Children with ADHD typically have difficulty understanding their peers’ social cues. What do I mean? Here is an example:
Children are playing a hide and seek game on the playground. Jimmy wants to play with them. Instead of waiting to see if the children in question ask him to play, he tries to get involved in their game, which has already started. He goes up to one child who is hiding and says “I see you.” The children rebuff Jimmy and make mean faces at him while continuing their play. Jimmy does not pick up their cues that they do not want him to play.
Misinterpreting social cues in a school setting may be among many reasons that children with ADHD do not pay attention to another child’s actions or words.
Here is a statement that one of the Moms whom I researched told me:
(FALSE NAMES ARE USED HERE)
Like he took it away, and I didn’t know what to do, and I took
it back, then he started hitting me. The poor kid has a lot of
instances of that sort of thing happening, because he’ll misinterpret what is going on. And then when some kid does something, he’ll think he, Aaron, is innocent in the eyes of the other, and won’t understand why the other did something that seems mean. And then Aaron will react in a mean way to respond.
Another Mom also explained to me how difficult it was for Max to “read people.”
And you need to realize and read, and that is something that is his most difficult part of life, is that he doesn’t know how to read people. He just doesn’t really care if they’re getting upset because he’ll just get more upset.”
What happens when a child misunderstands another’s social
cues? He generally behaves in a socially inappropriate manner.
He does not listen to the exact words others are saying. If he
does not pay attention to those words, how would he know
how to act and react?
When the child with ADHD does not comprehend what another
child is saying, the child with ADHD may appear different
and vulnerable. Children look at him strangely wondering
why he doesn’t “get it.” When someone appears vulnerable,
others often take advantage of him; this is sad but true. Children with ADHD often become targets for others to bully.
Thursday, September 30, 2010
Re: Comments
I looked at the stats today that delineate the number of people who read my blog as well as their geographical distribution and saw that many people are reading my blog from all over the world.
Please ask me questions and make comments, because then I will be able to respond to the issues that are the most important to you and your child.
If you are unsure as how to comment, please go to my website, http://www.socialskillstrainingservices.com/ where you can find my contact information. If you contact me, I will help you to figure out how to make commemts.
I will look forward to hearing from you.
Please ask me questions and make comments, because then I will be able to respond to the issues that are the most important to you and your child.
If you are unsure as how to comment, please go to my website, http://www.socialskillstrainingservices.com/ where you can find my contact information. If you contact me, I will help you to figure out how to make commemts.
I will look forward to hearing from you.
Wednesday, September 29, 2010
Students and Teachers Respecting Each Other
I had an interesting conversation with one of the children with whom I work. We were discussing respect and he asked me “How can students respect teachers when they do not respect us?” I asked him exactly what he meant. He told me that in gym class, the teacher divides the students into two groups. His group sits towards the side of the teacher and he cannot see over the heads of the other students to see the teacher. Therefore, he cannot see nor hear the teacher’s instructions. Due to the fact that he cannot hear the teacher’s instructions, he asks questions of the other students, who also cannot see or hear the teacher. I assume that at some point, all of the students in that corner are talking. Then, the teacher apparently “yells” at them to stop talking without realizing that they cannot hear his instructions.
I agreed with him that teachers should respect children. However, I also told him that children should respect teachers, as well. I could see that he was angry because of his perception that the teacher did not respect the students. I was not in the room, so I cannot say definitively what exactly happened. As I said, I certainly agree with this student that the teacher and the student should respect each other.
However, if the teacher does not know why the students are talking, how could he respect them? The teacher’s perception is that the students are being rude because instead of listening to his instructions, they are talking when he is talking.
What do you think may be a remedy here for this problem?
I agreed with him that teachers should respect children. However, I also told him that children should respect teachers, as well. I could see that he was angry because of his perception that the teacher did not respect the students. I was not in the room, so I cannot say definitively what exactly happened. As I said, I certainly agree with this student that the teacher and the student should respect each other.
However, if the teacher does not know why the students are talking, how could he respect them? The teacher’s perception is that the students are being rude because instead of listening to his instructions, they are talking when he is talking.
What do you think may be a remedy here for this problem?
Tuesday, September 28, 2010
Making Friends: The Importance of Greeting Other Children Nonverbally
This is an easy one to explain. Imagine that child 1 is walking down the hall in school and another child approaches. Child 1 looks toward the ground or to the right or to the left. Child 2
gets the cue or signal that the first child does not want to be friendly. How? If child 1 wanted to be friendly, he would have turned his body toward child 2 and not only looked at him, but smiled at him, indicating a feeling of welcome. By looking at the ground or at the side, child 1 gave the impression that he had no interest in any sort of interaction. You may be saying, now, that is ridiculous. I have a couple of shy students who find it difficult to look at other children as they pass by, and they certainly do want to make friends. That may be true, but the children with ADHD must be taught exactly what their nonverbal body language means, especially
what it is saying to other approaching students.
What is body language, exactly? In my own personal definition, it is nonverbal behavior that a person exhibits, such as the way people walk; the way they carry themselves (lean closely over to others, stay back from others, etc.); the gestures they make (pointing, putting their hand on someone’s knee or shoulder, etc.); facial expressions (frowning, shaking their head in frustration, holding their head down, looking away during the conversation); or eye contact, among others. Children with ADHD must be accountable for their body language as well as their verbiage. They must be taught alternate ways of behaving. In order to be taught the more appropriate ways of interacting, they may first have to be taught how to role play. Children usually enjoy role playing, especially if it is done privately.
You can explain to children with ADHD that role playing is similar to scenes they see on television or in the movies, but done in a private context to teach them how to behave appropriately in public. The teacher can demonstrate role playing by playing both parts in a very short script. Oftentimes children without ADHD can benefit by role playing as well. In fact, the child without ADHD can be paired with a child with ADHD to create a modeling effect. In addition to the child with ADHD showing other children body language that communicates to them that he would like to be friends.
gets the cue or signal that the first child does not want to be friendly. How? If child 1 wanted to be friendly, he would have turned his body toward child 2 and not only looked at him, but smiled at him, indicating a feeling of welcome. By looking at the ground or at the side, child 1 gave the impression that he had no interest in any sort of interaction. You may be saying, now, that is ridiculous. I have a couple of shy students who find it difficult to look at other children as they pass by, and they certainly do want to make friends. That may be true, but the children with ADHD must be taught exactly what their nonverbal body language means, especially
what it is saying to other approaching students.
What is body language, exactly? In my own personal definition, it is nonverbal behavior that a person exhibits, such as the way people walk; the way they carry themselves (lean closely over to others, stay back from others, etc.); the gestures they make (pointing, putting their hand on someone’s knee or shoulder, etc.); facial expressions (frowning, shaking their head in frustration, holding their head down, looking away during the conversation); or eye contact, among others. Children with ADHD must be accountable for their body language as well as their verbiage. They must be taught alternate ways of behaving. In order to be taught the more appropriate ways of interacting, they may first have to be taught how to role play. Children usually enjoy role playing, especially if it is done privately.
You can explain to children with ADHD that role playing is similar to scenes they see on television or in the movies, but done in a private context to teach them how to behave appropriately in public. The teacher can demonstrate role playing by playing both parts in a very short script. Oftentimes children without ADHD can benefit by role playing as well. In fact, the child without ADHD can be paired with a child with ADHD to create a modeling effect. In addition to the child with ADHD showing other children body language that communicates to them that he would like to be friends.
Sunday, September 26, 2010
The Importance of Making and Keeping Friends for Children with ADHD
Children with ADHD typically have difficulty making and keeping friends due to their socially inappropriate behavior as we have discussed before. It is so important that both parents and teachers encourage these children to make friends but more importantly, give them the tools to do so. To many people, making friends is a natural occurrence, but to children with ADHD, especially those who are characterized by any type of anxiety, making friends can very difficult.
I have had children tell me that they have friends in school, so therefore, it does not matter if they do not have friends at home. It is vital to generalize the issue of making friends from school to home. In consideration of the new technology of text messaging and emailing, it is so much easier for these children to ask someone to hang out than it used to be. Previously, a child had to get up the courage to call another child and deal with the anxiety of talking to him. Now, talking to the child as such is out of the equation.
Teach your children how to text message and make sure that they have their own email account. Also, and this is so important, make sure that they learn what I call “email courtesy,” and respond to the text messages or the emails they receive. In order to respect their privacy, just ask them if they have received any messages and whether or not they responded to them.
Tomorrow, we will talk about the issue of how they can approach their peers in a way to make friends.
I have had children tell me that they have friends in school, so therefore, it does not matter if they do not have friends at home. It is vital to generalize the issue of making friends from school to home. In consideration of the new technology of text messaging and emailing, it is so much easier for these children to ask someone to hang out than it used to be. Previously, a child had to get up the courage to call another child and deal with the anxiety of talking to him. Now, talking to the child as such is out of the equation.
Teach your children how to text message and make sure that they have their own email account. Also, and this is so important, make sure that they learn what I call “email courtesy,” and respond to the text messages or the emails they receive. In order to respect their privacy, just ask them if they have received any messages and whether or not they responded to them.
Tomorrow, we will talk about the issue of how they can approach their peers in a way to make friends.
Saturday, September 25, 2010
The Use of Self-Talk to Teach a Child with ADHD How Not to Take Something Without Permission
Most of you may think that it is assumed that children only take things with permission. Not so. Children with ADHD often do not live according to the rules of behavior that others assume to be correct. They find many things tempting that others do not. Most of the children whom I observed in my field research touched most things that they saw, whether they had permission to touch them or not. One boy’s mother had taught him not to touch another’s possessions as well as not to take another’s possessions.
However, he simply could not resist temptation. Small items, such as his mother’s lip balm, would tantalize him so much that he would have to take it. As I was observing one of the homeschool mothers teaching her son, he took her pair of scissors without permission. His mother then said, “Put my scissors away and get your own.” “Johnny, did you take my lip balm? Do you think you should have had my permission before you took it?”
How do you teach these children to resist temptation? That is a tough one. This is where self-talk is a good technique for children with ADHD to learn. The following is an example of SELF-TALK as it is related to trying to prevent oneself from exhibiting impulsive behavior such as taking something without permission.
The setting: The classroom. The circumstance: The child with ADHD notices the teacher’s brand new, shiny stapler and begins to walk over to touch it. The child is thinking about and looking at that brand new, shiny, red stapler on the teacher’s desk. He begins to walk over to pick it up and to touch it.
Method 1
1. The child thinks about touching the stapler.
2.He asks himself: “Is that stapler mine? Does it belong to me? Am I supposed to touch and to pick up things that do not belong to me?”
3.He answers “No.” to himself nonverbally.
4.He goes back to his seat.
Method 2
1.The child thinks about how cool the new stapler is and the fact that he wants to touch it.
2.He self-talks: “I am not supposed to touch a stapler that is not mine.”
3.He begins to walk over to the teacher’s desk to pick up the stapler.
4.He stops. He has a a stop sign at his desk that his teacher made for him in paper or cardboard form to remind him not to touch the stapler. He picks it up and thinks about trying to STOP himself from touching the stapler.
5.He asks himself, “Will my teacher be happy with my behavior if I pick up the stapler?”
6.He answers “no” to the previous question nonverbally, and walks back to his seat.
However, he simply could not resist temptation. Small items, such as his mother’s lip balm, would tantalize him so much that he would have to take it. As I was observing one of the homeschool mothers teaching her son, he took her pair of scissors without permission. His mother then said, “Put my scissors away and get your own.” “Johnny, did you take my lip balm? Do you think you should have had my permission before you took it?”
How do you teach these children to resist temptation? That is a tough one. This is where self-talk is a good technique for children with ADHD to learn. The following is an example of SELF-TALK as it is related to trying to prevent oneself from exhibiting impulsive behavior such as taking something without permission.
The setting: The classroom. The circumstance: The child with ADHD notices the teacher’s brand new, shiny stapler and begins to walk over to touch it. The child is thinking about and looking at that brand new, shiny, red stapler on the teacher’s desk. He begins to walk over to pick it up and to touch it.
Method 1
1. The child thinks about touching the stapler.
2.He asks himself: “Is that stapler mine? Does it belong to me? Am I supposed to touch and to pick up things that do not belong to me?”
3.He answers “No.” to himself nonverbally.
4.He goes back to his seat.
Method 2
1.The child thinks about how cool the new stapler is and the fact that he wants to touch it.
2.He self-talks: “I am not supposed to touch a stapler that is not mine.”
3.He begins to walk over to the teacher’s desk to pick up the stapler.
4.He stops. He has a a stop sign at his desk that his teacher made for him in paper or cardboard form to remind him not to touch the stapler. He picks it up and thinks about trying to STOP himself from touching the stapler.
5.He asks himself, “Will my teacher be happy with my behavior if I pick up the stapler?”
6.He answers “no” to the previous question nonverbally, and walks back to his seat.
Friday, September 24, 2010
Self-Talk: What is it? How Can We Use It?
What do I mean by self-talk? Have you ever talked to yourself when you are getting ready to go on a trip? Have you asked yourself, “Have I packed that sweater?” either nonverbally or verbally? Children may use that type of self-talk to tell themselves to exhibit an appropriate behavior. For example, a child
may say to himself, “Stay in your seat.” Now in school, the child would preferably tell himself that statement mentally so as not to disturb others! Children can also rehearse how to exhibit socially appropriate behavior by using self-talk.
When a child with ADHD becomes frustrated with his schoolwork, it is generally due to one of many reasons. One of the most salient reasons is that the work that the child is required to do is either too difficult or too easy for him. In order to encourage the child to achieve academically to his optimal level, the child should be presented with work that is just a little bit too difficult for him. When these children are given work that is much too difficult for them, they become academically frustrated. Because of this frustration, they may exhibit socially inappropriate behavior. If they are required to do work that they have already learned and are bored, they may exhibit socially inappropriate behavior then as well.
What behaviors might they exhibit? Perhaps getting up from their seat; annoying other children who are working; asking inappropriate questions; jumping up and down; racing back and forth throughout the classroom; or simply staring out of the window and not doing the required work, among other
behaviors.
So what can the teacher do then? The teacher can design either a verbal or a nonverbal signal so that the student can alert the teacher the moment he realizes that he is becoming frustrated. If the student and the teacher can “grab” the moment right before the child with ADHD becomes frustrated, she can teach him how to use self-talk to try to prevent or inhibit himself from exhibiting socially inappropriate behavior.
Back to the signal—when the teacher touches the child with ADHD on the shoulder, for example, the child says to himself, “Sit quietly.” There could be different nonverbal signals for helping the child with ADHD to stop certain types of behaviors. Be as creative as you can be. For instance, if the child is asking too many inappropriate questions, the teacher can give the child a note with a symbol
of a question mark on it that says, “Listen now.” Then the child says to himself, “Eric, listen now.” It is imperative to communicate the socially appropriate behavior that you want the child to exhibit, instead of accentuating the inappropriate behavior that he is currently executing.
may say to himself, “Stay in your seat.” Now in school, the child would preferably tell himself that statement mentally so as not to disturb others! Children can also rehearse how to exhibit socially appropriate behavior by using self-talk.
When a child with ADHD becomes frustrated with his schoolwork, it is generally due to one of many reasons. One of the most salient reasons is that the work that the child is required to do is either too difficult or too easy for him. In order to encourage the child to achieve academically to his optimal level, the child should be presented with work that is just a little bit too difficult for him. When these children are given work that is much too difficult for them, they become academically frustrated. Because of this frustration, they may exhibit socially inappropriate behavior. If they are required to do work that they have already learned and are bored, they may exhibit socially inappropriate behavior then as well.
What behaviors might they exhibit? Perhaps getting up from their seat; annoying other children who are working; asking inappropriate questions; jumping up and down; racing back and forth throughout the classroom; or simply staring out of the window and not doing the required work, among other
behaviors.
So what can the teacher do then? The teacher can design either a verbal or a nonverbal signal so that the student can alert the teacher the moment he realizes that he is becoming frustrated. If the student and the teacher can “grab” the moment right before the child with ADHD becomes frustrated, she can teach him how to use self-talk to try to prevent or inhibit himself from exhibiting socially inappropriate behavior.
Back to the signal—when the teacher touches the child with ADHD on the shoulder, for example, the child says to himself, “Sit quietly.” There could be different nonverbal signals for helping the child with ADHD to stop certain types of behaviors. Be as creative as you can be. For instance, if the child is asking too many inappropriate questions, the teacher can give the child a note with a symbol
of a question mark on it that says, “Listen now.” Then the child says to himself, “Eric, listen now.” It is imperative to communicate the socially appropriate behavior that you want the child to exhibit, instead of accentuating the inappropriate behavior that he is currently executing.
Thursday, September 23, 2010
The Goal of the Treatment Process for Children with ADHD
The goal of the treatment process is for children with ADHD to learn how to self-regulate their behavior. Why is this so important? Children with ADHD may appear to be very “annoying” to their peers, in terms of interrupting, bursting into social situations that are ongoing and talking excessively. Have you ever taken a long car trip and drank way too much coffee? When you arrive home, how do you behave? If you are like the rest of us, you engage in non-stop talking, which only a very understanding spouses, partners or children will understand. Now you can see how the children with ADHD's peers may see them.
The reason that many children with ADHD have few friends is linked to the inappropriate behavior that they exhibit. These children often have no filter and say whatever comes into their minds whenever they feel like saying it. If they are taught to self-talk, or talk silently to themselves to diminish their erratic behavior, their peers will view them differently.
Look for my next post which will explain how to teach self-talk..
The reason that many children with ADHD have few friends is linked to the inappropriate behavior that they exhibit. These children often have no filter and say whatever comes into their minds whenever they feel like saying it. If they are taught to self-talk, or talk silently to themselves to diminish their erratic behavior, their peers will view them differently.
Look for my next post which will explain how to teach self-talk..
Wednesday, September 22, 2010
The Beginning of the School Year: Has Bullying Started Already?
If your child with ADHD has been bullied in past years, you are certainly hoping that it will not happen this year. You are thinking to yourself that even though he was bullied two years ago, last year was not such a bad year.
What are the signs to look for in your child's behavior that might indicate that he has been bullied and/or teased
Is he usually outgoing and seems to be keeping to himself?
Has his appetite diminished?
Has he stopped wanting to do fun things with the family?
Is his behavior different than it was in any way?
If any of these statements are true, then you might want to find a quiet moment to talk to your child. What would you say? Remain calm and very low-key and merely say that you have noticed that he has been quieter than usual and keeping to himself, for example, and you wanted to make sure that everything is okay with him.
Please do not forget that there are many "new" types of bullying that includes cyberbullying and even text messaging bullying! If you are not technologically adept, it may be time for you to become so. However, speaking with your child is the first step to managing any problems that he has had with being teased or bullied. It is vital to establish open communication so the he will feel that it is safe to speak with you about any social difficulty that he experiences. Remember to remain calm.....
What are the signs to look for in your child's behavior that might indicate that he has been bullied and/or teased
Is he usually outgoing and seems to be keeping to himself?
Has his appetite diminished?
Has he stopped wanting to do fun things with the family?
Is his behavior different than it was in any way?
If any of these statements are true, then you might want to find a quiet moment to talk to your child. What would you say? Remain calm and very low-key and merely say that you have noticed that he has been quieter than usual and keeping to himself, for example, and you wanted to make sure that everything is okay with him.
Please do not forget that there are many "new" types of bullying that includes cyberbullying and even text messaging bullying! If you are not technologically adept, it may be time for you to become so. However, speaking with your child is the first step to managing any problems that he has had with being teased or bullied. It is vital to establish open communication so the he will feel that it is safe to speak with you about any social difficulty that he experiences. Remember to remain calm.....
Where you can buy my book
I received an email from my publisher yesterday who reminded me that I should inform you as to where you can purchase my book. The following are the links where you can go to in order to buy my book:
http://www.amazon.com/ADHD-Social-Skills-Step---Step/dp/1607092808/ref=sr_1_1?s=books&ie=UTF8&qid=1285169318&sr=1-1
http://search.barnesandnoble.com/ADHD-and-Social-Skills/Esta-M-Rapoport/e/9781607092810/?itm=1&USRI=adhd+and+social+skills
Questions? The one on Amazon is the hardcover and the one on Barnes and Noble is the softcover.
Questions?
http://www.amazon.com/ADHD-Social-Skills-Step---Step/dp/1607092808/ref=sr_1_1?s=books&ie=UTF8&qid=1285169318&sr=1-1
http://search.barnesandnoble.com/ADHD-and-Social-Skills/Esta-M-Rapoport/e/9781607092810/?itm=1&USRI=adhd+and+social+skills
Questions? The one on Amazon is the hardcover and the one on Barnes and Noble is the softcover.
Questions?
Tuesday, September 21, 2010
A Story of a "Real" Child with ADHD: Timmy (false name) Part 3
I was hired to be what was called an itinerant teacher. My job description stated that I was to supervise eight-year-old Timmy in his classroom for six hours a day for four days a week for a period of one year. I believe the actual reason that I was hired was that they wanted me to isolate Timmy from the other children as well as from the teacher. The principal thought that if I was in charge of Timmy, Timmy’s behavior, which was the only perception they had of Timmy, would not annoy anyone. Over that year, I got to know Timmy well. He told me how terrible he felt when other children rejected him, and that he so desperately wanted to have a friend. Without going into exactly what interventions I used to remediate his inappropriate behavior, I can tell you that from that first day forward, I observed the other children rejecting Timmy and saw how it affected his self-esteem. Little by little, this cute little boy became very insecure and felt very unwanted.
He would walk with his head down so no one could say anything negative to his face. How do I know that? He told me so. Additionally, I observed him exhibiting that type of body language, which certainly validated what he had told me. More often than not, I would see tears streaming down his little face when I tried to get him to maintain eye contact. I needed to have him maintain eye contact, of course, so that I could be sure that he was paying attention when I was teaching him social skills.
There is hope for children like Timmy in terms of learning social skills. Even though it took a year for me to help Timmy learn how to self-regulate his behavior, by the end of the year he was attending gym class, with me in tow. It was a good thing since my rusty skills as a soccer coach came in handy that year! The other children were learning how to play soccer, so I taught Timmy to play as well. I ran right next to him and helped to model soccer skills for him. On the last day of school, Timmy’s class was playing soccer. I convinced the gym teacher to permit him to play on one of the teams. The score was tied at 2-2. I signaled to one of the other boys to pass the ball to Timmy, who was waiting right in front of the goal. The other little boy dribbled the ball to Timmy. Timmy dribbled the ball a few more feet, and with a good “foot” kicked the ball into the goal for the point to win the game. I still become emotional upon thinking about the end of this rather tumultuous story. After Timmy kicked the ball into the goal, his “team” jumped on top of him, chanting his name: “Timmy, Timmy, Timmy!” As I watched each and every one of those
children slap Timmy a high-five, I was just stunned to see how far Timmy had come.
I saw that Timmy felt so proud of himself. I could also see that all of the hard work that we had done together over that past year was worth it. I am not telling you that that was the end of Timmy’s socially inappropriate behavior. I will tell you, though, that from that point onward Timmy knew that he was capable of self-regulating his socially inappropriate behavior.
He began to have some ownership over his socially appropriate behavior as well.
Now that I have given you a real-life example of how poor social skills can affect a child with ADHD and the people around him, does Timmy sound like anyone that you know?
He would walk with his head down so no one could say anything negative to his face. How do I know that? He told me so. Additionally, I observed him exhibiting that type of body language, which certainly validated what he had told me. More often than not, I would see tears streaming down his little face when I tried to get him to maintain eye contact. I needed to have him maintain eye contact, of course, so that I could be sure that he was paying attention when I was teaching him social skills.
There is hope for children like Timmy in terms of learning social skills. Even though it took a year for me to help Timmy learn how to self-regulate his behavior, by the end of the year he was attending gym class, with me in tow. It was a good thing since my rusty skills as a soccer coach came in handy that year! The other children were learning how to play soccer, so I taught Timmy to play as well. I ran right next to him and helped to model soccer skills for him. On the last day of school, Timmy’s class was playing soccer. I convinced the gym teacher to permit him to play on one of the teams. The score was tied at 2-2. I signaled to one of the other boys to pass the ball to Timmy, who was waiting right in front of the goal. The other little boy dribbled the ball to Timmy. Timmy dribbled the ball a few more feet, and with a good “foot” kicked the ball into the goal for the point to win the game. I still become emotional upon thinking about the end of this rather tumultuous story. After Timmy kicked the ball into the goal, his “team” jumped on top of him, chanting his name: “Timmy, Timmy, Timmy!” As I watched each and every one of those
children slap Timmy a high-five, I was just stunned to see how far Timmy had come.
I saw that Timmy felt so proud of himself. I could also see that all of the hard work that we had done together over that past year was worth it. I am not telling you that that was the end of Timmy’s socially inappropriate behavior. I will tell you, though, that from that point onward Timmy knew that he was capable of self-regulating his socially inappropriate behavior.
He began to have some ownership over his socially appropriate behavior as well.
Now that I have given you a real-life example of how poor social skills can affect a child with ADHD and the people around him, does Timmy sound like anyone that you know?
A Story of a "Real" Child with ADHD: Timmy (false name) Part 2
I asked for and received permission from his parents, the other children’s parents, and the school to videotape him during class, in lunch, in recess, and in gym class. I included the stipulation that the videotape was for my use only. The other children thought that I was videotaping them as well, so they did not complain. I only had to show Timmy a few minutes of the videotape before he got the idea of the annoying nature of his behavior. That tape was a great teaching tool for me over the year that I worked with him, but I will not get into those details here. After working with Timmy during that year, I knew that I had to find a way to help teachers and parents teach social skills to children with ADHD, so that these children’s socially inappropriate behavior would not result in their becoming isolated, bullied, and rejected. I knew that I had to do something to try to prevent other children with ADHD from experiencing their childhood years in a sad and lonely place like the world in which Timmy lived. If children with ADHD learn positive social skills, they will naturally feel better about themselves. If they succeed in learning these socially appropriate skills, they will be less likely to form negative opinions about themselves, as Timmy had already done at eight years old.
Do you remember that I discussed how Timmy’s teacher felt about him? Let me mention some of the reactions of the other children in the classroom, among others. Every day that I entered the classroom, another child would come running up to tell me what a horrible thing Timmy had
done to them. Then, they asked me, “Could you please keep Timmy away from us?”
I told these children that those kinds of comments were unacceptable and hurtful. However, even though I told them to stop saying those negative things about Timmy, they did not do so. Timmy heard every one of these hurtful comments, which made him tear up right in front of me. He quickly became angry at the child who said it, which caused him to strike out against that child, as well as all of the children in his class, even more. In an attempt to find out more about Timmy, I spoke to his mom.
According to her, children have been saying negative comments to Timmy ever since he was in preschool. She also told me that Timmy was always so hyperactive, that it seemed as if he was perpetually in motion. As I observed him in class, he would talk in an obsessive way about anything and everything. For instance, he would ask why the teacher was wearing her hair in a ponytail, perhaps thirty times. Additionally, his comments were almost never on the topic being discussed. In addition, when he realized that no one was listening to him, he began to move closer to the child or adult to whom he was speaking. He would also try to touch that child
or adult. If you are familiar with the “Close Talker” in the Seinfeld episodes, that was the style of Timmy’s interactions. The more the child became annoyed, the more annoying Timmy became.
Consequently, none of the children wanted to sit next to him or be anywhere near him. Imagine how an eight-year old boy would feel when no one, not his peers or his teachers, wanted to be around him. This sweet and discerning child was rejected by everyone. He was such a bright little boy. Why couldn’t he add his insightful comments to the conversations in class or at recess? Sadly, he never was given the chance to enter into those conversations, either during gym, art, or recess, because as I have said before, he was not permitted to attend any activity where the teacher thought that he might be disruptive. His teacher felt that he was misunderstanding much of the instructions that she gave the class, in terms of how to go about doing activities as well as instructions concerning how to do his class work.
However, in the year that I worked with Timmy, his teacher never attempted to clarify those instructions for him. In fact, it appeared that even though he was so many steps ahead of everyone intellectually (he had a diagnosis of giftedness), he could not attend to either his teachers or his peers for an extended period of time without “bouncing all over the room,” as his teacher told me. Because of Timmy’s socially inappropriate behavior, his teachers responded unkindly to him, while his peers verbally abused and rejected him. Timmy certainly needed to learn how to behave in a more socially appropriate way, and apparently, I was the one who was going to teach him.
See my next post for how I taught Timmy.
Do you remember that I discussed how Timmy’s teacher felt about him? Let me mention some of the reactions of the other children in the classroom, among others. Every day that I entered the classroom, another child would come running up to tell me what a horrible thing Timmy had
done to them. Then, they asked me, “Could you please keep Timmy away from us?”
I told these children that those kinds of comments were unacceptable and hurtful. However, even though I told them to stop saying those negative things about Timmy, they did not do so. Timmy heard every one of these hurtful comments, which made him tear up right in front of me. He quickly became angry at the child who said it, which caused him to strike out against that child, as well as all of the children in his class, even more. In an attempt to find out more about Timmy, I spoke to his mom.
According to her, children have been saying negative comments to Timmy ever since he was in preschool. She also told me that Timmy was always so hyperactive, that it seemed as if he was perpetually in motion. As I observed him in class, he would talk in an obsessive way about anything and everything. For instance, he would ask why the teacher was wearing her hair in a ponytail, perhaps thirty times. Additionally, his comments were almost never on the topic being discussed. In addition, when he realized that no one was listening to him, he began to move closer to the child or adult to whom he was speaking. He would also try to touch that child
or adult. If you are familiar with the “Close Talker” in the Seinfeld episodes, that was the style of Timmy’s interactions. The more the child became annoyed, the more annoying Timmy became.
Consequently, none of the children wanted to sit next to him or be anywhere near him. Imagine how an eight-year old boy would feel when no one, not his peers or his teachers, wanted to be around him. This sweet and discerning child was rejected by everyone. He was such a bright little boy. Why couldn’t he add his insightful comments to the conversations in class or at recess? Sadly, he never was given the chance to enter into those conversations, either during gym, art, or recess, because as I have said before, he was not permitted to attend any activity where the teacher thought that he might be disruptive. His teacher felt that he was misunderstanding much of the instructions that she gave the class, in terms of how to go about doing activities as well as instructions concerning how to do his class work.
However, in the year that I worked with Timmy, his teacher never attempted to clarify those instructions for him. In fact, it appeared that even though he was so many steps ahead of everyone intellectually (he had a diagnosis of giftedness), he could not attend to either his teachers or his peers for an extended period of time without “bouncing all over the room,” as his teacher told me. Because of Timmy’s socially inappropriate behavior, his teachers responded unkindly to him, while his peers verbally abused and rejected him. Timmy certainly needed to learn how to behave in a more socially appropriate way, and apparently, I was the one who was going to teach him.
See my next post for how I taught Timmy.
A Story of a "Real" Child with ADHD: Timmy (false name) Part 1
I walked into the school where I would be working for the next year and was stunned to see Timmy, an eight-year-old, curly haired, mop-topped imp sitting right outside of the principal’s
office. He had his head down and was not talking to anyone. I sat down next to him and after just a few minutes, tears began to flow gently down his cheek. He told me that he was trying to make himself invisible so that no one could see him as they walked by, because unlike him, they were going to gym class. Why was he not going to gym class like everyone else? His teacher told me that he was not yet ready to go to gym, art, music, or recess with the other children because he talked incessantly; he did not pay attention to instructions; he interrupted whomever was speaking; and he continuously touched others. How obstructive could a little boy’s behavior be that would prevent him from attending classes and activities that would seemingly be fun for him?
In a way, one could not blame his teacher. Apparently the last time he entered the gym, he immediately darted to the closet where all of the equipment was stored and one by one, threw
each and every piece of equipment out onto the gym floor. In fact, he threw some of the balls at the other children. His behavior was certainly obstructive. However, was there not one teacher who could try to teach him how to behave appropriately? Timmy’s teacher quickly told me the answer to that question. She said that “He just wouldn’t listen.” She also told me that she “just didn’t have the time to work with one child.” Timmy was one student in an eight-student class. Was she kidding? Her response gave me a clear picture of how she felt about Timmy and his behavior. I know that you are asking yourself, why did Timmy exhibit these socially inappropriate behaviors? Why did he exhibit poor social skills? Timmy had a diagnosis of attention-deficit/ hyperactive disorder (ADHD) as well as a diagnosis of giftedness.
The symptoms that he exhibited are typical for children with the diagnosis of ADHD as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Certainly, Timmy exhibited the following from the DSM-IV-TR: (b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(h) is often easily distracted by extraneous stimuli
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively (APA 2000, p. 66).
In fact, if children with ADHD do not learn how to diminish or self-regulate these symptoms, they may arguably spend their entire adult lives feeling friendless, devoid of spouses, and having
difficulty obtaining and keeping a job. As hard as it is for me to admit it, you can see how a child
like Timmy could be annoying for other children to have around. It was just about impossible for Timmy to get children to like him, let alone to make friends. Each time I entered the classroom, Timmy appeared to be happy. However, within a few moments, his face showed more and more sadness and hurt. Whenever he tried to talk to his classmates, they would ignore him or make insulting comments to him. His behavior would then suddenly become inappropriate.
This was the cycle of Timmy’s behavior: he would talk to his classmates; they would ignore him or make hurtful comments to him; and then he would exhibit socially inappropriate behavior
that would irritate them. This cycle was prevalent during all of his classes as well as throughout lunch. When I came to school to work with Timmy, no one wanted to sit next to him at lunch. Let us look at what typically happened. As Timmy ate his lunch, if the other children did not get up from their chairs immediately upon seeing him walking toward them and sit somewhere else, he would speak to them. They would say insulting comments to him, such as, “Oh no, here he is again, the talking monster,” or “The jumping jack in a boy’s body is sitting here, yuck.” He would then exhibit inappropriate behavior, such as purposely chewing his food with his mouth open. The other children would then say to me that “He grosses us out.” Since Timmy clearly did not understand how his behavior was causing his peers to respond to him in a negative way, he did not do anything to change his behavior. I tried to talk to Timmy to help him to understand exactly why his peers were rejecting him, but he just did not understand. He would speak to me about feeling rejected and unwanted but just did not understand the origin of his own socially inappropriate behavior. So I tried a different approach, which you will read in my next post, part 2.
office. He had his head down and was not talking to anyone. I sat down next to him and after just a few minutes, tears began to flow gently down his cheek. He told me that he was trying to make himself invisible so that no one could see him as they walked by, because unlike him, they were going to gym class. Why was he not going to gym class like everyone else? His teacher told me that he was not yet ready to go to gym, art, music, or recess with the other children because he talked incessantly; he did not pay attention to instructions; he interrupted whomever was speaking; and he continuously touched others. How obstructive could a little boy’s behavior be that would prevent him from attending classes and activities that would seemingly be fun for him?
In a way, one could not blame his teacher. Apparently the last time he entered the gym, he immediately darted to the closet where all of the equipment was stored and one by one, threw
each and every piece of equipment out onto the gym floor. In fact, he threw some of the balls at the other children. His behavior was certainly obstructive. However, was there not one teacher who could try to teach him how to behave appropriately? Timmy’s teacher quickly told me the answer to that question. She said that “He just wouldn’t listen.” She also told me that she “just didn’t have the time to work with one child.” Timmy was one student in an eight-student class. Was she kidding? Her response gave me a clear picture of how she felt about Timmy and his behavior. I know that you are asking yourself, why did Timmy exhibit these socially inappropriate behaviors? Why did he exhibit poor social skills? Timmy had a diagnosis of attention-deficit/ hyperactive disorder (ADHD) as well as a diagnosis of giftedness.
The symptoms that he exhibited are typical for children with the diagnosis of ADHD as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Certainly, Timmy exhibited the following from the DSM-IV-TR: (b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(h) is often easily distracted by extraneous stimuli
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively (APA 2000, p. 66).
In fact, if children with ADHD do not learn how to diminish or self-regulate these symptoms, they may arguably spend their entire adult lives feeling friendless, devoid of spouses, and having
difficulty obtaining and keeping a job. As hard as it is for me to admit it, you can see how a child
like Timmy could be annoying for other children to have around. It was just about impossible for Timmy to get children to like him, let alone to make friends. Each time I entered the classroom, Timmy appeared to be happy. However, within a few moments, his face showed more and more sadness and hurt. Whenever he tried to talk to his classmates, they would ignore him or make insulting comments to him. His behavior would then suddenly become inappropriate.
This was the cycle of Timmy’s behavior: he would talk to his classmates; they would ignore him or make hurtful comments to him; and then he would exhibit socially inappropriate behavior
that would irritate them. This cycle was prevalent during all of his classes as well as throughout lunch. When I came to school to work with Timmy, no one wanted to sit next to him at lunch. Let us look at what typically happened. As Timmy ate his lunch, if the other children did not get up from their chairs immediately upon seeing him walking toward them and sit somewhere else, he would speak to them. They would say insulting comments to him, such as, “Oh no, here he is again, the talking monster,” or “The jumping jack in a boy’s body is sitting here, yuck.” He would then exhibit inappropriate behavior, such as purposely chewing his food with his mouth open. The other children would then say to me that “He grosses us out.” Since Timmy clearly did not understand how his behavior was causing his peers to respond to him in a negative way, he did not do anything to change his behavior. I tried to talk to Timmy to help him to understand exactly why his peers were rejecting him, but he just did not understand. He would speak to me about feeling rejected and unwanted but just did not understand the origin of his own socially inappropriate behavior. So I tried a different approach, which you will read in my next post, part 2.
Monday, September 20, 2010
Does your Child Interrupt his Teacher?
This is one of the most important social skills for a child with ADHD to learn. Why? Because whether in a classroom, on an athletic field, in a music class, or during an extracurricular activity, teachers and coaches give instructions as to exactly what to do. These instructions are typically given to the whole group and are not usually repeated. What happens if the child interrupts? First, the teacher becomes annoyed very quickly. Second, the student misses a step before he begins his assignment; he hasn’t listened, so, therefore, he does not know what to do.
Why do children with ADHD have difficulty listening to instructions?
Why do they interrupt?
Children with ADHD have all of their thoughts spinning around in their minds. They just
cannot wait to say what is in their thoughts. They must say those thoughts immediately. What can a teacher or a parent do to help children with ADHD to wait before they interrupt another person? This social skill is one that requires children with ADHD to learn how to self-regulate.
Here are some possible steps:
Method!
This intervention is particularly good for a child with ADHD who is of an older elementary age, perhaps ten to twelve years old, for example. Within a role playing situation, the teacher practices the following steps with the child with ADHD:
1. When the child with ADHD wants to talk when his teacher is giving him instructions, the teacher shows the child how take three DEEP breaths and count each one: one deep breath; two deep breaths; and three deep breaths.
2. Instruct the child to write down two things he wants to say. (If he does not write, have him draw a picture or choose from a choice of pictures that the teacher provides.)
3. Write down two instructions that the teacher is saying. (The child can choose pictures here as well, in order to indicate what the instructions incorporate.)
4. As the teacher is speaking, wait for a break in conversation.
5. The child reads the conversation points that he has written down. (Or, he can describe the pictures that he has chosen to represent the instructions.)
6. The child asks himself: Are my conversation points related to the teacher’s instructions?
7. If the conversation points are not related, the child does not speak.
8. If the conversation is related, the child raises his hand and WAITS for the teacher to call on him.
9. When the teacher calls on him, he states his two points.
Why do children with ADHD have difficulty listening to instructions?
Why do they interrupt?
Children with ADHD have all of their thoughts spinning around in their minds. They just
cannot wait to say what is in their thoughts. They must say those thoughts immediately. What can a teacher or a parent do to help children with ADHD to wait before they interrupt another person? This social skill is one that requires children with ADHD to learn how to self-regulate.
Here are some possible steps:
Method!
This intervention is particularly good for a child with ADHD who is of an older elementary age, perhaps ten to twelve years old, for example. Within a role playing situation, the teacher practices the following steps with the child with ADHD:
1. When the child with ADHD wants to talk when his teacher is giving him instructions, the teacher shows the child how take three DEEP breaths and count each one: one deep breath; two deep breaths; and three deep breaths.
2. Instruct the child to write down two things he wants to say. (If he does not write, have him draw a picture or choose from a choice of pictures that the teacher provides.)
3. Write down two instructions that the teacher is saying. (The child can choose pictures here as well, in order to indicate what the instructions incorporate.)
4. As the teacher is speaking, wait for a break in conversation.
5. The child reads the conversation points that he has written down. (Or, he can describe the pictures that he has chosen to represent the instructions.)
6. The child asks himself: Are my conversation points related to the teacher’s instructions?
7. If the conversation points are not related, the child does not speak.
8. If the conversation is related, the child raises his hand and WAITS for the teacher to call on him.
9. When the teacher calls on him, he states his two points.
Friday, September 17, 2010
How Teachers can Help Children with ADHD to Join Activities
In order for the child with ADHD to ask another child to join him in activities, that child must be able to get an idea of whether or not the child may be interested in playing with
him. Many times, body language and facial expressions are the only hints that individuals express. Children with ADHD need to see and understand the relationship between body
language, facial expressions, and behavior. Until they do, they cannot begin to interact in a more positive way.
In order to assist these children in improving their social interactions, it is important to give them just a few, simple steps at a time. Why? Because children with ADHD often get caught up in so many details that they do not internalize
their teachers’ instructions. Here are some steps a teacher can implement so the child with ADHD can learn to invite others to join activities:
✱ Walk close to the child you would like to ask to join in your activity.
✱ Look at his facial expression: Is he happy, sad, angry, and so on?
✱ Look at his body language: Is he sitting in a relaxed way in a chair? Is he walking around the room?
✱ After you have made a decision that the child is happy and relaxed, walk up a little closer to him.
✱ Very simply, ask if he would like to join you in whatever activity you are involved in.
✱ If he tells you that he would like to join you in your activity, then begin to interact with him.
✱ If he tells you that he is busy or that he does not want to join you in your activity, you can tell him to let you know if he changes his mind, or just say okay, and walk away.
As a teacher, you can modify my list as you wish. You may want to use pictures as a way of demonstrating what the various facial expressions look like, for example. As I have said
before, and just to emphasize the point, the child with ADHD is more likely to remember something that is meaningful. Therefore, perhaps using pictures of the child and his family
showing angry, happy, or sad faces may teach the child what the various facial expressions look like more easily. You may want to make each step simpler yet by minimizing the words
on the list. Check my next post for some examples.
him. Many times, body language and facial expressions are the only hints that individuals express. Children with ADHD need to see and understand the relationship between body
language, facial expressions, and behavior. Until they do, they cannot begin to interact in a more positive way.
In order to assist these children in improving their social interactions, it is important to give them just a few, simple steps at a time. Why? Because children with ADHD often get caught up in so many details that they do not internalize
their teachers’ instructions. Here are some steps a teacher can implement so the child with ADHD can learn to invite others to join activities:
✱ Walk close to the child you would like to ask to join in your activity.
✱ Look at his facial expression: Is he happy, sad, angry, and so on?
✱ Look at his body language: Is he sitting in a relaxed way in a chair? Is he walking around the room?
✱ After you have made a decision that the child is happy and relaxed, walk up a little closer to him.
✱ Very simply, ask if he would like to join you in whatever activity you are involved in.
✱ If he tells you that he would like to join you in your activity, then begin to interact with him.
✱ If he tells you that he is busy or that he does not want to join you in your activity, you can tell him to let you know if he changes his mind, or just say okay, and walk away.
As a teacher, you can modify my list as you wish. You may want to use pictures as a way of demonstrating what the various facial expressions look like, for example. As I have said
before, and just to emphasize the point, the child with ADHD is more likely to remember something that is meaningful. Therefore, perhaps using pictures of the child and his family
showing angry, happy, or sad faces may teach the child what the various facial expressions look like more easily. You may want to make each step simpler yet by minimizing the words
on the list. Check my next post for some examples.
Thursday, September 16, 2010
Helping the Child with ADHD to Understand your Frustrations: They have Nothing to do with him!!
The idea of helping your child to manage his own frustrations seems simple enough. You teach him how to take deep breaths, how to use self-talk or other calming mechanisms. What do you tell your child about your behavior if it is more erratic than usual, due to the fact that you have been recently laid off from your job?
Tell him the truth with as much information that you feel he needs to know in order to understand how you feel. Clearly, you will tell a six year old a different type of information than you would tell a 13 year old. If you have been short-tempered and even angry, your child needs to know that those behaviors have nothing to do with him.
Our kids have been reprimanded, criticized and demeaned their whole lives by people who do not understand the symptoms associated with ADHD. Once again, it is vital that your child knows that if you react to him in ways that upset him, the reason for your behavior is related to your own frustration in terms of being out of job, and is not related to his behavior.
Tell him the truth with as much information that you feel he needs to know in order to understand how you feel. Clearly, you will tell a six year old a different type of information than you would tell a 13 year old. If you have been short-tempered and even angry, your child needs to know that those behaviors have nothing to do with him.
Our kids have been reprimanded, criticized and demeaned their whole lives by people who do not understand the symptoms associated with ADHD. Once again, it is vital that your child knows that if you react to him in ways that upset him, the reason for your behavior is related to your own frustration in terms of being out of job, and is not related to his behavior.
How to Avoid Frustration by the Child with ADHD: Keep him Correctly Informed
The child with ADHD must be taught to self-regulate his socially inappropriate behavior. The child must learn mechanisms for self-calming and exhibiting socially appropriate behavior in a consistent way. After the child calms down, the teacher or parent can offer the child cues to encourage him to talk about why he is so upset. They can also help the child with ADHD to try to prevent that problem from occurring again. Sometimes the answers are simple.
For example, the child with ADHD is overtired and demands that his parent buy him
a new toy now. Sometimes the answers are complex. For example, the parents of the child with ADHD are divorced. The child thought that his dad promised to take him out for the day, and the dad does not arrive. Let us think about what really may have happened.
The child did not listen carefully when his father told him the day that he was planning to come for a visit. The child, therefore, mixed up the days that his father was planning on coming to visit. When his father did not arrive on the day that the child with ADHD thought that he would, the child became very frustrated. Instead of asking his mother if this was the correct day, he became angry and overwhelmed with disappointment. This child was vulnerable and reacted to incorrect information, which resulted in him having a temper tantrum.
Children with ADHD are very vulnerable. It is vital for the teacher as well as the parent to make sure that the information the child is told is completely and correctly understood, so that socially inappropriate behavior does not erupt as a result of a misunderstanding of that information.
For example, the child with ADHD is overtired and demands that his parent buy him
a new toy now. Sometimes the answers are complex. For example, the parents of the child with ADHD are divorced. The child thought that his dad promised to take him out for the day, and the dad does not arrive. Let us think about what really may have happened.
The child did not listen carefully when his father told him the day that he was planning to come for a visit. The child, therefore, mixed up the days that his father was planning on coming to visit. When his father did not arrive on the day that the child with ADHD thought that he would, the child became very frustrated. Instead of asking his mother if this was the correct day, he became angry and overwhelmed with disappointment. This child was vulnerable and reacted to incorrect information, which resulted in him having a temper tantrum.
Children with ADHD are very vulnerable. It is vital for the teacher as well as the parent to make sure that the information the child is told is completely and correctly understood, so that socially inappropriate behavior does not erupt as a result of a misunderstanding of that information.
Wednesday, September 15, 2010
Executive Function and ADHD: What is it?
I talk all of the time about the executive function problems (organizing, self-regulation, inhibiting inappropriate responses, using working memory, etc. of children with ADHD.
Take a look at this article by one of the elite in the field, Dr. Thomas E. Brown from Yale about executive function.
Here is the link:
http://www.chadd.org/AM/Template.cfm?Section=Attention_Magazine&Template=/CM/ContentDisplay.cfm&ContentID=5802
Take a look at this article by one of the elite in the field, Dr. Thomas E. Brown from Yale about executive function.
Here is the link:
http://www.chadd.org/AM/Template.cfm?Section=Attention_Magazine&Template=/CM/ContentDisplay.cfm&ContentID=5802
Tuesday, September 14, 2010
Professional Athletes who have ADHD
Do you ever wonder if professional athletes have ADHD? Well many do, including Michael Phelps, Adam LaRoche, Derek Lowe, Terry Bradshaw, Pete Rose, etc. Check out an article about some other athletes at
http://www.additudemag.com/adhd/article/989.html
http://www.additudemag.com/adhd/article/989.html
False Information About ADHD
I am writing this post as a warning to everyone to be careful to whom you listen regarding ADHD. There is so much misinformation out there. For example, yesterday on Twitter, there was a link to a seemingly legitimate article about ADHD stating that it was a disease!
ADHD is NOT a disease! Children have ADHD just like they have a certain hair color or eye color. When people call children with ADHD, "ADHD children" it implies a very negative connotation, which also indicates that the child's symptoms cannot be modified or changed. So...please be careful to whom you listen!!!! If you need to know who is legitimate, please ask me and I will look into it.
ADHD is NOT a disease! Children have ADHD just like they have a certain hair color or eye color. When people call children with ADHD, "ADHD children" it implies a very negative connotation, which also indicates that the child's symptoms cannot be modified or changed. So...please be careful to whom you listen!!!! If you need to know who is legitimate, please ask me and I will look into it.
Monday, September 13, 2010
Understanding ADHD as a Developmental Disorder
As you have read from the study that was completed by Shaw et al., ADHD is now considered a developmental disorder. What does that mean? It means that children with ADHD behave in a manner that reflects a child who is really approximately three years younger than his actual age. Therefore, a child who is 12 years old child with ADHD actually behaves as if he is nine years old. According to the researchers, children with ADHD will eventually “catch up” and behave in an age-appropriate manner. (However, children with ADHD STILL need to behave appropriately, which I have been working on with the children to whom I teach social skills in my practice.)
You can certainly understand a teacher’s frustration when a 12 year old child with ADHD is interacting with his peers in a much less mature way than she would expect from a 12 year old, so that she constantly has to intervene. However, I believe that if the teacher has a new mindset and understands that children with ADHD may behave as a younger child, she might be able to manage the child’s behavior in a more positive way, offering the child praise when he does behave in a mature manner.
Our kids are so used to hearing “Don’t touch that,” “Don’t say that,” “Oh no, he did that again,” that their self-esteem becomes chipped away very quickly. Let’s try to be more positive. There has to be one positive comment that a parent and/or a teacher can make to a child with ADHD each day to bolster their self-confidence. Let’s give it a try….
You can certainly understand a teacher’s frustration when a 12 year old child with ADHD is interacting with his peers in a much less mature way than she would expect from a 12 year old, so that she constantly has to intervene. However, I believe that if the teacher has a new mindset and understands that children with ADHD may behave as a younger child, she might be able to manage the child’s behavior in a more positive way, offering the child praise when he does behave in a mature manner.
Our kids are so used to hearing “Don’t touch that,” “Don’t say that,” “Oh no, he did that again,” that their self-esteem becomes chipped away very quickly. Let’s try to be more positive. There has to be one positive comment that a parent and/or a teacher can make to a child with ADHD each day to bolster their self-confidence. Let’s give it a try….
ADHD is a Developmental Disorder
Please read this longitudinal study completed by Shaw et al. in 2007 at the National Institute of Health who proved definitively that ADHD is a developmental disorder. I will comment on this article in my next post.
Attention-deficit/hyperactivity disorder is
characterized by a delay in cortical maturation
P. Shaw†‡, K. Eckstrand†, W. Sharp†, J. Blumenthal†, J. P. Lerch§, D. Greenstein†, L. Clasen†, A. Evans§,
J. Giedd†, and J. L. Rapoport†
†Child Psychiatry Branch, National Institute of Mental Health, Room 3N202, Building 10, Center Drive, Bethesda, MD 20892; and §Montreal Neurological
Institute, McGill University, Montreal, QC, Canada H3A 2T5
Edited by Leslie G. Ungerleider, National Institutes of Health, Bethesda, MD, and approved October 5, 2007 (received for review August 17, 2007)
There is controversy over the nature of the disturbance in brain
development that underpins attention-deficit/hyperactivity disorder
(ADHD). In particular, it is unclear whether the disorder results
from a delay in brain maturation or whether it represents a
complete deviation from the template of typical development.
Using computational neuroanatomic techniques, we estimated
cortical thickness at >40,000 cerebral points from 824 magnetic
resonance scans acquired prospectively on 223 children with ADHD
and 223 typically developing controls. With this sample size, we
could define the growth trajectory of each cortical point, delineating
a phase of childhood increase followed by adolescent decrease
in cortical thickness (a quadratic growth model). From these trajectories,
the age of attaining peak cortical thickness was derived
and used as an index of cortical maturation. We found maturation
to progress in a similar manner regionally in both children with and
without ADHD, with primary sensory areas attaining peak cortical
thickness before polymodal, high-order association areas. However,
there was a marked delay in ADHD in attaining peak thickness
throughout most of the cerebrum: the median age by which 50%
of the cortical points attained peak thickness for this group was
10.5 years (SE 0.01), which was significantly later than the median
age of 7.5 years (SE 0.02) for typically developing controls (log rank
test (1)2 5,609, P < 1.0 10 20). The delay was most prominent
in prefrontal regions important for control of cognitive processes
including attention and motor planning. Neuroanatomic documentation
of a delay in regional cortical maturation in ADHD has not
been previously reported.
cortical development structural neuroimaging
Attention-deficit/hyperactivity disorder (ADHD) is the most
common neurodevelopment disorder of childhood affecting
between 3% and 5% of school-aged children (1). Since its
earliest descriptions, there has been debate as to whether the
disorder is a consequence partly of delay in brain maturation or
as a complete deviation from the template of typical development
(2). Several studies find that brain activity at rest and in
response to cognitive probes is similar between children with
ADHD and their slightly younger but typically developing peers,
evidence congruent with a maturational lag in cortical development
(3–5). However, others report a quantitatively distinct
neurophysiology, with a unique architecture of the electroencephalogram
and some highly anomalous findings in functional
imaging studies, more in keeping with ADHD as a deviation
from typical development (6–10).
In a previous longitudinal study, we found parallel trajectories
of gray lobar volume change in children with ADHD and
typically developing controls, but more focal changes in cortical
maturation occurring at a sublobar level would not be detected
by this lobar measure (11). We thus aimed to define the
trajectory of cortical development using a measure of cortical
thickness that affords exquisite spatial resolution. Cortical thickness
was chosen as a metric that both captures the columnar
architecture of the cortex and is sensitive to developmental
change in typically developing and clinical populations (12–15).
Most of the 446 children in the current study had repeated
neuroanatomic imaging—112 (25%) had two scans, 88 (20%)
had three scans, and 30 (7%) had four or more scans, performed
at a mean interval between scans of 2.8 years. Such longitudinal
data can be combined with cross-sectional data by using mixedmodel
regression to model developmental change, with the
longitudinal data being particularly informative. For cortical
thickness data, the simplest trajectory that can be fitted to
describe its change over time is a straight line. More complex
growth models include distinct phases of increase and decrease
in cortical thickness: A quadratic model has two such phases
(typically an initial increase that reaches a peak before declining)
and a cubic model has three. Derived properties of these
developmental curves are frequently used as developmental
indices, such as the age at which points of inflection in the curve
are attained (16, 17). When considering cortical change, the age
at which peak cortical thickness is reached—the point where
increase gives way to decrease in cortical thickness—emerges as
a particularly useful index. Note that the ability to detect a
quadratic or cubic growth model is a prerequisite for defining the
age of peak cortical thickness; it cannot be determined from a
linear model.
We thus compared the age of attaining peak cortical thickness in
children with and without ADHD to determine whether the
disorder is characterized by a delay in cerebral cortical maturation.
Results
The temporal sequence of cortical maturation, reflected by the
age of reaching peak cortical thickness at cortical points where
a quadratic model was appropriate, was similar in both groups
[see supporting information (SI) Movies 1 and 2 and Fig. 1]. In
the frontal cortex, the superior, precentral, and polar regions
reached an early peak in cortical thickness, followed by a
centripetal wave moving toward the middle prefrontal cortex. In
the temporal cortex, posterior portions of the middle and
superior temporal cortex matured before more anterior temporal
regions. In the occipital cortex, for both the typically developing
and ADHD subjects, there were early peaks with little
developmental change in the age period covered. Direct comparison
of cortical change in the parietal regions was complicated
because the groups differed in the regions where a
quadratic model was appropriate.
However, although the overall pattern of development was
similar, there were pronounced diagnostic differences in timing.
Where a peak age could be determined, the ADHD group
Author contributions: P.S. and J.L.R. designed research; P.S., W.S., J.B., L.C., J.G., and J.L.R.
performed research; K.E., J.B., J.P..L., and A.E. contributed new reagents/analytic tools; P.S.,
K.E., and D.G. analyzed data; and P.S. and J.L.R. wrote the paper.
The authors declare no conflict of interest.
This article is a PNAS Direct Submission.
‡To whom correspondence should be addressed. E-mail: shawp@mail.nih.gov.
This article contains supporting information online at www.pnas.org/cgi/content/full/
0707741104/DC1.
© 2007 by The National Academy of Sciences of the USA
www.pnas.org cgi doi 10.1073 pnas.0707741104 PNAS December 4, 2007 vol. 104 no. 49 19649–19654
PSYCHOLOGY
generally reached this milestone later than the typically developing
controls; see Fig. 2. Kaplan–Meier curves showed that the
median age by which 50% of the cortical points had attained
peak thickness for the ADHD group was 10.5 years (SE 0.01),
which was significantly later than the median age of 7.5 years (SE
0.02) for the typically developing controls (log-rank test (1)2
5,609, P 1.0 10 20); Fig. 3. Differences were most prominent
in the middle prefrontal cortex, where theADHDgroup reached
their peak thickness 5 years after the typically developing
controls, and to a lesser extent in the superior prefrontal and
medial prefrontal cortex (with the ADHD group peaking 2
years later). Kaplan–Meier curves for the prefrontal region
demonstrated that, although both groups had a similar rates of
attaining cortical thickness, this was delayed in theADHDgroup
with a median age of 10.4 years (SE 0.02), compared with
typically developing control median age of 7.5 years (SE 0.02)
(log-rank test (1)2 9,599, P 1.0 10 20). Posteriorly, delay
was present bilaterally in the middle and superior temporal
cortex, extending to the middle occipital gryi, with the ADHD
group having a peak age of 10.6 years (SE 0.04) and the
typically developing controls peaking at 6.8 years (SE 0.08)
log-rank test (1)2 303, P 1.0 10 20).
The ADHD group had an earlier peak thickness predominately
in the primary motor cortex, with a median age by which
50% of points within this region peaked at 7 years (SE 0.16)
compared with 7.4 years (SE 0.12) for the typically developing
controls (log-rank test (1)2 10, P 0.001); Fig. 4.
The pattern of results held when the degree of motion artifact
was entered into the regression equation (see SI Figs. 5 and 6).
Discussion
Cortical development in children with ADHD lagged behind
that of typically developing children by several years. However,
the ordered sequence of regional development, with primary
sensory and motor areas attaining their peak cortical thickness
before high-order association areas, was similar in both groups,
suggesting that ADHD is characterized by delay rather than
deviance in cortical maturation. This contrasts with other neurodevelopmental
disorders such as autism in which there appears
to be a dramatic shift of brain growth curves to the right along
the age axis, resulting in peak brain volumes being reached at a
7 8 9 10 11 12
ADHD
Typically developing controls
7 8 9 10
ADHD
Typically developing controls
11 12 13
A
B
Fig. 1. The age of attaining peak cortical thickness in children with ADHD compared with typically developing children. (A) dorsal view of the cortical regions
where peak thickness was attained at each age (shown, ages 7–12) in ADHD (Upper) and typically developing controls (Lower). The darker colors indicate regions
where a quadratic model was not appropriate (and thus a peak age could not be calculated), or the peak age was estimated to lie outside the age range covered.
Both groups showed a similar sequence of the regions that attained peak thickness, but the ADHD group showed considerable delay in reaching this
developmental marker. (B) Right lateral view of the cortical regions where peak thickness was attained at each age (shown, ages 7–13) in ADHD (Upper) and
typically developing controls (Lower). Again, the delay in ADHD group in attaining peak cortical thickness is apparent.
Greater than 2 yearsʼ delay
0 to 2 years delay
Fig. 2. Regions where the ADHD group had delayed cortical maturation, as
indicated by an older age of attaining peak cortical thickness.
19650 www.pnas.org cgi doi 10.1073 pnas.0707741104 Shaw et al.
much earlier age—the opposite of the pattern we note in ADHD
(18, 19).
The cortical maturation delay in ADHD was most prominent
in the lateral prefrontal cortex, the region with the most
consistent reports of structural anomalies in the disorder (11,
20), particularly within the superior and dorsolateral prefrontal
regions (21–23). The prefrontal cortex supports a host of cognitive
functions, such as the ability to suppress inappropriate
responses and thoughts (24, 25), the executive ‘‘control’’ of
attention (26), evaluation of reward contingencies (27, 28),
higher-order motor control (5), and working memory (29).
Deficits in these cognitive functions have all been implicated in
the pathogenesis of ADHD (30), and prefrontal cortical hypoactivation
in children with ADHD during performance of many
of these tasks is a relatively consistent finding (10).
Delay was also found in the temporal cortex, most prominently
in the posterior portions of the middle/superior temporal gyrus
bilaterally, relatively circumscribed on the left, and with more
posterior extension on the right. Structural change in the temporal
lobes is a common finding in studies of ADHD, from the
level of the entire lobe (11) through more focal gray matter
density and cortical thickness anomalies (31, 32) and may have
metabolic (9, 33), functional (10, 34–36), and electrophysiological
correlates (37, 38). A unifying feature of the frontal and
temporal regions with greatest maturational delay is the involvement
of heteromodal cortex (39). These are interconnected
cortical regions that integrate information from lower-order
sensory areas giving higher-order percepts that guide the control
of attention and action. Structural anomalies of this system have
been implicated in the pathogenesis of ADHD (31).
By contrast, the primary motor cortex was the only cortical
area in which the ADHD group showed slightly earlier maturation.
It is possible that the combination of early maturation of
the primary motor cortex with late maturation of higher-order
motor control regions may reflect or even drive the excessive and
poorly controlled motor activity cardinal to the syndrome.
Reaching peak cortical thickness at a younger age also means
the typically developing children enter earlier the phase of
cortical thinning that dominates adolescence (40, 41). Because of
the limited age range, we were not able to define the age at which
the adolescent phase of cortical thinning levels off, transitioning
into stable adult cortical dimensions. We predict that the age of
reaching this essentially static adult phase would also be later in
the subjects with ADHD.
To our knowledge, neuroanatomic evidence supportive of the
theory of delay in cortical maturation in ADHD has not been
previously reported. The use of a cortical measure that affords
exquisite spatiotemporal resolution allows us to demonstrate
considerable variability in timing of cortical maturation within
each lobe not detectable by our earlier lobar volumetric analyses
(11). Additionally, we are able to localize the greatest maturational
delay to prefrontal cortical regions implicated in the
pathogenesis of ADHD.
In other work on a subsample of subjects with clinical outcome
data from this cohort, we were only able to detect linear patterns
of change in cortical thickness (and thus could not define the age
of peak cortical thickness) and found generally parallel trajectories
with the exception of a region in the right parietal cortex
(12). By including additional subjects, we are able to detect
higher-order effects of age and thus map out diagnostic regional
differences in the age of attaining peak cortical thickness (12).
Because we lacked clinical outcome data on the majority of the
ADHD subjects in the current study, we were unable to examine
the possibility that good or poor clinical outcome is linked to
differences in the timing of key developmental markers, such as
the age of peak cortical thickness.
Returning to the central finding, the generally older age of
attaining peak cortical thickness in ADHD presumably represents
a temporal shift in the balance between the cellular
Fig. 3. Kaplan–Meier curves illustrating the proportion of cortical points that had attained peak thickness at each age for all cerebral cortical points (Left) and the
prefrontal cortex (Right). The median age by which 50% of cortical points had attained their peak differed significantly between the groups (all P 1.0 10 20)
Fig. 4. Regions where the ADHD group had early cortical maturation, as
indicated by a younger age of attaining peak cortical thickness.
Shaw et al. PNAS December 4, 2007 vol. 104 no. 49 19651
PSYCHOLOGY
processes that result in an initial increase and later decrease in
cortical thickness. The exact nature of these processes in typically
developing children is yet to be determined. Extrapolating from
animal studies, the increase in cortical thickness may be driven
by mechanisms such as dendritic spine growth and elaboration
of supporting glia and vasculature (42, 43). Cortical thinning in
adolescence may reflect intracortical myelination and the usedependent
selective elimination of synapses that may help create
and sculpt neural circuits, including those supporting cognitive
abilities (44–46). Turning to ADHD, animal models are mostly
based on perturbations in monoaminergic neurotransmission
arising in response to either early insults (e.g., induced transient
hyperthyroidism, or neonatal 6-OHDA lesions) or anomalies of
neurotransmitters (such as the 160-bp insertion in exon 3 of the
dopamine transport gene in the spontaneously hypertensive rat)
(47, 48). How such changes might influence the dynamics of
cortical development remains unclear but would be an important
area for future research.
What etiological factors might underpin this delay? Trophic
effects of treatment with psychostimulants in the ADHD group
are possible but unlikely, given our previous reports of no effect
of psychostimulants on gray matter volume (11). Because our
studies have been observational, however, any conclusions about
stimulants are tentative. Our overall results cannot be attributed
to group differences in intelligence and gender, which, although
they effect cortical development (14, 41, 49, 50), were strictly
controlled in our design. Genetic factors will certainly play a role,
with a perturbation in the developmental sequence of the
activation and deactivation of genes that sculpt cortical architecture.
In this context, neurotrophins, essential for the proliferation,
differentiation, and survival of neuronal and nonneuronal
cells, emerge as promising candidates, and, indeed,
polymorphisms within the brain-derived neurotrophic factor and
nerve growth-factor 3 genes have already been tentatively linked
with ADHD (51, 52).
Trajectories of brain development built on longitudinal and
cross-sectional neuroanatomic data sets are providing rich insights
into ADHD. Not only do they informkey debates that have
existed since the earliest descriptions of the disorder (2), but they
may also guide the future search for factors that delay, rather
than derail, cortical development.
Methods
Subjects. The clinical group comprised 223 children and adolescents
with Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV)-defined ADHD. Diagnosis was
based on the Parent Diagnostic Interview for Children and
Adolescents (53), Conner’s Teacher Rating Scales (54), and the
Teacher Report Form; see Table 1. Exclusion criteria were IQ
under 80 and evidence of medical or neurological disorders. Two
hundred five (92%) had combined-type ADHD at baseline, 13
(6%) had inattentive subtype, and 5 (2%) had hyperactive/
impulsive subtype. One hundred fifty-four unrelated singletons
and 25 sets of affected singleton siblings (with 53 individuals)
and 16 twin-births (only one child per twin-pair) were included.
Typically developing controls were recruited, and each subject
completed the Childhood Behavior Checklist as a screening tool
and then underwent a structured diagnostic interview by a child
psychiatrist to rule out any psychiatric or neurological diagnoses
(55). The typically developing participants in this study were
matched to the ADHD group on gender, age, and intelligence as
measured by age-appropriate version of the Wechsler Intelligence
Scales. There were 169 singletons, 17 sets of unaffected
siblings (with 38 individuals), and 16 twin births (one child per
twin pair). The institutional review board of the National
Institutes of Health approved the research protocol, and written
informed consent and assent to participate in the study were
obtained from parents and children, respectively.
The total number of subjects scanned at each age is given in
Table 2, which also shows the numbers of subjects undergoing
repeated scanning and the mean age at each wave of scan
acquisition. The mean interscan interval was 2.9 years (SD 1.5)
for the ADHD group and 2.8 years (SD 1.4) for the typically
developing controls [t (317) 1.3, P 0.2].
Neuroimaging. All children had neuroanatomic magnetic resonance
imaging on the same 1.5-T General Electric Signa scanner throughout
the study. Imaging parameters were echo time of 5 ms,
repetition time of 24 ms, flip angle of 45°, acquisition matrix of
256 192, number of excitations equaling 1, and 24-cm field of
view. Head placement was standardized as described (56). The
same 1.5-T General Electric Signa scanner was used throughout the
study. The native MRI scans were registered into standardized
stereotaxic space by using a linear transformation and corrected for
Table 1. Demographic and clinical details of the subjects
Characteristic
ADHD, N
223
Controls, N
223
Age at initial scan, yr, mean (SD)* 10.2 (3.2) 10.6 (3.5)
Gender
Male:female 141:82 141:82
Estimated IQ,† mean (SD) 109 (15) 111 (13)
Comorbid diagnoses
Oppositional defiant disorder, no. (%) 77 (35) NA
Conduct disorder, no. (%) 15 (7) NA
Learning disorder, no. (%) 19 (9) NA
Mood disorder, no. (%) 8 (4) NA
Anxiety disorder, no. (%) 13 (6) NA
Tic (NOS), no. (%) 14 (6) NA
Clinical details
Clinical Global Assessment Scale, mean (SD) 48 (7) NA
CBCL Attention Problems T score, mean (SD) 71 (8) NA
TRF Attention Problems T score, mean (SD) 66 (10) NA
Prior stimulant treatment, no. (%) 108 (66) NA
NA, not applicable; NOS, not otherwise specified; CBCL, Child Behavior Checklist; TRF, Teacher Report Form.
*P (ADHD vs controls), t (444) 1.4, P 0.16.
†P (ADHD vs controls), t (426) 1.5, P 0.14
19652 www.pnas.org cgi doi 10.1073 pnas.0707741104 Shaw et al.
nonuniformity artifacts (57). The registered and corrected volumes
were segmented into white matter, gray matter, cerebrospinal fluid,
and background by using an advanced neural net classifier (58). The
inner and outer cortical surfaces were then extracted by using
deformable models and nonlinearly aligned toward a standard
template surface (59). Cortical thickness was then measured in
native space millimeters by using the linked distance between the
pial white and gray matter surfaces at 40,960 vertices throughout the
cerebral cortex. In estimating cortical thickness, we chose a 30-
mm-bandwidth blurring kernel on the basis of a population simulation
study, which showed that this bandwidth maximized statistical
power while minimizing false positives (60). This kernel
preserves the capacity for anatomical localization because 30-mm
blurring along the surface by using a diffusion smoothing operator
preserves cortical topological features and represents considerably
less cortex than the equivalent volumetric Gaussian blurring kernel
(60). All scans were rated for degree of motion artifact (none, mild,
moderate, or severe), as detailed in SI Text and ref. 61. Scans with
moderate or severe motion artifact were excluded from further
analyses; scans with mild motion artifact were included.
Statistical Analyses. First, we determined developmental trajectories,
using mixed model regression analysis that allows the
inclusion of multiple measurements per person, missing data,
and irregular intervals between measurements, thereby increasing
statistical power (62). A random effect for each individual
was nested within a random effect for each family, thus accounting
for both within-person and within-family dependence. Our
classification of developmental trajectories was based on a
step-down model selection procedure: At each cortical point, we
modeled cortical thickness by using a mixed-effects polynomial
regression model, testing for cubic, quadratic, and linear age
effects. If the cubic age effect was not significant at P 0.05, it
was removed, and we stepped down to the quadratic model and
so on. In this way, we were able to classify the development of
each cortical point as being best explained by a cubic, quadratic,
or linear function of age. A quadratic model proved appropriate
for much of the cortex, in which kth cortical thickness of the ith
individual in the jth family was modeled as Thicknessijk
intercept dij 1(age mean age) 2*(age mean
age)**2) eijk, where dij are nested random effects modeling
within-person and within family dependence, the intercept and
terms are fixed effects, and eijk represents the residual error.
Specifically, for both the ADHD and typically developing controls,
a quadratic model was appropriate throughout most of the
lateral prefrontal and medial prefrontal cortex, the superior and
middle temporal cortex, superior and middle occipital cortex,
and angular and supramarginal gyri. The ADHD group showed
a linear fit in the superior parietal lobules and postcentral gyri,
unlike the typically developing controls, for whom a quadratic
model held. The analyses were repeated, entering the degree of
motion artifact into the regression equation.
Next, the age of reaching peak cortical thickness for each
group was calculated in these regions from the first-order
derivatives of the fitted curves and illustrated through dynamic
time-lapse sequences (‘‘movies’’). Kaplan–Meier curves were
constructed showing the proportion of cortical points that had
reached peak cortical thickness throughout the age range covered.
The significance of the group difference in the median age
by which half of the cortical points had attained their peak
thickness was calculated by using the log-rank (Mantel–Cox) test.
Brain maps show the regions where the ADHD group attained
peak thickness at either an earlier or later age.
We thank F. X. Castellanos for initiating the study and for advice and
support and the children and their families who participated in the study.
This work was supported by the Intramural Research Program of the
National Institutes of Health. The sponsor of the study had no role in
study design, data interpretation, or writing of the report.
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19654 www.pnas.org cgi doi 10.1073 pnas.0707741104 Shaw et al.
Attention-deficit/hyperactivity disorder is
characterized by a delay in cortical maturation
P. Shaw†‡, K. Eckstrand†, W. Sharp†, J. Blumenthal†, J. P. Lerch§, D. Greenstein†, L. Clasen†, A. Evans§,
J. Giedd†, and J. L. Rapoport†
†Child Psychiatry Branch, National Institute of Mental Health, Room 3N202, Building 10, Center Drive, Bethesda, MD 20892; and §Montreal Neurological
Institute, McGill University, Montreal, QC, Canada H3A 2T5
Edited by Leslie G. Ungerleider, National Institutes of Health, Bethesda, MD, and approved October 5, 2007 (received for review August 17, 2007)
There is controversy over the nature of the disturbance in brain
development that underpins attention-deficit/hyperactivity disorder
(ADHD). In particular, it is unclear whether the disorder results
from a delay in brain maturation or whether it represents a
complete deviation from the template of typical development.
Using computational neuroanatomic techniques, we estimated
cortical thickness at >40,000 cerebral points from 824 magnetic
resonance scans acquired prospectively on 223 children with ADHD
and 223 typically developing controls. With this sample size, we
could define the growth trajectory of each cortical point, delineating
a phase of childhood increase followed by adolescent decrease
in cortical thickness (a quadratic growth model). From these trajectories,
the age of attaining peak cortical thickness was derived
and used as an index of cortical maturation. We found maturation
to progress in a similar manner regionally in both children with and
without ADHD, with primary sensory areas attaining peak cortical
thickness before polymodal, high-order association areas. However,
there was a marked delay in ADHD in attaining peak thickness
throughout most of the cerebrum: the median age by which 50%
of the cortical points attained peak thickness for this group was
10.5 years (SE 0.01), which was significantly later than the median
age of 7.5 years (SE 0.02) for typically developing controls (log rank
test (1)2 5,609, P < 1.0 10 20). The delay was most prominent
in prefrontal regions important for control of cognitive processes
including attention and motor planning. Neuroanatomic documentation
of a delay in regional cortical maturation in ADHD has not
been previously reported.
cortical development structural neuroimaging
Attention-deficit/hyperactivity disorder (ADHD) is the most
common neurodevelopment disorder of childhood affecting
between 3% and 5% of school-aged children (1). Since its
earliest descriptions, there has been debate as to whether the
disorder is a consequence partly of delay in brain maturation or
as a complete deviation from the template of typical development
(2). Several studies find that brain activity at rest and in
response to cognitive probes is similar between children with
ADHD and their slightly younger but typically developing peers,
evidence congruent with a maturational lag in cortical development
(3–5). However, others report a quantitatively distinct
neurophysiology, with a unique architecture of the electroencephalogram
and some highly anomalous findings in functional
imaging studies, more in keeping with ADHD as a deviation
from typical development (6–10).
In a previous longitudinal study, we found parallel trajectories
of gray lobar volume change in children with ADHD and
typically developing controls, but more focal changes in cortical
maturation occurring at a sublobar level would not be detected
by this lobar measure (11). We thus aimed to define the
trajectory of cortical development using a measure of cortical
thickness that affords exquisite spatial resolution. Cortical thickness
was chosen as a metric that both captures the columnar
architecture of the cortex and is sensitive to developmental
change in typically developing and clinical populations (12–15).
Most of the 446 children in the current study had repeated
neuroanatomic imaging—112 (25%) had two scans, 88 (20%)
had three scans, and 30 (7%) had four or more scans, performed
at a mean interval between scans of 2.8 years. Such longitudinal
data can be combined with cross-sectional data by using mixedmodel
regression to model developmental change, with the
longitudinal data being particularly informative. For cortical
thickness data, the simplest trajectory that can be fitted to
describe its change over time is a straight line. More complex
growth models include distinct phases of increase and decrease
in cortical thickness: A quadratic model has two such phases
(typically an initial increase that reaches a peak before declining)
and a cubic model has three. Derived properties of these
developmental curves are frequently used as developmental
indices, such as the age at which points of inflection in the curve
are attained (16, 17). When considering cortical change, the age
at which peak cortical thickness is reached—the point where
increase gives way to decrease in cortical thickness—emerges as
a particularly useful index. Note that the ability to detect a
quadratic or cubic growth model is a prerequisite for defining the
age of peak cortical thickness; it cannot be determined from a
linear model.
We thus compared the age of attaining peak cortical thickness in
children with and without ADHD to determine whether the
disorder is characterized by a delay in cerebral cortical maturation.
Results
The temporal sequence of cortical maturation, reflected by the
age of reaching peak cortical thickness at cortical points where
a quadratic model was appropriate, was similar in both groups
[see supporting information (SI) Movies 1 and 2 and Fig. 1]. In
the frontal cortex, the superior, precentral, and polar regions
reached an early peak in cortical thickness, followed by a
centripetal wave moving toward the middle prefrontal cortex. In
the temporal cortex, posterior portions of the middle and
superior temporal cortex matured before more anterior temporal
regions. In the occipital cortex, for both the typically developing
and ADHD subjects, there were early peaks with little
developmental change in the age period covered. Direct comparison
of cortical change in the parietal regions was complicated
because the groups differed in the regions where a
quadratic model was appropriate.
However, although the overall pattern of development was
similar, there were pronounced diagnostic differences in timing.
Where a peak age could be determined, the ADHD group
Author contributions: P.S. and J.L.R. designed research; P.S., W.S., J.B., L.C., J.G., and J.L.R.
performed research; K.E., J.B., J.P..L., and A.E. contributed new reagents/analytic tools; P.S.,
K.E., and D.G. analyzed data; and P.S. and J.L.R. wrote the paper.
The authors declare no conflict of interest.
This article is a PNAS Direct Submission.
‡To whom correspondence should be addressed. E-mail: shawp@mail.nih.gov.
This article contains supporting information online at www.pnas.org/cgi/content/full/
0707741104/DC1.
© 2007 by The National Academy of Sciences of the USA
www.pnas.org cgi doi 10.1073 pnas.0707741104 PNAS December 4, 2007 vol. 104 no. 49 19649–19654
PSYCHOLOGY
generally reached this milestone later than the typically developing
controls; see Fig. 2. Kaplan–Meier curves showed that the
median age by which 50% of the cortical points had attained
peak thickness for the ADHD group was 10.5 years (SE 0.01),
which was significantly later than the median age of 7.5 years (SE
0.02) for the typically developing controls (log-rank test (1)2
5,609, P 1.0 10 20); Fig. 3. Differences were most prominent
in the middle prefrontal cortex, where theADHDgroup reached
their peak thickness 5 years after the typically developing
controls, and to a lesser extent in the superior prefrontal and
medial prefrontal cortex (with the ADHD group peaking 2
years later). Kaplan–Meier curves for the prefrontal region
demonstrated that, although both groups had a similar rates of
attaining cortical thickness, this was delayed in theADHDgroup
with a median age of 10.4 years (SE 0.02), compared with
typically developing control median age of 7.5 years (SE 0.02)
(log-rank test (1)2 9,599, P 1.0 10 20). Posteriorly, delay
was present bilaterally in the middle and superior temporal
cortex, extending to the middle occipital gryi, with the ADHD
group having a peak age of 10.6 years (SE 0.04) and the
typically developing controls peaking at 6.8 years (SE 0.08)
log-rank test (1)2 303, P 1.0 10 20).
The ADHD group had an earlier peak thickness predominately
in the primary motor cortex, with a median age by which
50% of points within this region peaked at 7 years (SE 0.16)
compared with 7.4 years (SE 0.12) for the typically developing
controls (log-rank test (1)2 10, P 0.001); Fig. 4.
The pattern of results held when the degree of motion artifact
was entered into the regression equation (see SI Figs. 5 and 6).
Discussion
Cortical development in children with ADHD lagged behind
that of typically developing children by several years. However,
the ordered sequence of regional development, with primary
sensory and motor areas attaining their peak cortical thickness
before high-order association areas, was similar in both groups,
suggesting that ADHD is characterized by delay rather than
deviance in cortical maturation. This contrasts with other neurodevelopmental
disorders such as autism in which there appears
to be a dramatic shift of brain growth curves to the right along
the age axis, resulting in peak brain volumes being reached at a
7 8 9 10 11 12
ADHD
Typically developing controls
7 8 9 10
ADHD
Typically developing controls
11 12 13
A
B
Fig. 1. The age of attaining peak cortical thickness in children with ADHD compared with typically developing children. (A) dorsal view of the cortical regions
where peak thickness was attained at each age (shown, ages 7–12) in ADHD (Upper) and typically developing controls (Lower). The darker colors indicate regions
where a quadratic model was not appropriate (and thus a peak age could not be calculated), or the peak age was estimated to lie outside the age range covered.
Both groups showed a similar sequence of the regions that attained peak thickness, but the ADHD group showed considerable delay in reaching this
developmental marker. (B) Right lateral view of the cortical regions where peak thickness was attained at each age (shown, ages 7–13) in ADHD (Upper) and
typically developing controls (Lower). Again, the delay in ADHD group in attaining peak cortical thickness is apparent.
Greater than 2 yearsʼ delay
0 to 2 years delay
Fig. 2. Regions where the ADHD group had delayed cortical maturation, as
indicated by an older age of attaining peak cortical thickness.
19650 www.pnas.org cgi doi 10.1073 pnas.0707741104 Shaw et al.
much earlier age—the opposite of the pattern we note in ADHD
(18, 19).
The cortical maturation delay in ADHD was most prominent
in the lateral prefrontal cortex, the region with the most
consistent reports of structural anomalies in the disorder (11,
20), particularly within the superior and dorsolateral prefrontal
regions (21–23). The prefrontal cortex supports a host of cognitive
functions, such as the ability to suppress inappropriate
responses and thoughts (24, 25), the executive ‘‘control’’ of
attention (26), evaluation of reward contingencies (27, 28),
higher-order motor control (5), and working memory (29).
Deficits in these cognitive functions have all been implicated in
the pathogenesis of ADHD (30), and prefrontal cortical hypoactivation
in children with ADHD during performance of many
of these tasks is a relatively consistent finding (10).
Delay was also found in the temporal cortex, most prominently
in the posterior portions of the middle/superior temporal gyrus
bilaterally, relatively circumscribed on the left, and with more
posterior extension on the right. Structural change in the temporal
lobes is a common finding in studies of ADHD, from the
level of the entire lobe (11) through more focal gray matter
density and cortical thickness anomalies (31, 32) and may have
metabolic (9, 33), functional (10, 34–36), and electrophysiological
correlates (37, 38). A unifying feature of the frontal and
temporal regions with greatest maturational delay is the involvement
of heteromodal cortex (39). These are interconnected
cortical regions that integrate information from lower-order
sensory areas giving higher-order percepts that guide the control
of attention and action. Structural anomalies of this system have
been implicated in the pathogenesis of ADHD (31).
By contrast, the primary motor cortex was the only cortical
area in which the ADHD group showed slightly earlier maturation.
It is possible that the combination of early maturation of
the primary motor cortex with late maturation of higher-order
motor control regions may reflect or even drive the excessive and
poorly controlled motor activity cardinal to the syndrome.
Reaching peak cortical thickness at a younger age also means
the typically developing children enter earlier the phase of
cortical thinning that dominates adolescence (40, 41). Because of
the limited age range, we were not able to define the age at which
the adolescent phase of cortical thinning levels off, transitioning
into stable adult cortical dimensions. We predict that the age of
reaching this essentially static adult phase would also be later in
the subjects with ADHD.
To our knowledge, neuroanatomic evidence supportive of the
theory of delay in cortical maturation in ADHD has not been
previously reported. The use of a cortical measure that affords
exquisite spatiotemporal resolution allows us to demonstrate
considerable variability in timing of cortical maturation within
each lobe not detectable by our earlier lobar volumetric analyses
(11). Additionally, we are able to localize the greatest maturational
delay to prefrontal cortical regions implicated in the
pathogenesis of ADHD.
In other work on a subsample of subjects with clinical outcome
data from this cohort, we were only able to detect linear patterns
of change in cortical thickness (and thus could not define the age
of peak cortical thickness) and found generally parallel trajectories
with the exception of a region in the right parietal cortex
(12). By including additional subjects, we are able to detect
higher-order effects of age and thus map out diagnostic regional
differences in the age of attaining peak cortical thickness (12).
Because we lacked clinical outcome data on the majority of the
ADHD subjects in the current study, we were unable to examine
the possibility that good or poor clinical outcome is linked to
differences in the timing of key developmental markers, such as
the age of peak cortical thickness.
Returning to the central finding, the generally older age of
attaining peak cortical thickness in ADHD presumably represents
a temporal shift in the balance between the cellular
Fig. 3. Kaplan–Meier curves illustrating the proportion of cortical points that had attained peak thickness at each age for all cerebral cortical points (Left) and the
prefrontal cortex (Right). The median age by which 50% of cortical points had attained their peak differed significantly between the groups (all P 1.0 10 20)
Fig. 4. Regions where the ADHD group had early cortical maturation, as
indicated by a younger age of attaining peak cortical thickness.
Shaw et al. PNAS December 4, 2007 vol. 104 no. 49 19651
PSYCHOLOGY
processes that result in an initial increase and later decrease in
cortical thickness. The exact nature of these processes in typically
developing children is yet to be determined. Extrapolating from
animal studies, the increase in cortical thickness may be driven
by mechanisms such as dendritic spine growth and elaboration
of supporting glia and vasculature (42, 43). Cortical thinning in
adolescence may reflect intracortical myelination and the usedependent
selective elimination of synapses that may help create
and sculpt neural circuits, including those supporting cognitive
abilities (44–46). Turning to ADHD, animal models are mostly
based on perturbations in monoaminergic neurotransmission
arising in response to either early insults (e.g., induced transient
hyperthyroidism, or neonatal 6-OHDA lesions) or anomalies of
neurotransmitters (such as the 160-bp insertion in exon 3 of the
dopamine transport gene in the spontaneously hypertensive rat)
(47, 48). How such changes might influence the dynamics of
cortical development remains unclear but would be an important
area for future research.
What etiological factors might underpin this delay? Trophic
effects of treatment with psychostimulants in the ADHD group
are possible but unlikely, given our previous reports of no effect
of psychostimulants on gray matter volume (11). Because our
studies have been observational, however, any conclusions about
stimulants are tentative. Our overall results cannot be attributed
to group differences in intelligence and gender, which, although
they effect cortical development (14, 41, 49, 50), were strictly
controlled in our design. Genetic factors will certainly play a role,
with a perturbation in the developmental sequence of the
activation and deactivation of genes that sculpt cortical architecture.
In this context, neurotrophins, essential for the proliferation,
differentiation, and survival of neuronal and nonneuronal
cells, emerge as promising candidates, and, indeed,
polymorphisms within the brain-derived neurotrophic factor and
nerve growth-factor 3 genes have already been tentatively linked
with ADHD (51, 52).
Trajectories of brain development built on longitudinal and
cross-sectional neuroanatomic data sets are providing rich insights
into ADHD. Not only do they informkey debates that have
existed since the earliest descriptions of the disorder (2), but they
may also guide the future search for factors that delay, rather
than derail, cortical development.
Methods
Subjects. The clinical group comprised 223 children and adolescents
with Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV)-defined ADHD. Diagnosis was
based on the Parent Diagnostic Interview for Children and
Adolescents (53), Conner’s Teacher Rating Scales (54), and the
Teacher Report Form; see Table 1. Exclusion criteria were IQ
under 80 and evidence of medical or neurological disorders. Two
hundred five (92%) had combined-type ADHD at baseline, 13
(6%) had inattentive subtype, and 5 (2%) had hyperactive/
impulsive subtype. One hundred fifty-four unrelated singletons
and 25 sets of affected singleton siblings (with 53 individuals)
and 16 twin-births (only one child per twin-pair) were included.
Typically developing controls were recruited, and each subject
completed the Childhood Behavior Checklist as a screening tool
and then underwent a structured diagnostic interview by a child
psychiatrist to rule out any psychiatric or neurological diagnoses
(55). The typically developing participants in this study were
matched to the ADHD group on gender, age, and intelligence as
measured by age-appropriate version of the Wechsler Intelligence
Scales. There were 169 singletons, 17 sets of unaffected
siblings (with 38 individuals), and 16 twin births (one child per
twin pair). The institutional review board of the National
Institutes of Health approved the research protocol, and written
informed consent and assent to participate in the study were
obtained from parents and children, respectively.
The total number of subjects scanned at each age is given in
Table 2, which also shows the numbers of subjects undergoing
repeated scanning and the mean age at each wave of scan
acquisition. The mean interscan interval was 2.9 years (SD 1.5)
for the ADHD group and 2.8 years (SD 1.4) for the typically
developing controls [t (317) 1.3, P 0.2].
Neuroimaging. All children had neuroanatomic magnetic resonance
imaging on the same 1.5-T General Electric Signa scanner throughout
the study. Imaging parameters were echo time of 5 ms,
repetition time of 24 ms, flip angle of 45°, acquisition matrix of
256 192, number of excitations equaling 1, and 24-cm field of
view. Head placement was standardized as described (56). The
same 1.5-T General Electric Signa scanner was used throughout the
study. The native MRI scans were registered into standardized
stereotaxic space by using a linear transformation and corrected for
Table 1. Demographic and clinical details of the subjects
Characteristic
ADHD, N
223
Controls, N
223
Age at initial scan, yr, mean (SD)* 10.2 (3.2) 10.6 (3.5)
Gender
Male:female 141:82 141:82
Estimated IQ,† mean (SD) 109 (15) 111 (13)
Comorbid diagnoses
Oppositional defiant disorder, no. (%) 77 (35) NA
Conduct disorder, no. (%) 15 (7) NA
Learning disorder, no. (%) 19 (9) NA
Mood disorder, no. (%) 8 (4) NA
Anxiety disorder, no. (%) 13 (6) NA
Tic (NOS), no. (%) 14 (6) NA
Clinical details
Clinical Global Assessment Scale, mean (SD) 48 (7) NA
CBCL Attention Problems T score, mean (SD) 71 (8) NA
TRF Attention Problems T score, mean (SD) 66 (10) NA
Prior stimulant treatment, no. (%) 108 (66) NA
NA, not applicable; NOS, not otherwise specified; CBCL, Child Behavior Checklist; TRF, Teacher Report Form.
*P (ADHD vs controls), t (444) 1.4, P 0.16.
†P (ADHD vs controls), t (426) 1.5, P 0.14
19652 www.pnas.org cgi doi 10.1073 pnas.0707741104 Shaw et al.
nonuniformity artifacts (57). The registered and corrected volumes
were segmented into white matter, gray matter, cerebrospinal fluid,
and background by using an advanced neural net classifier (58). The
inner and outer cortical surfaces were then extracted by using
deformable models and nonlinearly aligned toward a standard
template surface (59). Cortical thickness was then measured in
native space millimeters by using the linked distance between the
pial white and gray matter surfaces at 40,960 vertices throughout the
cerebral cortex. In estimating cortical thickness, we chose a 30-
mm-bandwidth blurring kernel on the basis of a population simulation
study, which showed that this bandwidth maximized statistical
power while minimizing false positives (60). This kernel
preserves the capacity for anatomical localization because 30-mm
blurring along the surface by using a diffusion smoothing operator
preserves cortical topological features and represents considerably
less cortex than the equivalent volumetric Gaussian blurring kernel
(60). All scans were rated for degree of motion artifact (none, mild,
moderate, or severe), as detailed in SI Text and ref. 61. Scans with
moderate or severe motion artifact were excluded from further
analyses; scans with mild motion artifact were included.
Statistical Analyses. First, we determined developmental trajectories,
using mixed model regression analysis that allows the
inclusion of multiple measurements per person, missing data,
and irregular intervals between measurements, thereby increasing
statistical power (62). A random effect for each individual
was nested within a random effect for each family, thus accounting
for both within-person and within-family dependence. Our
classification of developmental trajectories was based on a
step-down model selection procedure: At each cortical point, we
modeled cortical thickness by using a mixed-effects polynomial
regression model, testing for cubic, quadratic, and linear age
effects. If the cubic age effect was not significant at P 0.05, it
was removed, and we stepped down to the quadratic model and
so on. In this way, we were able to classify the development of
each cortical point as being best explained by a cubic, quadratic,
or linear function of age. A quadratic model proved appropriate
for much of the cortex, in which kth cortical thickness of the ith
individual in the jth family was modeled as Thicknessijk
intercept dij 1(age mean age) 2*(age mean
age)**2) eijk, where dij are nested random effects modeling
within-person and within family dependence, the intercept and
terms are fixed effects, and eijk represents the residual error.
Specifically, for both the ADHD and typically developing controls,
a quadratic model was appropriate throughout most of the
lateral prefrontal and medial prefrontal cortex, the superior and
middle temporal cortex, superior and middle occipital cortex,
and angular and supramarginal gyri. The ADHD group showed
a linear fit in the superior parietal lobules and postcentral gyri,
unlike the typically developing controls, for whom a quadratic
model held. The analyses were repeated, entering the degree of
motion artifact into the regression equation.
Next, the age of reaching peak cortical thickness for each
group was calculated in these regions from the first-order
derivatives of the fitted curves and illustrated through dynamic
time-lapse sequences (‘‘movies’’). Kaplan–Meier curves were
constructed showing the proportion of cortical points that had
reached peak cortical thickness throughout the age range covered.
The significance of the group difference in the median age
by which half of the cortical points had attained their peak
thickness was calculated by using the log-rank (Mantel–Cox) test.
Brain maps show the regions where the ADHD group attained
peak thickness at either an earlier or later age.
We thank F. X. Castellanos for initiating the study and for advice and
support and the children and their families who participated in the study.
This work was supported by the Intramural Research Program of the
National Institutes of Health. The sponsor of the study had no role in
study design, data interpretation, or writing of the report.
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Typically
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Number of subjects with scans at each age, yr*
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6 18 24
7 37 28
8 44 24
9 45 31
10 40 39
11 33 38
12 33 38
13 24 33
14 29 30
15 22 30
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17 19 15
18 13 17
19 8 7
20 and over 13 13
No. of subjects at each wave of scan acquisition†
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Time 2 111 119
Time 3 59 59
Time 4 15 15
Mean age at each scan, yr (SD)
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Time 2§ 12.8 (3.6) 13.3 (4.0)
Time 3¶ 15.3 (3.7) 14.8 (3.6)
Time 4 17.9 (3.6) 16.1 (3.3)
*Absolute number of scans obtained at each age for each group.
†Number of subjects in each group who had scans at each wave of acquisition
and the mean age (and SD) of each wave.
‡t (444) 1.4, P 0.16.
§t (228) 1.1, P 0.26.
¶t (116) 0.73, P 0.46.
t (28) 1.46, P 0.15.
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Saturday, September 11, 2010
ADHD Awareness Week
ADHD Awareness week Please become aware! ADHD IS REAL!!http://www.sacbee.com/2010/09/08/3014205/consortium-of-adhd-organizations.html
Friday, September 10, 2010
Creating Stability at Home for Children with ADHD
Schools were closed this week on certain days because of the Jewish High Holy Days. Therefore, children with ADHD might have felt less consistency. Parents need to help their children with ADHD to manage times that are not typically consistent because those times are emblematic of life. Even though in the best of worlds children with ADHD are more focused and less hyperactive when their days are organized and stable, there are many days and weeks that cannot be so.
What can parents do to create a sense of stability at home even though the events of the child’s school day are varied? It is vital to keep the same schedule at home for the child with ADHD, in terms of when they play, complete their homework, have their meals (if possible), bathe as well as go to sleep. Even though you may vary the place where your child completes his homework, make sure that the time that he does it is the same each day. If your child’s schedule is as precise and structured as possible they will feel more organized. If they feel more organized and know when certain events in the day are likely to occur, they will behave more appropriately.
What can parents do to create a sense of stability at home even though the events of the child’s school day are varied? It is vital to keep the same schedule at home for the child with ADHD, in terms of when they play, complete their homework, have their meals (if possible), bathe as well as go to sleep. Even though you may vary the place where your child completes his homework, make sure that the time that he does it is the same each day. If your child’s schedule is as precise and structured as possible they will feel more organized. If they feel more organized and know when certain events in the day are likely to occur, they will behave more appropriately.
Thursday, September 9, 2010
When should your Child do his Homework?
By now, your child has undoubtedly come home with homework. Has the old “homework argument” ensued as of yet?
Parent: “When are you going to do your homework?” “Child: Oh, I don’t know, maybe later.” Parent: “I want you to do it immediately after coming home from school.” “ Child: “I am going to do it after dinner.” Parent: “If you do it after dinner, you will be too tired to do quality work.” “Child: “But I am too tired now to do it.”
It sounds like a seesaw, right? Each child has an optimal time for completing their homework. One child does his best work after he immediately comes off of the bus, while another child does his best work after he takes a walk or after dinner.
First of all, I would help your child learn to become accountable, and therefore, have input in terms of when to do his homework. Remember that we are trying to encourage your child to become independent. If decisions are constantly made for him, it will be exponentially more difficult for him to make his own decisions as he gets older.
I would discuss the various choices of times in which he could complete his homework and the advantages of doing it at a specific time as compared to another time. LISTEN TO HIS OPINION. You want to give him the respect of listening to his opinion just as you expect him to give you the respect of listening to your opinion. A good idea might be to vary the times that he does his homework for a week or so and follow up with a discussion with your child as to which time you both think produces the highest quality work.
How will he manage his time? See my next blog post.
Parent: “When are you going to do your homework?” “Child: Oh, I don’t know, maybe later.” Parent: “I want you to do it immediately after coming home from school.” “ Child: “I am going to do it after dinner.” Parent: “If you do it after dinner, you will be too tired to do quality work.” “Child: “But I am too tired now to do it.”
It sounds like a seesaw, right? Each child has an optimal time for completing their homework. One child does his best work after he immediately comes off of the bus, while another child does his best work after he takes a walk or after dinner.
First of all, I would help your child learn to become accountable, and therefore, have input in terms of when to do his homework. Remember that we are trying to encourage your child to become independent. If decisions are constantly made for him, it will be exponentially more difficult for him to make his own decisions as he gets older.
I would discuss the various choices of times in which he could complete his homework and the advantages of doing it at a specific time as compared to another time. LISTEN TO HIS OPINION. You want to give him the respect of listening to his opinion just as you expect him to give you the respect of listening to your opinion. A good idea might be to vary the times that he does his homework for a week or so and follow up with a discussion with your child as to which time you both think produces the highest quality work.
How will he manage his time? See my next blog post.
Wednesday, September 8, 2010
Organizing the Child's Class Notes: One of the Most Important Keys to Academic Success
Many children with ADHD, especially young boys, have a laborious time writing by hand. Let us talk about the children in grades sixth to eighth who are generally required to take notes in class. Oftentimes, the students are not aware that a pop quiz will depend on those class notes. Many of "our children" begin to take notes and by the time the teacher is at the end of the second sentence, they are still writing the teacher’s words from the middle of the first sentence. Additionally, it is difficult for some children to multi-task and listen to the teacher while at the same time making a decision on which are important things to write down and which are not so.
I am in favor of having the child type the class notes on a computer (and one would hope that your child’s accommodations would allow for this method). Then, the child saves them on a file on the classroom computer (or his own laptop if this is the case in your school), saves the notes on a flash drive and/or emails them to himself. You know how fast these kids can facilitate these procedures. The child then prints the class notes out and brings them home in a folder or prints them out at home.
THIS IS THE KEY: After they arrive home, they IMMEDIATELY print out the class notes for each subject (if they have not already done so) or hole punch the class notes they brought home and place them in a flexible binder, preferably a different color for each academic subject.
The important point about the class notes in these binders is that the child can go over them briefly either the night before class, or optimally, as they are having breakfast, and are immediately reminded of what the specific teacher taught the previous day. If the teacher gives the class a pop quiz, then the children are prepared. They will do better on their quizzes, which will build better self-esteem and confidence.
I KNOW that this method of organizing their class notes seems complicated, but trust me, after a few times it will go smoothly and the child, the parents and the teachers will be very happy that the child is more organized.
I am in favor of having the child type the class notes on a computer (and one would hope that your child’s accommodations would allow for this method). Then, the child saves them on a file on the classroom computer (or his own laptop if this is the case in your school), saves the notes on a flash drive and/or emails them to himself. You know how fast these kids can facilitate these procedures. The child then prints the class notes out and brings them home in a folder or prints them out at home.
THIS IS THE KEY: After they arrive home, they IMMEDIATELY print out the class notes for each subject (if they have not already done so) or hole punch the class notes they brought home and place them in a flexible binder, preferably a different color for each academic subject.
The important point about the class notes in these binders is that the child can go over them briefly either the night before class, or optimally, as they are having breakfast, and are immediately reminded of what the specific teacher taught the previous day. If the teacher gives the class a pop quiz, then the children are prepared. They will do better on their quizzes, which will build better self-esteem and confidence.
I KNOW that this method of organizing their class notes seems complicated, but trust me, after a few times it will go smoothly and the child, the parents and the teachers will be very happy that the child is more organized.
Tuesday, September 7, 2010
Looking for my book?
If you are looking for my book, ADHD and Social Skills: A Step by Step Guide for Teachers and Parents, here is the link from Amazon: http://www.amazon.com/ADHD-Social-Skills-Step-Step/dp/1607092808/ref=sr_1_1?ie=UTF8&s=books&qid=1283902167&sr=8-1
I am also including here the publicity sheet from my book which includes endorsements from elite researchers in the field, such as Dr. Russell Barkley.
FOR IMMEDIATE RELEASE
Contact Emily Todd 301-459-3366 x5314 etodd@rowman.com
“An insightful resource filled with useful examples and anecdotes from Dr. Rapoport's field research with families of children with ADHD. This book provides parents and teachers numerous concrete methods and techniques to help children with ADHD learn and perform appropriate social skills that are critical for getting along with others and experiencing social success.”—Sandra Rief, Author of How to Reach & Teach Children with ADD/ADHD and The ADHD Book of Lists
“This is a lavishly detailed book providing numerous recommendations for ways to address the social interaction problems and social skills impairments associated with ADHD in children. Dr. Rapoport combines her knowledge of the research literature on social skills interventions for children with her own direct, hands-on experience in designing and implementing social skills programs for socially impaired children. Teachers will find here a wealth of information on how to improve the manner in which they educate children with ADHD around their social interaction problems while parents are likely to benefit as well from adapting these same methods for use at home with their children's peer relationship problems.”—Russell A. Barkley, Clinical Professor of Psychiatry, Medical University of South Carolina, Charleston
Children with attention-deficit/hyperactivity disorder (ADHD) leave for school in the morning with a smile and a backpack, ready to make friends. They often return from school after having been bullied. Children with ADHD appear vulnerable to their peers, because they misinterpret social cues and behave in a socially inappropriate manner. These children have few if any friends.
This book explains the difficulties that children with ADHD endure to those individuals who do not understand the complexities of these children's problems. Difficulties with attention, organization and social interaction are listed, defined, and described. Teachers and personnel who work with these children in school and parents who work with their children at home are offered innovative techniques for improving these children's behavior, in a way that everyone can understand and implement. Real-life experiences of average people living with children with ADHD are included, so that parents can feel less alone in their experiences.
Esta M. Rapoport is an Assistant Professor of Special Education at The College of New Rochelle in New York, and does social skills training with children who have ADHD.
ROWMAN & LITTLEFIELD EDUCATION
www.rowmaneducation.com
August 2009 1-6070-9280-8 $75.00 Cloth 250 pages
August 2009 1-6070-9281-6 $32.95 Paper 250 pages
I am also including here the publicity sheet from my book which includes endorsements from elite researchers in the field, such as Dr. Russell Barkley.
FOR IMMEDIATE RELEASE
Contact Emily Todd 301-459-3366 x5314 etodd@rowman.com
“An insightful resource filled with useful examples and anecdotes from Dr. Rapoport's field research with families of children with ADHD. This book provides parents and teachers numerous concrete methods and techniques to help children with ADHD learn and perform appropriate social skills that are critical for getting along with others and experiencing social success.”—Sandra Rief, Author of How to Reach & Teach Children with ADD/ADHD and The ADHD Book of Lists
“This is a lavishly detailed book providing numerous recommendations for ways to address the social interaction problems and social skills impairments associated with ADHD in children. Dr. Rapoport combines her knowledge of the research literature on social skills interventions for children with her own direct, hands-on experience in designing and implementing social skills programs for socially impaired children. Teachers will find here a wealth of information on how to improve the manner in which they educate children with ADHD around their social interaction problems while parents are likely to benefit as well from adapting these same methods for use at home with their children's peer relationship problems.”—Russell A. Barkley, Clinical Professor of Psychiatry, Medical University of South Carolina, Charleston
Children with attention-deficit/hyperactivity disorder (ADHD) leave for school in the morning with a smile and a backpack, ready to make friends. They often return from school after having been bullied. Children with ADHD appear vulnerable to their peers, because they misinterpret social cues and behave in a socially inappropriate manner. These children have few if any friends.
This book explains the difficulties that children with ADHD endure to those individuals who do not understand the complexities of these children's problems. Difficulties with attention, organization and social interaction are listed, defined, and described. Teachers and personnel who work with these children in school and parents who work with their children at home are offered innovative techniques for improving these children's behavior, in a way that everyone can understand and implement. Real-life experiences of average people living with children with ADHD are included, so that parents can feel less alone in their experiences.
Esta M. Rapoport is an Assistant Professor of Special Education at The College of New Rochelle in New York, and does social skills training with children who have ADHD.
ROWMAN & LITTLEFIELD EDUCATION
www.rowmaneducation.com
August 2009 1-6070-9280-8 $75.00 Cloth 250 pages
August 2009 1-6070-9281-6 $32.95 Paper 250 pages
Study Habits: New Research
Here is an article that discusses the new research on study skills. What do you think? If you cannot access the link, please let me know.
http://www.nytimes.com/2010/09/07/health/views/07mind.html?emc=eta1
http://www.nytimes.com/2010/09/07/health/views/07mind.html?emc=eta1
The First Day of School: Parents' Feelings
Your child has just left for school and as you are walking away from the bus stop, what are your thoughts? I am sure that you are telling yourself, "Oh please let this be a good year with no teasing and no bullying but on a positive note, being able to make some new friends." Now that you will probably be nervous awaiting your child's conversation about his new teacher, the children in his class and the work requirements, go get some exercise. By taking a walk, a run or a few minutes on an elliptical trainer, you will calm down enough to wait out the six hours or so until your child comes home with "the report."
A few suggestions here: As much as you just cannot wait for his news, as he comes off of the bus, do not ask any questions for a few minutes. Perhaps take him for an ice cream cone or for a short walk and wait for him to tell you the details of his first day. I know this requires patience, but your child needs to feel in control of when he tells you the details of his day as well as which details he tells you.
I hope that this information helps. Comments?
A few suggestions here: As much as you just cannot wait for his news, as he comes off of the bus, do not ask any questions for a few minutes. Perhaps take him for an ice cream cone or for a short walk and wait for him to tell you the details of his first day. I know this requires patience, but your child needs to feel in control of when he tells you the details of his day as well as which details he tells you.
I hope that this information helps. Comments?
Monday, September 6, 2010
Making Buying School Supplies a Positive Experience
Tomorrow is the first day of school in many locals. Consequently, I am sure that tomorrow afternoon will find many of you in the store buying your child school supplies. How can you help your child with ADHD enjoy and learn from this experience instead of becoming overwhelmed and lost in the crowds of people?
First of all, your attitude is paramount to a positive experience for both of you. Treat the experience as if it is a treasure hunt. Seriously? Seriously. Sit down with your child tonight if you were already sent a list of supplies by the school or tomorrow when he comes home with a list. Take an index card book and write down one supply on each page. If your child is too young to read, draw a picture or cut out a picture out of a magazine so he can recognize the object.
Bring the index card book to the store and have your child be in charge of it. Discuss with him as you go along where the items might be located in the specific categorized aisles. Then, have him check off each supply as you both find it.
It is vital that he sees that you do not find the items immediately either. You can even pretend not to know where an item is located so that he has the challenge of finding it.
If you have an older child who needs more of a challenge, (and has learned that he cannot always win a game), you can make two index cards books and split the supply list up between you both and race to see who finds the items on their list first.
What do you think of my treasure hunt?
First of all, your attitude is paramount to a positive experience for both of you. Treat the experience as if it is a treasure hunt. Seriously? Seriously. Sit down with your child tonight if you were already sent a list of supplies by the school or tomorrow when he comes home with a list. Take an index card book and write down one supply on each page. If your child is too young to read, draw a picture or cut out a picture out of a magazine so he can recognize the object.
Bring the index card book to the store and have your child be in charge of it. Discuss with him as you go along where the items might be located in the specific categorized aisles. Then, have him check off each supply as you both find it.
It is vital that he sees that you do not find the items immediately either. You can even pretend not to know where an item is located so that he has the challenge of finding it.
If you have an older child who needs more of a challenge, (and has learned that he cannot always win a game), you can make two index cards books and split the supply list up between you both and race to see who finds the items on their list first.
What do you think of my treasure hunt?
Sunday, September 5, 2010
How Organized is your Child for the first Day of School?
The first day of school is a great excuse for an organization overhaul. First, help your child to organize his clothes the night before by making a checklist together of the items that he wants to wear. Always give the child two choices. For example, which jeans do you want to wear, the dark blue or the light blue? In that way, he cannot say I do not want to wear that one. He has to make a decision based on two choices, which leaves the decision within his control.
Remember, teaching him to become more independent is one of the primary goals for this year. Make copies of the checklist and tape it up in his room so that eventually, he can take the responsibility of choosing his own clothes and then checking them off his own list. It is very important to choose a place that is blatantly obvious to line up his clothes so there is a smooth transition in the morning from getting up to getting dressed to walking out of the door.
More tomorrow.....
Remember, teaching him to become more independent is one of the primary goals for this year. Make copies of the checklist and tape it up in his room so that eventually, he can take the responsibility of choosing his own clothes and then checking them off his own list. It is very important to choose a place that is blatantly obvious to line up his clothes so there is a smooth transition in the morning from getting up to getting dressed to walking out of the door.
More tomorrow.....
Thursday, September 2, 2010
Going Back to School: Starting Off on the Right Foot
Next week, all children will be returning to school. Some children with ADHD become anxious about not only the first day of school, but more importantly, the entire year. Here are some questions they might be asking themselves:
Will I be able to remember where my locker is and where my classrooms are located? Will I have friends in my class? Will I be able to make new friends? Will I be bullied or teased? Will the work be more difficult for me? Will the teachers like me?
There are several things that you can do to diminish some of your child's anxieties. You might visit the school, even if the child has already attended school there. Go to his/her classrooms as well as his/her locker. Help him/her figure out how to work a combination lock, and more importantly, some tricks as to how to remember the combination during the start of a busy morning with the halls full of other children.
Something as simple as having a conversation with your child about his/her anxieties might ease some of your child's anxieties. Remember: Always ask open-ended questions that require a descriptive answer rather than a closed-ended question that requires a yes or a no reply.
Try to help your child to organize himself/herself for school while incorporating his/her learning styles, strengths and/or needs. For example, if your child has a difficult time writing out his/her schedule, help them to set up an Excel chart on the computer or a computer calendar that he/she can modify as the months go by.
More later...comments? draft
Will I be able to remember where my locker is and where my classrooms are located? Will I have friends in my class? Will I be able to make new friends? Will I be bullied or teased? Will the work be more difficult for me? Will the teachers like me?
There are several things that you can do to diminish some of your child's anxieties. You might visit the school, even if the child has already attended school there. Go to his/her classrooms as well as his/her locker. Help him/her figure out how to work a combination lock, and more importantly, some tricks as to how to remember the combination during the start of a busy morning with the halls full of other children.
Something as simple as having a conversation with your child about his/her anxieties might ease some of your child's anxieties. Remember: Always ask open-ended questions that require a descriptive answer rather than a closed-ended question that requires a yes or a no reply.
Try to help your child to organize himself/herself for school while incorporating his/her learning styles, strengths and/or needs. For example, if your child has a difficult time writing out his/her schedule, help them to set up an Excel chart on the computer or a computer calendar that he/she can modify as the months go by.
More later...comments? draft
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