Author: Dr. Weissglass

Kindergarten Testing Success

Children entering Kindergarten need social and emotional skills to succeed in addition to learning their ABCs, colors, and numbers. Read more about the social and emotional skills needed for school success.
 
Children need similar skills to be successful on the Kindergarten entrance exams, or the ERBs as they are often called. These exams test common cognitive and academic skills that are thought to be prerequisite skills for succeeding in school such as a child’s knowledge of certain vocabulary, their ability to explain themselves and their reasoning with words, their ability to think abstractly, their visual-spatial skills, their memory skills, and their processing speed skills. These exams also assess their early math, reading, and writing skills.
 
However, for your child to be successful on these exams, they also need the same social and emotional skills that they need to succeed in Kindergarten. For example, if your child cannot sit still for the more than a few minutes at a time, if they cannot wait for instructions to begin a task or have difficulty understanding or remembering instructions, or if they become easily frustrated and give up or become angry and upset, they might have difficulty on the exam. The academic skills directly assessed on these exams are easy to remember, but these other skills that are necessary for success both on the exams and in school are often overlooked by parents and professionals alike.
 
Most parents know about good preschool programs or private tutors to help their child with the necessary academic skills. But many parents do not know about the tools available to help their child with these skills of listening, memory, sitting still, or social skills. You can talk with a professional who is knowledgeable about child development and experienced in working with children of several different developmental stages to learn more about the skills needed, where your child should be, and where they might be. There are several resources available, depending on your child’s needs, including one-on-one social skills training, group social skills training, and cognitive training to address the skills of patience, persistence, listening, and sitting still. Read more about social skills and cognitive training resources available. 

Kindergarten Success

Your little one is growing up and its time to start thinking about Kindergarten placement. It’s a big step for you and your child. How do you know what they need to learn and what is the best type of program for them? Atlanta has some of the best schools in the country, but all of the choices and the competitiveness of getting in can be stressful and even overwhelming. By now, most parents have worked with their children to learn their ABC’s, colors, and counting. Many parents have also invested in specialized daycares, preschools, or private tutors.
 
But there is more to Kindergarten success than just having a large vocabulary, learning math and reading, or even learning a second language. The skills important for Kindergarten that are less often talked about, but are just as important if not more so, are social and emotional maturity.
 
Children entering Kindergarten need social skills to get along with new peers, to get along with and listen to teachers, and to make new friends. Children also need to learn how to handle transitions as the school day includes many different activities and new schedules. Children need to learn how to understand, remember, and follow directions. Children need to get used to sitting still to listen to instructions and complete tasks so that they can gain the most out of their school experience. Children also need the skills to wait their turn, wait for directions, and wait for permission from adults to adjust to the new Kindergarten day. Another skill is having the stamina to persist working and following directions throughout the day. Kindergarten teachers don’t expect their students to be able to sit through hours of lectures like high school or college students, but learning for 7 or 8 hours a day is quite a change fore many children. Many children weren’t developmentally ready to do this before, and Kindergarten is their first experience with more traditional school models.
 
While learning to read is an important skill, learning to make new friends and to feel successful in and enjoy school are also important goals for your child’s Kindergarten year. The early academic skills learned in Kindergarten are important, but your child having a positive early school experience may be even more so. This sets the stage for you child enjoying school, building their self-esteem and their confidence in themselves and their academic abilities, and setting academic goals for themselves.
 
Similarly, these skills are important for the Kindergarten entrance exams, or ERBs, and private school entrance exams. Learn more about these skills with the Kindergarten testing. Learn more about resources available to help your child build these skills.

Adult ADHD

ADHD is also common in teens and adults, though it can be even harder to diagnose at these ages. ADHD in adulthood is still divided into the three subtypes of ADHD in childhood. These include:

• Predominantly Inattentive Type- most difficulties are related to inattention. This type may also be called ADD or Attention Deficit Disorder. Some studies suggest that this type is more common in teens and adults than the other types.
• Predominantly Hyperactive-Impulsive Type- most difficulties are related to overactivity or restlessness.
• Combined Type- difficulties with both inattention and hyperactivity.

 
Read more about what is ADHD.
 
The difficulty in accurately diagnosing ADHD in very young children is determining the cause of the difficulties with attention or hyperactivity as these can be common symptoms in childhood.  Read more about ADHD testing and evaluations. On the other hand, the difficulty in accurately diagnosing ADHD in adolescents or adults is twofold. The first is that the symptoms must have first started in childhood. Getting information about childhood behaviors can be difficult for the professional making the diagnosis, but also sometimes for people to remember what they were like in elementary school. The second is that the symptoms, while they may present and distressing, look different in adulthood than they do in, say, an 8 year old. For example, the description of symptoms for ADHD say things like “act as if driven by a motor.” This may be a very accurate description of how a child acts day to day, but maybe not a teen or adult. Instead, the professional making the diagnosis must get information about how the adult acted as a child, and if they still continue to seem over-active compared to their peers now. This is why it is important to seek out a comprehensive evaluation by someone who specializes in diagnosing ADHD.
 
This may be confusing, so how do you know if you should consult a professional? Here are some questions you can ask about your teenager or about yourself:

• Do you find yourself always running late or getting places “just in time?”
• Do you find yourself forgetting appointments or meetings?
• Is it hard for you to sit through an entire movie, meeting at work, or lecture at school?
• Do your friends or your partner tease you for being “forgetful?”
• Do you start several projects but then have difficulty finishing them?

 
Similar to treating ADHD in childhood, there are several options for treating ADHD in adulthood. The most commonly known treatment modality is medication. However, many professionals recommend combining medication treatment with other types of treatment including cognitive training, behavioral training, social skills training, or individual therapy. Learn more about ADHD treatment.
 
ADHD is not just for kids. If you answered “yes” to any of the questions above, it may be worthwhile to talk to your doctor about finding the right services for you. Not only medication, but first the right diagnosis by an expert, and then a discussion about all of the options, including medications.

Therapy Techniques for Treating ADHD

Medication and cognitive training can be highly effective in helping increase attention, reduce hyperactivity, and reduce impulsivity. Read about these treatments for ADHD. But sometimes, these treatments are not enough and adding social skills training, behavioral therapy, parent training, or individual therapy can be extremely helpful.
 
Social Skills Training
A hallmark of children with ADHD is that they often act without thinking. That is, they are able to state rules, but have difficulty internalizing them and using them consistently because they have difficulty “slowing down.” This difficulty can negatively affect their relationships with peers as well as teachers and even parents who might become tired or frustrated with their behaviors. For this reason, sometimes it is helpful for children to participate in clubs, on teams, or in other organized activities so that they can get positive peer experiences in structured settings that are fun. In addition, some children benefit from social skills groups with other children who have ADHD so that they can learn from each other, increase their social skills, and even increase their sense of self-esteem and they realize that they are not so different from other children.
 
Behavioral Therapy
Often children with ADHD struggle with remembering to complete chores, or lose their homework, or have difficulty completing school projects. Research has shown that behavioral therapy is another important part of treatment for children with ADHD. Some common recommendations from the American Academy of Pediatrics include:

• Creating a routine- try following a daily schedule including bed and wake times, regular meal times, and routines for chores
• Getting organized- try putting your child’s school bag, clothes, or toys in the same place every day so they are less likely to lose them.
• Avoiding distractions- find a quiet place for your child to do their homework that is free from distractions of noise (other people, the TV, or the radio) and free from distractions of toys or other objects on their desk or near them in the room.
• Keeping it short and simple- limit choices to two things (to wear, eat, activities) so that your child does not become overwhelmed. Also, keep explanations clear and brief. Give information in short chunks at a time and give gentle reminders.
• Increasing the positive- use goals and rewards for tracking positive behaviors. Remember to keep it short and simple- small steps are important so that your child feels a sense of accomplishment and does not become discouraged. Similarly, help your child find out what they enjoy and do well. Encourage that to help them build their self-esteem.

Parent Training
Parents often find that the same techniques they use with their other children do not work the same with their child who has ADHD. This does not mean that parents are ineffective, but only that their child needs some different approaches or techniques. Parent training can be conducted in groups or individually and are often offered by therapists. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) offers an educational program to help parents address the challenges of ADHD across the lifespan.
 
Individual Therapy
Sometimes children continue to struggle with low self-esteem, low mood, or continued temper tantrums despite these other treatments. With these instances, individual therapy can be helpful. Find a mental health professional who specializes in working with children and they can work and your child with you to address these symptoms so that your child can be happier and feel more confident and successful. 

ADHD Treatment

ADHD, a common disorder typically diagnosed in childhood, but sometimes also diagnosed in adulthood, gets a lot of media attention. Read for more information about what is ADHD. Read for more information about adult ADHD.
 
The first step is to get a thorough evaluation by a qualified professional who specializes in the diagnosis of ADHD. Read for more information about ADHD testing and evaluations.
 
So you or your child has been diagnosed with ADHD. What now? There are several options that your treatment provider can cover with you, depending on your or your child’s needs.
 
Medication
A very common treatment for ADHD is medication. The most common class of medication prescribed for ADHD is stimulants. “Why would I give my hyper child a stimulant?” many parents ask. The answer is that ADHD is thought to be caused by a decrease in brain activity in the area of the brain that controls attention and decreasing impulses. Taking a medication that stimulates this area of the brain actually works to hopefully give the child more ability to maintain attention or act more thoughtfully, and less impulsively.

• Some of the most common stimulants used to treat ADHD include Ritalin, Adderall, Concerta, and Focalin.

There are also non-stimulant medications that can be effective in reducing ADHD symptoms. It is a little more complicated how these medications work, but they also work on the neurotransmitters (chemicals) in the brain to help increase attention and decrease impulsivity.

• Common non-stimulants include Strattera and Tenex.

Many parents are wary of medications, the side effects, or want to try something else first. Talk with your pediatrician or your psychiatrist if you have any of these concerns about medications. In some cases, medications are helpful, but not quite enough. If medications are not right for you, not right for you right now, or not enough, there are more options.  
 
Cognitive Training
Research suggests that cognitive training can help increase sustained and shifting attention and reduce impulsivity. Cognitive training can also increase processing speed (the ability to do routine tasks quickly without making mistakes). Processing speed is the skill we use when taking notes in class.
 
Two common programs for cognitive training include Play Attention and Captain’s Log Mental Gym.

• Play Attention uses similar technology that US Air Force pilots and NASA astronauts use. With this software, the user wears a special bicycle helmet that monitors brain activity through sensors. Only when the user maintains attention can they complete the activity on the screen. In this way, there is immediate feedback regarding whether or not they are paying attention.  Through these games, learning to keep attention can be fun and motivating. Eventually, the user starts to learn how it feels to concentrate and focus. Read more about Play Attention at their website.
• Captain’s Log uses over 40-multilevel programs to build attention, working memory, impulse control, processing speed, and logic and reasoning. It is a game-like program that first assesses a baseline of the child’s abilities in these areas. Then the professional creates a program for your child to train any areas of weakness. Read more about Captain’s Log at their website.

There are also therapy techniques for treating ADHD.

ADHD Testing and Evaluations

If you are concerned that your child may have ADHD, it is important to seek an evaluation by a qualified professional. ADHD is characterized by inattention, hyperactivity, and impulsivity. Unfortunately, these symptoms are common in childhood and can be caused by a myriad of factors. ADHD is only one of the causes of these symptoms in children. Because of this, it is especially difficult to accurately diagnose ADHD in children under 4 or 5 years old. Read for more information on what is ADHD.
 
Many parents worry that their child will be misdiagnosed. This is a legitimate concern as the over-diagnosis of ADHD has received attention for a while now. This is precisely why it is important to seek a thorough evaluation by a professional who specializes in the diagnosis of ADHD.
 
The publicity of the over-diagnosis and over-medication of ADHD in the past several years has spurred quite a bit of research on ADHD evaluations. It is important for the evaluator to have expertise in child development, mental health diagnoses in general, and ADHD specifically to correctly identify the causes, and eventually, the best form of treatment for your child’s symptoms. Read for more information on ADHD treatment.
 
The “best practices” for ADHD testing suggests gaining a comprehensive picture by getting information from multiple sources including parents, teachers, the child, and direct observations by the professional. It is important that your evaluator not only know what these best practices are, but that they have received training in using these techniques with all ages as ADHD looks different between ages and across individuals. Read more about adult ADHD.
 
Conducting a thorough evaluation for ADHD involves interviewing the parent, the child’s teachers as often as possible, and the child themselves. In addition to interviews, the evaluator should use standardized rating forms for ADHD and other childhood disorders with the parents, teachers, and child when possible. Evaluators should be observing the child in both structured and unstructured activities, ideally over a period of time or across two days. Lastly, it is also recommended to use standardized computer testing to assess children’s attention, activity, and impulsivity. Without the right diagnosis, it becomes very difficult to accurately and effectively treat the symptoms that your child is experiencing. 

What is ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly diagnosed in childhood, with rates estimated around 7% in school-aged children.1  ADHD is also common in adults, with rates estimated around 4.4% or 8-9 million American adults.2  Read more about adult ADHD.
 
ADHD is thought to be caused by biological factors in the brain, specifically neurotransmitter (chemical) activity in certain parts of the brain. Brain studies have shown that in people with ADHD, the brain areas that control attention are less active compared to people without.  
 
ADHD is also thought to have a strong genetic basis with rates estimated between 25-35% if one other person in the family is also diagnosed with ADHD.
 
But what is it exactly? ADHD is a common cognitive disorder that results in difficulties with attention, hyperactivity, and impulsivity. But it is not that simple. There are actually three different subtypes of ADHD that a child may present with.

• The first is called Predominantly Inattentive Type, which is when the child mostly has difficulties with attention. This is also commonly referred to as ADD or Attention Deficit Disorder. Some studies say that this type is more common in females than males, and that this type persists more through teens and adulthood than the other types.
• The second is called Predominantly Hyperactive-Impulsive Type, in which the child mostly has difficulties with remaining seated, waiting his turn, or is often very overactive. This type is more commonly found in young boys compared to girls or older adolescents and adults.
• The last is called Combined Type, in which the child has difficulties with both inattention and hyperactivity. 

So how do you know if your child has ADHD?
 
Here are some questions to ask yourself:

• Does your child have difficulty with homework?
• Does your child have trouble getting started on school projects?
• Does your child often talk during class or get up out of their seat?
• Does your child’s mood seem to change quickly or “out of the blue?”
• Does your child constantly change activities or quickly get bored?

Some children with ADHD may also have a lower frustration tolerance or have more temper tantrums. Often times, children with ADHD act before thinking, which can negatively affect their social relationships. In addition, many children with ADHD struggle more in school because they have a hard time maintaining attention throughout class or when trying to complete their homework. These difficulties can lead to lower self-esteem in childhood and adolescence. There are effective treatments for ADHD and these related difficulties, read more about ADHD treatment.
 
It is hard to make an accurate diagnosis of ADHD in children younger than 4 or 5. But if you are concerned, you can still seek a consultation with a physician, psychiatrist, or psychologist who specializes in diagnosing and treating ADHD to learn more about it.
 
If your child is struggling with any of these symptoms, it is important to seek a referral.  Because many symptoms of ADHD are extremely common and may be related to other factors, it is important to seek a thorough evaluation from an expert. Learn more about ADHD evaluations and testing.
 

1. American Psychological Association (2000) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision). Washington, DC: Author.
2. Jaska, Peter (1998) Attention Deficit Disorder Association (ADDA). Attention Deficit Disorder (ADD/ADHD) Fact Sheet. Retrieved July 16, 2012 from http://www.add.org/?page=ADHD_Fact_Sheet

Resources after the bombing in Boston

In the aftermath of the bombing at the Boston Marathon, communities and mental health professionals are pulling together to help those affected. As with any tragedy, a range of emotions and reactions are common. Here are some of the currently available resources that may be helpful to you or your family. As the situation unfolds, there are likely to be more resources which surface. If you are worried about yourself, your loved one, or those close to you, remind them that mental health professionals are available to help them through this difficult time. 

• Coping with Disaster http://www.ready.gov/coping-with-disaster  
•  Managing traumatic stress: Tips for recovering from disaster and other traumatic events http://www.apa.org/helpcenter/recovering-disasters.aspx
•  Taking Care of Your Emotional Health After a Disaster http://www.redcross.org/images/MEDIA_CustomProductCatalog/m4240142_EmotionalHealth.pdf
• Recovering Emotionally http://www.redcross.org/find-help/disaster-recovery/recovering-emotionally
•  Helping Children Cope with Disaster http://www.fema.gov/pdf/library/children.pdf
• American Psychological Association web services is working to upload relevant resources for the public on the landing page very soon on the Psychology Help Center:  http://www.apa.org/helpcenter/
•  Disaster Distress Helpline (24/7 phone and text) via Substance Abuse Mental Health Services Administration  http://disasterdistress.samhsa.gov/about.aspx

Resources for Parents in the Aftermath of the Shooting

In the aftermath of the devastating shooting in Connecticut, you may be struggling with your own feelings of shock, sorrow, anger, confusion, numbness, or fear while you’re also thinking about the best way to talk with your child or handle their questions and feelings. First, know that it is normal for you and your child to have a range of emotions. Be there as a source of support and comfort for your child to give hugs, answer their questions, let them know it is okay to talk to you about their feelings, and offer as much predictability in their routine as possible. Encourage them to communicate their feelings however they might want to express them, through talking, writing, stories, or art.
 
Talk to your child about what happened so that they can have an open conversation with you and you can help clear up any misconceptions they may have and try to help soothe their fears. Encourage them to ask questions and answer them honestly, in language that they can understand. Remember that, as adults, we are role models to our children in how to handle our feelings. It is okay to show them your true feelings, but also show them healthy ways to cope with their feelings through talking and through your example.
 
Give both yourself and your children a break from the media coverage, as watching the coverage can add to stress and grief. When they do watch the media, watch it with them and talk about it. Often children look as if they are engrossed in play or their own activities, but they are aware of adult conversations or what is being played on the television. Monitor what they are exposed to and be there to answer questions.
 
Let your children know that you are there to protect them and love them. Let them know that what happened is rare, it was wrong, that the person who did it wasn’t well and made bad choices. Also help them to focus on healing and coming together of people. Talk with them about the heroics, bravery, and compassion of the first responders and the community. If they would like, engage in activities with them such as making cards for the families of the victims or for the first responders and support personal.  
 
Be patient with your children as they resume normalcy after trauma such as this. Be on the lookout for signs that they are having difficulty adjusting such as increased clinginess, difficulty separating from loved ones, difficulty sleeping, an increase in physical complaints such as headaches and stomachaches, or an increase in anger or acting out behaviors. With older children and teenagers, also be on the lookout for isolation, acting out behaviors, or using drugs or alcohol to cope. If you notice these difficulties, or if you feel overwhelmed or stuck, a licensed mental health professional can help.
 
Below are some additional resources for parents during this difficult time.
 
An article by the National Child Traumatic Stress Network (NCTSN) about talking with your child about the shooting.
 
An article by the Substance Abuse and Mental Health Services Administration (SAMHSA) with tips for talking with children of different ages after a traumatic event.
 
An article by the American Psychological Association (APA) about helping your child manage distress in the aftermath of the shooting. 
 
An article by the American Psychological Association (APA) about managing your distress in the aftermath of the shooting.
 
An article by the National Child Traumatic Stress Network (NCTSN) about tips for parents regarding media coverage.
 
An article by the National Child Traumatic Stress Network (NCTSN) about tips for parents with children who were directly affected by the shooting.

Resources for Children after the Hurricane

Hurricane Sandy has passed, but the widespread destruction and effects have not. Many families are still without power, heat, adequate food, and are displaced from their homes. Sadly, many families have lost their homes and some people have lost their loved ones.
 
The community support and coming together of friends and neighbors has been helpful, and a lot more work remains to be done. Natural disasters and such widespread loss and destruction can leave people reeling and struggling with many different feelings. Parents may be out of work and children have been out of school. It can be hard to try to restore a sense of normalcy and comfort for children during this time. 
 
This coloring/activity book and guide for children and parents affected by storms and flooding was first made available in the mid-90’s. Shortly after, FEMA published thousands of copies and it has been sent to families after several storms including Katrina and Rita. The purpose of this activity book is to encourage communication between parents and children regarding the storm and the aftermath and to provide some sense of calm for children. Here is the Spanish version of the same activity book. Here is another resource that has multiple free activity books for children including books for hurricanes and floods including some children’s stories from their point of view. It can be helpful for children to know that they are not the only ones going through things or having the feelings they might be having.
 
Please share these free resources with anyone who you feel might benefit. This is a time to reach out to others. Contact your child’s school counselor, ask their pediatrician, or find a therapist in your area who might help you, your child, and your family to cope and move forward during such a difficult time.