I am Back!

Hi Everyone:

I am finally back writing again after losing power caused by the wind and rain from Hurricane Irene. Stay tuned for a new blog entry by tomorrow. 

Dr. Rapoport

Writing Problems in Children with ADHD

I  frequently see children with ADHD who have writing difficulties. The most typical difficulty that I have seen is poor handwriting, which can impact a child's academic achievement in a negative way.

I am often amazed when I hear that in addition to the fact that no one has diagnosed this problem, that more importantly, no one has developed a plan in order to either remediate this difficulty (often arguably a written language disability) or a plan to teach the child how to type competently on a computer and have him do most of his writing on a computer.

Please comment to this article.

Writing problems common in kids with ADHD

Mon Aug 22 21:14:49 UTC 2011

By Genevra Pittman

NEW YORK (Reuters Health) - Kids with attention-deficit hyperactivity disorder are more likely to have writing problems such as poor spelling and grammar than their peers, suggests a new study. And the difference may be especially conspicuous in girls with ADHD.

Reading and math problems often raise red flags for teachers and parents, but "written-language disorder is kind of overlooked," said study author Dr. Slavica Katusic, from the Mayo Clinic in Rochester, Minnesota.

Writing "is a critical skill for academic success, social and behavioral well-being," she added. And if writing problems aren't noticed early on and addressed in kids with ADHD, they can suffer long into adulthood, Katusic told Reuters Health.

According to the Centers for Disease Control and Prevention, close to 10 percent of kids ages four to 17 in the U.S. have ever been diagnosed with ADHD -- a number that has been on the rise in recent years.

The current study included close to 6,000 kids -- everyone born in Rochester between 1976 and 1982 who was still living there after age 5. Katusic and her colleagues tracked school, tutoring and medical records to see which kids showed signs of ADHD, as well as how well they performed on writing, reading and general intelligence tests through high school.

In total, 379 of the kids fit the criteria for ADHD, which was more common in boys than girls, the study authors report in Pediatrics. Of all kids in the study, just over 800 scored poorly on tests of writing abilities. Most kids who had trouble with writing also had reading difficulties.

Writing problems were much more common in both boys and girls with ADHD. Close to two-thirds of boys with ADHD had trouble with writing, compared to one in six boys without ADHD.

For girls, 57 percent with ADHD had a writing problem, compared to less than 10 percent without ADHD. And girls with ADHD were almost ten times more likely to have a combination of writing and reading disorders compared to girls without the condition.

Memory and planning problems in kids with ADHD may affect the writing process, the authors explain, and ADHD has been linked to learning disorders in the past.

Annette Majnemer, who has studied handwriting in kids with ADHD at McGill University in Montreal, Canada, said that many with the disorder seem to have difficulty with that component of writing.

"It might be partially the fact that they're inattentive and distractable and hyperactive," she told Reuters Health. It's also possible that motor skills and coordination problems are partly to blame, said Majnemer, who was not involved in the new research.

Katusic added that genetics might be behind both ADHD and some writing problems, but that in general, it's very hard to tease out exactly how ADHD is linked to writing and reading disorders.

Treatment for the ADHD, as well as individual education plans that address some of those related difficulties, can help, Katusic said -- especially if they're started when problems first arise.

"When parents notice something or teachers notice something, (kids) have to be treated not only for ADHD, but they have to be tested to see if they have other learning problems," she said.

"Clinicians and the teachers have to emphasize that the testing has to be done for everything, every kind of learning disability," Katusic said. "It has to be identified early and the treatment has to start early."

SOURCE: bit.ly/n0SSfj Pediatrics, online August 22, 2011.

This is an Article from a Few Years Ago, but it is Worth Reading: San Francisco Giants Pitcher Reveals ADHD Diagnosis and Dramatic Life Changes ... On and Off the Field

ADHD Game Plan Helps Scott Eyre Manage His Disorder;


Pitcher Stresses Importance of Early Diagnosis and Treatment

(PRNewswire) -- For most of his life, San Francisco Giants relief pitcher Scott Eyre could not understand why it was so difficult to pay attention at school, concentrate while trying to do homework or play ball, or why he seemed to get easily frustrated with his family and friends. At age 30, he found the answer when he was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), a common neurobehavioral disorder affecting millions of children, adolescents and adults.


In 2002, while Scott was a member of the Toronto Blue Jays, a team psychologist recognized the characteristics of ADHD and urged him to undergo a comprehensive evaluation by a doctor. "After being diagnosed with ADHD, I understood that my constant hyperactivity and inability to focus on activities are symptoms of a common and treatable medical condition," says Scott. "And, more importantly, by developing a personal ADHD game plan with the help of my doctor and my wife, I found that I could gain better control of my life at home and at the ballpark."


"A total treatment plan consisting of management strategies and medication are the most effective tools physicians have to help patients manage symptoms of ADHD to reach their full potential in home, school, social and work settings," notes David Goodman, M.D., Assistant Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. "As children transition from unstructured summer time to a more regimented school year, it is critical for parents to discuss their child's ADHD with a doctor and develop their own ADHD game plan or strategy to manage it effectively."


Signs of ADHD Followed Eyre from Childhood to Adulthood


Growing up, there were many tell-tale signs of ADHD in Scott's life. He struggled in school because he was easily distracted and hyperactive. One of five siblings, including a brother who has also been diagnosed with ADHD, Scott says he acted like he was "driven by a motor" at all times. He would become easily frustrated with his family, and could not block out the activities of his household when he tried to do homework. "I often wonder what my life would have been like had I been diagnosed and treated when I was younger," says Scott.


"When a child is struggling in school, the symptoms of ADHD are often overlooked," explains Dr. Goodman. "The child might feel 'stupid' or inadequate after continual failure, which can greatly affect self-esteem and relationships with peers and family. Left unmanaged, children with ADHD often suffer academically and can experience behavioral and emotional problems into adulthood."


Scott's organizational problems, impulsivity and distractibility followed him through to adulthood. Throughout a successful baseball career at the high school, college and professional levels, Scott found himself continually fighting to stay focused. While on the mound he would find himself drifting off and listening to the crowd instead of "bearing down" on the batter. His teammates noticed his impulsive behavior and noted that it was nearly impossible for Scott to sit still in the bullpen and concentrate on the game.


Scott's wife, Laura, noticed that he had extreme difficulty waiting his turn to speak, would often interrupt people, and could rarely carry on a conversation with her without doing something else at the same time. Because of his struggle with ADHD symptoms, Scott exhibited little patience with his two young sons.


ADHD Game Plan Helps Pitcher Deal With Life's Curveballs


Working with his physician and wife Laura, Scott developed a personal ADHD game plan which now includes behavioral management strategies like keeping a running "to-do" list, establishing parameters for unstructured time or days off, and organizing his schedule with an electronic pocket calendar. He also takes CONCERTA(R) (methylphenidate HCl) CII, a long-acting medication for ADHD. "Now that Scott has been diagnosed and is managing his ADHD, he spends less time feeling frustrated and overwhelmed with the tasks he has to complete," says Laura Eyre.


"Sticking with a treatment program that includes focus techniques and medication is the right ADHD game plan for me," says Scott. "Parents should talk with their child's physician, teachers, and others to help determine the best ADHD game plan for their child."

CDC Report on the Rise of Children Diagnosed with ADHD to 9% from 2007 to 2009

This is interesting reading concerning the recent CDC report on ADHD, as written by the Wall Street Journal on August 19, 2011.

Attention Disorder on the Rise

By SHALINI RAMACHANDRAN

The number of children diagnosed with attention-deficit/hyperactivity disorder rose more than 30% over the past decade, with much of the increase likely due to more awareness and diagnosis, according to a new government report.

Wider access to health-care services and increased recognition of the disorders mean more children are being diagnosed, said Lara Akinbami, lead researcher for the report, which was published by the Centers for Disease Control and Prevention. "It's unlikely that most of this is due to a new epidemic of ADHD," Dr. Akinbami said.

The percentage of children ages 5 to 17 who had ever been diagnosed with ADHD rose to 9% for 2007 through 2009, encompassing about 4.7 million children, from 6.9%, or about 3.6 million children, in the period from 1998 to 2000, according to the report, compiled by the CDC's National Center for Health Statistics. The prevalence of ADHD in children of families living below the poverty line rose nearly 40%, and it rose 50% among kids in families with income just above the poverty line.

The findings suggest that increased awareness, outreach groups and improvements in health care are encouraging more low-income parents to bring their children to pediatricians for diagnosis, said Ruth Hughes, chief executive of Children and Adults with Attention Deficit/Hyperactivity Disorder, a nonprofit organization that advocates for support for children and adults with ADHD.

The rise in diagnoses is significant for health systems and schools, as kids with ADHD use more services like special-education classes, Dr. Akinbami said. The estimated cost to society of children and adolescents with ADHD totals about $42.5 billion a year, according to a 2005 study led by the State University of New York that factored in health care, education, parental work loss and juvenile-justice costs.

ADHD is characterized by inattentiveness, impulsive behavior and hyperactivity. Until the early 1990s, kids who were inattentive but not necessarily hyper were diagnosed as having ADD, or attention deficit disorder. Any ADD diagnoses from the past now fall under the umbrella of ADHD.

Researchers surveyed 40,000 households with 8,000 to 12,000 children representing the demographic levels of the population across the country. The chances that results stem from overdiagnosis are low, experts say, because diagnosis takes several steps, including a medical exam, reports from parents and teachers and a functional impairment in at least two areas of life.

How to Deal with Teenagers with ADHD who are Stubborn and will not Comply with your Requests

Teenagers who do not have ADHD may be stubborn some of the time, but it is arguably more predictable that teenagers with ADHD are stubborn and noncompliant more frequently. The reason for their inflexibility is that teenagers with ADHD may be definite and even rigid in the way that they behave, which arguably makes it difficult for parents to manage their behavior. Sometimes, it seems as if even the smallest parental request cannot be satisfied for no reason other than the fact that the teenager arguably feels that if he agrees to cooperate with his parent, that he will not be behaving as is consistent with his typical behavioral repertoire.

It is vital to evaluate the battle that you are fighting. Is the issue related to school or home? If it is related to school, might it be a good idea for the child to live with his decision, such as, not completing his homework? If it is related to home, is it something that is not worth arguing over, such as taking a shower?

If you truly feel that the issue at hand must be accomplished, then here are a few things that you may try:

1. Take him to do something that he likes to do, such as to get pizza, or to play miniature golf, etc., On the way in the car, talk to him in a relaxed and comfortable demeanor concerning why he does not want to comply with what you are requiring him to do.

2. Offer him a choice in terms of complying with your requirement immediately or within a short period of time. However, make sure that he agrees to make a decision, and if necessary, draw up a short one line contract that you both agree to sign.

3. Offer him an incentive that he will receive if he complies with your request, i.e., “When you finish your homework, we will go out for an ice cream cone.” However, make sure that the incentive is really something that he is interested in getting.

4. If he considers your requirement long and taxing, split it up into two parts. For example, if he has to pick up his room so that it is neat when he begins his homework, compromise with him. Collaborate with him in order to decide on two separate, precise times when he will clean up his room and when he will do his homework.

"Profile of ADHD Sharpens in Each School Year" written in the Los Angeles Times

I am not a fan of articles that are written by reporters on ADHD. However, this article was sent to me by the Council for Exceptional Children and is basically on target. Let me know what you think. Here is the link:

http://www.latimes.com/health/la-he-adhd-20110813,0,1013908,full.story

Teenagers with ADHD: How to Help your Teenager Choose Friends

Over the next week, (I will address this issue for a longer time if you feel it would benefit you.) I will be addressing issues as related to teenagers who have ADHD. Please stay tuned.....


The life of a teenager is complicated enough, in terms of peer pressure, an increased emphasis on academics and arguably the most important issue, finding out the essence of who they are and who they want to be.


Teenagers with ADHD have difficulty seeing how the outside world sees them. Arguably, most teenagers experiment with make-up, clothes, activities, as well as the friends they choose. Experimenting is good, but these teenagers need to develop an internal barometer so that they can build a sense of who might be someone with whom to interact as compared to someone who might be detrimental to their self-esteem.


As parents, it is always important to win the war, even if we lose a few battles. An imperative consideration for parents is that you try to remain as unbiased as possible regarding your child’s friends. The ability to judge what kind of person your child is interacting with is far more important that the other teenager’s hair style or the style of clothes that he/she chooses to wear.


Judge as to whether or not that person is treating your child fairly, respectfully and/or kindly, instead of judging him/her based on torn jeans or shirts. Also, and very importantly, try to engage your child in a conversation where you discuss the values upon which choosing friends is based. Remember: Do not make judgments or negative comments about your teenager’s friends, because any negative response might push your teenager closer to someone whom you do not deem worthy.

Do Parents of Children who are Hyperactive, Impulsive and have Attention Problems (HIA) experience stress?

The parents with whom I have worked have told me time and time again that managing their children with ADHD’s inappropriate behavior has caused them considerable stress that has impacted their relationship with everyone else in their family, as well as with their friends.

In a recent study of 706 children aged between 10-12 and their parents over five years, researchers used theories of how parents perceived their power as well as to what they attributed their children’s behavior, in order to develop a model for understanding parents’ reactions to their children’s HIA.

The following measures were used:

·         Measures of children’s HIA

·         Children’s lack of responsiveness to correction

·         Parents’ perceptions of not being powerful

·         Parental monitoring

·         Parents’ negative behaviors toward their children

What were the results of this study?

“HIA in youths predicted increases in parents’ perceptions that their youths were unresponsive to correction, which in turn prompted parents to feel more powerless over time. Further, parents’ feelings of powerlessness were associated with increases in negative parenting behaviors over time. These results indicate a movement to more negative parenting practices over time as a result of youths’ HIA.”

What kind of stress have parents and/or teachers who follow my blog experienced? Please tell us because I am sure that your feedback would help many others.

Ruby (Dalmatian) and Rocky (Brittany) say "Woof, woof...please comment."

Is Popularity a Risk for Girls with ADHD?

I know that I usually discuss the fact that children with ADHD arguably have difficulty making friends. However, that is not always the case. In some instances, especially in terms of girls who have a diagnosis of ADHD-Predominantly Inattentive Type (ADHD-I), they do make friends. However, that being said, they may be drawn into the idea that if they are asked to join the “popular group,” that both the girls in that group as well as themselves are more worthy than the other girls who are not in that group.


Since children with ADHD often do not see the worldview, or how others are seeing them, they may not see and/or understand this very important issue. How do these girls’ parents feel about their daughter who has ADHD being involved with the “popular group?” They are typically happy, but may not be aware that in some cases, that their daughter may be used in terms of situations such as, doing homework for the other girls, typing the other girls’ reports on her computer, etc.


I do not blame the girls with ADHDs’ parents for being happy that their child with ADHD has friends. However, if the main reason that their daughters want to be in that group is to feel needed, important, better, smarter, and/or prettier than the other girls, that reasoning must be discussed, in the least.


Many girls experience this same problem. However, girls with ADHD typically have lower self-esteem and are more vulnerable than girls who do not have ADHD. Their low self-valuation is typically due to how they feel about themselves, especially regarding their difficulty focusing and paying attention in class, following instructions, and forgetting to hand in some of the assignments. Their low self-esteem is also related to oftentimes having a history of being rejected and rebuffed by their peers.


It is great that your child has made a group of friends. However, remember to keep the channels of communication open with your child, so you can see any danger signs as quickly as possible. Do not be judgmental. Instead, express the fact that since you love and care about your child so deeply, you just want to make sure that she is aware of any group dynamics that may not be healthy for her.

Today is Questions and Comments Day: Let Us Start a Conversation!

Hi Everyone:

In consideration of the fact that school starts soon, I am assuming that some anxiety is building up in you (parents), your children, as well as their teachers. 

I am at my computer today all day, so please feel free to either write me questions to my blog or to my email address in my profile. 

I look forward to answering any questions that you send to me. Let's start a conversation!!!

Dr. Rapoport

Emotional Stressors of Parenting a Child with ADHD

Take a look at this interesting question and answer, courtesy of CHADD:

http://www.chadd.org/AM/Template.cfm?Section=Attention_Magazine&CONTENTID=15292&DIRECTLISTCOMBOIND=D&NAVMENUID=3616&TEMPLATE=MembersOnly.cfm&s=20110802171552168

Some Characteristics of Children with ADHD

The following are some, among many characteristics of children with ADHD, as noted from an adapted Conners Rating Scale:


✱Restless in the “squirmy” sense

✱ Excitable, impulsive

✱ Fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

✱ Is an emotional child

✱ Restless or overactive

✱ Does not appear to listen to what is being said to him

✱ Leaves seat in classroom or in other situations in which remaining seated is expected

✱ Inattentive, easily distracted

✱ Has difficulty waiting his turn

✱ Does not know how to make friends

✱ Fidgeting

✱ Disturbs other children

✱ Talks excessively

✱ Runs about in situations where it is inappropriate

✱ Has poor social skills

✱ Fidgets with hands or feet

✱ Demands must be met immediately—easily frustrated

✱ Blurts out answers to questions before the questions have been completed

✱ Interrupts or intrudes on others

✱ Easily distracted by extraneous stimuli

✱ Restless, always up and on the go

The Definition of ADHD

The following is the well-accepted, current definition of it according to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV- TR):


The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development (Criterion A). Some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years, although many individuals are diagnosed after the symptoms have been present for a number of years, especially in the case of individuals with the Predominantly Inattentive Type (Criterion B) (APA, 2000, p. 85).





The DSM-IV-TR categorizes these children into four types:

✱ Attention-Deficit/Hyperactivity Disorder, Combined Type

✱ Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type

✱ Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type

✱ Attention-Deficit-Hyperactivity Disorder, Not Otherwise Specified (APA, 2000, p. 87).