good use."

"How will I be able to do that Mum?" he asked curiously.

"Well," she replied, "you may want to be a high flying businessman, with offices all over the world. But in order to keep ahead in business you will need to be determined, and yes, even bossy sometimes. This is where your character will come into it's own."

"Oh yeah." Zak laughed, "I could end up just like that Richard Brainstorm couldn't I?" he continued. "I think I will stay in awhile and watch television." His mum always made him feel cheerful when he was feeling sad or insecure.

Sometimes, even family members don't understand

Zak's older brother William looked sulkily at Zak. "Come on Zak, catch the ball. You're useless." Zak tried again, but the ball always slipped through his fingers.

"I don't like sport anyway," Zak complained. "You know I prefer working on my computer."

"Computers are for nerds," William sneered. "I'm going to call for Benson. At least he can catch a ball." He sloped off, leaving Zak standing forlornly on his own.

Zak found his mum in the kitchen up to her elbows in butter and flour.

"Buns won't be long " she said cheerily.

"Mum," interrupted Zak, "why am I out of step with the other children? I often feel like I don't understand their world."

His mum looked at him with a concerned look in her eye. "You are right Zak," she said, "you are different from the run-of-the-mill, but children like you have amazing talents and are usually very creative. Just think how boring the world would be if there were no artists, explorers or entertainers."

"Sometimes I would like to be like all the others though," said Zak sorrowfully. His mum smiled her special smile and bent down so that her face was at the same height as Zak's.

"Now listen to me young man," she said sternly, "you must be proud of who you are. You are an individual, a one-off. There is no one else like you in all the world. I know it feels hard sometimes, but when you grow up you will do great things, maybe invent a new type of computer, or become Prime Minister or President. Leaders and creative people, like you, make poor workers because of the way they are made."

"Are there any others like me?" Zak then asked.

"Of course, my love," his mum replied, "there are many children in the world who feel out of place and separated from the world around them, but many grow up to be famous scientists, actors, inventors or leaders."

"Thanks Mum," said Zak, as he dashed upstairs to play on his computer.

There are millions of children in this world, all of whom have good points and bad points. Some have special difficulties which makes it hard for them, and may make them feel that they are different from the crowd. But sometimes it is not always best to be ordinary. Life is not as exciting for ordinary people as those who were born to explore, and to take life by the scruff of the neck and shake it! We must all be proud of who we are, and try to make the best out of the qualities that God has given us.

©Gail Miller 1999

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Can anyone who hasn't lived with an ADHD kid ever really perceive the amount of stress parents like us endure every minute of each waking hour when these kids are around?

Does the parent of a "normal child" have any inkling of what it's like trying to instruct, or negotiate with a child who constantly moves the goalposts?

Will pediatricians, psychologists or psychiatrists ever really understand that the problems we encounter with these children on a minute-by-minute basis - they are NOT isolated incidents dotted throughout an otherwise normal or peaceful day?

Sheer Frustration

It is frustrating for parents to have to pick out incidents or altercations to be analyzed by these specialists because they don't occur in isolation.They carry on throughout the day, each one systematically going into the next and compounding the original problem.

It is this constant battling about every point, the literal way these children take your words, the aggression and attitude these children use in their daily life, the tantrums, etc. which can sometimes have you about a centimeter from a nervous breakdown. Add to this the impact these children have on other family members, how they affect the overall dynamics of family interaction, the frequent school problems, hospital appointments and the rest, and you have here the potential for a lethal brew!

Livin' La Vida Loca (Living the crazy life)

Following is just one interaction (if you can call it that) that occurred about halfway through the school summer holidays.

This morning, I was playing with my daughter when my son, George, came down stairs. "Hello Sunshine," I said.

"Hello Moonshine," he replied.

(George is ADHD, but there is now some discussion as to whether he is Asperger's too. He takes things completely literally and has extreme difficulty in understanding nuances of speech, tone of voice, facial expressions etc. He can also be extremely fastidious and has to have things put to him very precisely. This causes many, many hypothetical arguments, wastes lots of time and can be extremely exhausting for me.)

George gets under the duvet, which happens to be covering my three year old daughter and they start tittle tattling. So I ask him to move. He pointblank refuses, so we get into an argument and he tells me to f*** off. CHARMING! I fine him 20p from his pocket money for swearing (he's now at about minus £1.20 for this week) and eventually he calms down.

I pass him a magazine to look at to try to get him back on an even keel. "Here, George." He ignores me, so I repeat, "here George."

"Eye, Mum eye," he replies. Again, he has perceived "here" as "ear." It is so frustrating! I know George has a problem but this is not a now-and-again thing. It is constant and frankly it gets boring having to explain words, expressions and meanings the whole time. This sounds very unkind, but this type of thing wears on your nerves and simply the amount of talking one has to do in a day explaining things, or arguing, is simply exhausting for a parent.

We then have the usual breakfast argument. In a nutshell, he doesn't want any of the options I offer him so he ends the conversation with "I'll not have anything then. I'll just starve!" Starve, starve! I've just offered him a larger breakfast menu than he'd get at the Hilton!

By this time, I am starting to lose my patience. He gets up and goes to the door. "I'm going upstairs," he snaps.

"OK, I'll see you later," I reply nonchalantly. 2 seconds later, he's behind me. "I thought you were going upstairs?," I yell.

"Don't see why I have to!" he screams.

What do you do? Just what do you do? If only some of the people we go to for help could live in our houses for a couple of days and just experience the enormity of the situation, they would soon see that we are not overreacting or being incompetent parents. I would like to see anyone solve the problems that we have to contend with every hour of every day.

George returns to his chair and starts ragging his sister again, so I warn him that if he doesn't stop it, I am going to 'count' him. This is where you use the 1, 2, 3 - then time-out method. He hates this and it usually sends him into fits of rage. But what the hell do you do? It's like trying to juggle mercury. "When you do that with Ellie," he shouts, "she gets 2 and three-quarters and 2 and nine-tenths!"

Oh God, here we go again. He tries to goad me into another argument. He's always doing this by either mouthing off, or saying something extremely emotive or offensive to family members or teachers. He certainly knows which of my buttons to press that's for sure. The time is exactly 8.45 am. George has been out of bed approximately 20 minutes, my head is exploding and I am ready for walking out already. What a life!

Can anyone imagine what it is like in term time for mums trying to get these, (and any other) children ready for school? On top of the above aggravation, we have to somehow get these kids into uniform with their lack of motivation to get ready and often their inability to even dress, wash themselves or brush their hair/teeth. (George is 11 and-a-half, but I still get him ready in the morning.) Their poor planning and memory means that books and equipment, which have to be in school on certain days, just don't get there. No wonder we mums feel puddled the whole time too!

So anyone out there with a suspicion that these problems are of our own making, or who feels that maybe, just maybe, our parenting skills are at fault, remember that ADHD knows no boundaries. ANYONE can give birth to a child like this and only when one has lived with the daily turmoil and devastation this condition leaves in it's wake, does one really understand what living with ADHD actually means.

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a day in my life as a parent of an add child

OK. I'll put my hands in the air. I admit it. I am the mother of a disruptive child, according to some people the scourge of modern society.

What they don't know though, is that my son, George, has a neurological impairment which makes it impossible for him to put the brakes on unwise behavior. George is diagnosed as A.D.H.D. -Attention Deficit Hyperactivity Disorder; a genetic condition and not another name for a "naughty child."

From the moment he got to his feet, he behaved like a Tasmanian Devil on acid. As a toddler, he had to be watched constantly because the minute you turned your back he would have his finger in the light socket or be force-feeding the cat!

I was told by various health professionals over the years that George was just boisterous and he would grow out of it; but when you fear for the child's life because of the uncontrollable rages he flies into, when he is constantly covered in bruises because of all his dashing about, when he acts so impulsively that he cannot see the consequences of his actions, you know that something is just not right. Call it gut feeling or mother's intuition, but I just knew that he had a problem upstairs.

George is now eleven and he got his diagnosis just before his ninth birthday. It has been a long, hard struggle, but we are getting there. Unfortunately, the symptoms of A.D.H.D. cause trouble with a capital T. Apart from the three core symptoms of inattentiveness, hyperactivity and impulsiveness, these children are also argumentative, oppositional, insatiable and usually have very low self-esteem because of all the years of negative feedback they endure from those around them.

Living with George is like living in the shadow of a tiny timebomb waiting to explode. Everyday is eventful. In fact there is never a dull moment when you have a child with A.D.H.D., as any mother of a sufferer will tell you.

George could argue for Britain! How's this for a typical conversation;

George: "What's for breakfast Mam? Cereal or toast? Are there any cheeseburgers?"

Mum: "No, you ate those yesterday, and anyway, why can't you eat breakfast food like everybody else? You always have to be different."

George: "Have we got any eggs?"

Mum: "George, you can have cereal or toast."

George: "It's not fair! Can't I have a meat pie?"

Mum: "No. They are for supper. You don't eat that type of thing for breakfast either."

George: "Grandma makes me bacon and egg sandwiches for breakfast."

Mum: "Yes, but Grandma gives you that as a treat and she doesn't have the million and one things to do every day that I have."

George: "If I have toast, can I have cheese on it?"

Mum: "George, I haven't got any cheese until shopping tomorrow."

George: "Have you got any tuna paste..."

Mum: "SHUT UP!"

George: "Why can't I have something on my toast then?"

Mum: "George - I - don't - have - much - until - I - go - shopping - tomorrow. You - can - have - toast - WITH - MARGARINE - or - nothing!"

Pause...

George: "Can I have a seven pounds twenty for a new torch?"

Aaaaaggggghhhhh! You just can't win can you? A.D.H.D. kids nag and quibble to extreme proportions. By the end of the day you feel like you have been beaten about the head with a baseball bat.

George gets in to a lot of trouble at school because of this arguing. He always has to have the last word and he can be extremely cheeky to adults. Obviously this doesn't go down too well with teachers who don't like being told to sod off ..... and who can blame them? A.D.H.D. kids often appear rude and naughty individuals. It's a shame really, because under this terrible aggressive exterior are some of the sweetest, funniest, smartest and most affectionate children you could ever imagine. This side doesn't come to the fore very often though!

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Who Understands an ADHD Kid?

Dear Child,

I am the mum of a child who has ADHD, just like you. I know that you often feel sad because you get into trouble lots and don't do well in the school classroom. But I want to tell you that sometimes it is good to be different from the rest of the children. Maybe you feel that life and school is much easier for other kids? Well, yes it can be a little easier for people who are average. But children like you, who tend to be EXTREMELY good at some things and not so good at other things, often find that life can be less of an easy ride. Let's take school for example.

There are many children just like yourself in school, who can do the work, and who are even very, very good at some things, but who behave in a certain sort of way that is somehow different from the rest of the children. You feel you need to move about lots, so you end up wondering around the classroom for no apparent reason. Maybe you find it really hard to concentrate on what you are supposed to be doing. Perhaps you even get so frustrated that you shout at people or even lash out when you lose your temper.

Because of this behavior, teachers and other adults find these things difficult to deal with and they may even do and say things to you, which you feel is unfair. They cannot understand that sometimes certain children act on the spur of the moment and they often find your behaviors hard to deal with. Because they are grown ups, they sometimes don't see children as individuals, they see them as a mass and it's wrong. Because of this you are often left feeling sad, or cross, or frustrated at those adults.

Not all teachers are like this though. As you go through school you will find one or two who will like you for who you are, and accept the things you do without judging you. If you can find a teacher like this, make him or her your friend. Go to them when you are having problems.

What about home? Do you sometimes feel that your parents love your brothers or sisters more than you? You know, it may feel like this from time to time, but believe me your parents love you just as much as the other children in your family. Perhaps you feel that because you get into trouble more, that your parents prefer your brothers or sisters? Well, when your parents tell you off it is not YOU they are unhappy with, it is just the behavior that has got you into trouble that they are unhappy with. It can be very difficult when you are young to understand this. But I know! I am a mum to 2 children - 1 boy with ADHD and one younger daughter without ADHD. I love them BOTH in different ways, and I would hazard a guess that your parents are exactly the same.

All I can say to you is this: some of the greatest names in history were said to have symptoms like the ones you have. Winston Churchill, Albert Einstein, Walt Disney, Richard Branson, Tom Cruise, Robbie Williams, Thomas Edison, Robin Williams, Stephen Hawking...the list is much, much longer than this. All these people have made the world a better place for others BECAUSE of the way they are, not despite the way they are.

Love, Gail

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One of the main difficulties in diagnosing teenagers who may have Attention Deficit Hyperactivity Disorder is that all teenagers are begging to show some ADHD-like behaviors when their hormones kick into overdrive. To that extent, ADHD teens become typical adolescents, only more so. Attila was no exception. Attila survived childhood despite his potential for disaster. We now recount some of his exploits in adolescence.

Attila's Room

The adolescent search for identity did not strike Attila lightly. Take, for example, his room. Within the limits of available space and furniture, he tried every possible arrangement of furniture except leaning the bed on top of the radiator (actually he did try that, but he kept sliding to the bottom of the bed, so he put it back on the floor).

Attila's room was a prime example of the Law of Entropy - any system will degenerate into chaos over time. Even if there were a blender large enough, Attila could not have created more of a mixture of clothes, books, sporting equipment, camping gear and assorted collectibles. The floor had not been seen in years, but was believed to have been carpeted. Attila's search for identity started and ended with the search for anything in his room.

Attila the Scientist

Living in a small house with three sisters, Attila could only be creative if he found a place so unpleasant that his sisters would leave him alone - the furnace room was perfect. His creativity there found it's expression in the form of experimentation. Doctor Frankenstein would have been proud of him!

Chemistry and electrical experiments had a certain fascination for Attila. In the era before computer chips, tube radios provided Attila with untold ideas for new (and probably lethal) electrical devices. He was headless of the potential to curl his teeth on household voltage. He rewired parts from toasters, TV's, train transformers, and anything else he could scrounge from the neighborhood.

Attila's corner of the furnace room looked as if a tornado had hit an electrical supply house. Unfortunately (of fortunately depending on your point of view), Attila's explorations of electrical science were cut short when the main circuit breaker in the house blew for the third time. It was then that his otherwise supportive father told him he would be grounded until he was 26 if it happened again.

Chemistry was the next phase, and Attila tried every combination of every substance he could put his hands on. Some were not as disastrous as others. Some simply fizzed or changed colors. Some ate holes in the table. Long before toxic waste and environmental hazards were issues he discovered that simply pouring his concoctions down the laundry room sink was not a good idea. When the drain backed up and filled the tub with something that looked and smelled like 'The slime that swallowed Syracuse,' mother was not pleased.

"Attila the teen" was an accident about to happen, and it often did. On one occasion Attila won the praises of his school mates for being responsible for early dismissal from school due to a small accident that occurred in the chemistry class. Here's what happened. 'Chrome Dome,' the balding chemistry teacher, had set a two quart glass container of Hydrogen Sulfide on the wide shelf by the window so that students could get the small portions they needed for the day's experiment.

Attila came to the container and impulsively decided to open the window for some fresh air. Yes, Attila knocked over the container on himself and it broke on the floor. For those of you who may not remember, Hydrogen Sulfide smells like rotten eggs. There may be more unpleasant odors, but rotten egg was quite sufficient in this case. The odor soon filled the room and made it's way to the hallway. From there it proceeded to travel through the air ducts to fill the entire school.

As for Attila, no amount of water from the locker room showers could get the odor off Attila his clothes. Thankfully his gym sweat suit and sneakers were less smelly than the Hydrogen Sulfide soaked shirt, pants and shoes. The chemistry phase came to an end when Attila was unable to explain to his parents what he had mixed together that stained his hands a bright blue-green. Six weeks of scrubbing and the heckling of school mates about wearing gloves to class convinced Attila that chemistry was not his calling.

Attila and Puberty

The end of a promising chemistry career came with the discovery of girls. Attila's hormones raged and zits emerged at a time long before the appearance of full-frontal nudity on TV. It was a time when biology class curricular stopped short of exploring the human body and teenagers may actually have known less about sex than their parents.

Attila began to change from boy to man. His body grew by leaps and bounds. His brain had no idea where the ends of his arms and legs were. He became the perpetual klutz. We are not talking about just having difficulty walking and chewing gum at the same time. Before his body went on strike, Attila could pour milk into his mouth from an arm's length away. Now he couldn't drink from the foldout top of the carton without wearing half of the contents. As if that were not enough, fate (which had cursed him with terminally cute freckles earlier in life) now decreed that the skin upon his face would look like a red raspberry. So armed, Attila entered the social arena of dating.

Attila's Rebellion or Thank God for Aunt Grace

Finally, no discussion of Attila's teenage years would be complete without a word about rules and rebellion. The struggle for the independence of the American colonies a church was a picnic when compared to Attila's rebellion.

With the anxiety that only parents of an ADHD boy can muster, Attila's mum and dad drew the battle lines of curfew, household chores, dating, and last but not least, THE CAR. Later in life, Attila came to realize the truth about how he had lived to become an adult. It was all because of Aunt Grace.

When the angry arguments about rules and limits became hot at home, Attila hopped on his bike and burned excess energy off on the three mile ride to Aunt Grace's home. Unknown to him at the time, Attila's mum would call Aunt Grace and warn her of the coming invasion and of the latest issue Attila would carry to her door. When he arrived in her kitchen, she would give him the customary hug and kiss and offer whatever choice morsels of home cooking that were at hand. It was like putting a red hot horseshoe in cold water. As they chatted, Attila would 'chill out'. As she offered advice, he would listen. The words that fueled the flames, when spoken by mum and dad could be heard when spoken by Aunt Grace.

The author wishes to thank his parents, aunts and uncles (especially Aunt Grace) for remembering all of those stories about him as a teen. Those of you who have a good Attila story about yourself or your ADHD child, please send to the author - he likes to know that he wasn't the only one who grew up like that.

Copyright George W. Dorry, Ph. D. - Dr. Dorry is a psychologist in private practice who specializes in the assessment and treatment of childhood and adult ADD. He is the founder and director of The Attention and Behavior center in Denver, Colorado. He is a member of the ADDAG Board of Directors and served as their first Chairman of the Board from the organization's inception in March 1988 until January of 1995.

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