Wednesday, September 14, 2011

School Support for ADHD Children May Be Missing the Mark: Inattention, Not Hyperactivity, Is Associated With Educational Failure

ScienceDaily (Sep. 12, 2011) — New research from the University of Montreal shows that inattention, rather than hyperactivity, is the most important indicator when it comes to finishing a high school education.

"Children with attention problems need preventative intervention early in their development," explained lead author Dr. Jean-Baptiste Pingault, who is also affiliated with Sainte-Justine Mother and Child University Hospital. The researchers came to their conclusion after looking at data collected from the parents and teachers of 2000 children over a period of almost twenty years.
In this study, attention problems were evaluated by teachers who looked for behaviour such as an inability to concentrate, absentmindedness, or a tendency to give up or be easily distracted. Hyperactivity was identified by behaviour such as restlessness, running around, squirming and being fidgety. The researchers found that only 29% of children with attention problems finished high school compared to 89% of children who did not manifest these inattention problems. When it came to hyperactivity, the difference was smaller: 40% versus 77%. After correcting the data for other influencing factors, such as socioeconomic status and health issues that are correlated with ADHD, inattention still made a highly significant contribution which was not the case for hyperactivity.
"In the school system, children who have attention difficulties are often forgotten because, unlike hyperactive kids, they don't disturb the class," said Dr. Sylvana Côte, who led the study. "However, we know that we can train children to pay attention through appropriate activities, and that can help encourage success at school."
The results of the study have been published as mental health experts have begun to debate whether or not it would be appropriate to separate hyperactivity and inattention problems in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). "These two health issues have now been more precisely dissected, and we may now need to define a differentiated type of inattention that is independent from hyperactivity, to improve our understanding of the phenomenon and better tailor interventions," Pingault said.
The study will be published in the American Journal of Psychiatry on November 1, 2011. The research was funded in part by the Fonds Québécois de la recherche sur la société et la culture, the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research, the US National Science Foundation, the National Institute of Mental Health and the US National Consortium on Violence Research. The University of Montreal and Sainte-Justine Mother and Child University Hospital are known officially as Université de Montréal and Centre hospitalier universitaire Sainte-Justine, respectively.

Tuesday, September 6, 2011

The Mysteries of ADD and High IQ

The five truths about attention deficit disorder.
Published on August 16, 2011 by Thomas E. Brown, Ph.D. in The Mysteries of ADD

We recently published a study of 117 high IQ children and adolescents with ADD. (Note: In this article, the term ADD is used to refer to both ADD and ADHD). All of these very bright students were struggling in school and often also in social relationships because of their ADD-related problems. Results from that study uncovered a pattern of vulnerabilities in executive functions, the management system of the brain, that caused these bright students to have chronic difficulty in focusing on their work, in getting their work done adequately, in keeping in mind what they had just heard or read, and in organizing and completing assignments. Some have been mystified as to how very bright students could suffer from ADD. They assume that being smart protects a person from the difficulties associated with ADD. This study shows that it doesn'

Here are 5 questions that our research team repeatedly encountered from high IQ kids and their parents and teachers:

1. Doesn't a person have to be hyper or have behavior problems to have ADD?

No! Most of the children and teenagers in this study of ADD were not hyperactive and had few, if any, significant behavior problems. For decades, this syndrome now known as ADD or ADHD was seen as a behavior disorder, a set of problems seen just in little kids who couldn't sit still, wouldn't shut up and who frustrated parents and teachers with chronic misbehavior. Research over the past 20 years has dramatically changed understanding of ADD by showing that many who fully meet diagnostic criteria for ADD have never had significant behavior problems. The core of ADD as it is now understood is a developmental delay in executive functions, a cluster of cognitive abilities that regulate other functions of the mind.

2. How can someone be really smart and yet have ADD?

All of the 117 kids in this study fully met diagnostic criteria for ADD and all had IQ scores of 120 or more, placing them in the top 9 percent of their age group on basic intelligence. Some were strongest in verbal comprehension, some were strongest in visual-spatial reasoning, and some were equally strong in both.

ADD has nothing to do with how smart a person is. Some individuals with ADD are super-smart on IQ tests, many score in the average range, and some are much lower.

Students in this study, compared to others of the same age, were impaired not by lack of smarts, but by chronic inability to deploy their smarts in effective work and in getting along with other people. One of the measures used in our study was a rating scale that inquires about impairments in various clusters that describe executive functions (EF). Everyone has problems with these various functions sometimes; people with ADD have much more difficulty with these functions than do most others of the same age.


Data from this study show that individuals can have very high IQ and still suffer significant impairments in each of these executive functions that are essential for working effectively and for getting along with other people.

3. How can someone be an honor student in elementary school and then struggle and fail repeatedly in high school or college?

Most of the students in this study got high grades in elementary school. Many were in special programs for talented and gifted students. Their school difficulties tended to begin when they made the move from elementary school, where they were with one teacher and the same group of classmates most of the day. Entry into middle school or junior high often brought increasing difficulties in keeping track of assignments and in completing homework. We explain that these students struggled when required to operate more independently without that one teacher who can help to keep tasks and expectations organized for all subjects throughout the day. As homework requirements escalated and parents were less able to monitor what was going on in all the various classes, many of these very bright students began to flounder.

Some of the older students in the study had managed to function well even with the demands of middle school and high school. Many of them had parents who were successful in maintaining supportive scaffolding around their sons and daughters, helping them to prioritize, plan, monitor and complete multiple assignments. Often the ADD impairments of these strongly supported high IQ students did not show up until they went away to college or university. There, lost without the strong daily support of their parents, many of these very bright students were unable to cope with their schoolwork, had plummeting grades and were required to take a semester off or transfer to another, less challenging college. Just being very smart is not enough to be successful in college, university or employment; one also needs to be able to manage oneself, to work productively and to get along reasonably well with peers, professors, supervisors, and employers.

4. How can someone focus very well on playing a sport, video games, drawing, or making music and not be able to focus enough on almost anything else?

The most mystifying aspect of ADD is that everyone who has this disorder is able to focus very well on a few specific types of tasks, even though they have great difficulty in focusing effectively on almost everything else. All of the students in this study reported that they had no difficulty in exercising executive functions very well for a few specific activities. For some it was participating in a sport or making art or music. For others, focus came easily for repairing car engines, cooking, using the computer, or designing websites. When asked to explain why they could focus on those few specific activities, but not on other tasks they recognized as important, the students typically responded by saying: "If it's something that really interests me, I can focus. If it's not really interesting to me, I just can't focus, even when I know it's important and I really need to do it."

One of our patients explained this: "ADD is like having erectile dysfunction of the mind. If the task is something that really interests you, you're up for it and can perform. If it's not something that turns you on, you can't get it up and you're not able to perform." The capacity to focus and mobilize executive functions for a task depends primarily on release of dopamine in specific areas of the brain and that release of dopamine is not under voluntary control.

5. Does anyone ever get over having ADD as they get older?

Back when ADD was seen as simple hyperactivity, it was believed that anyone with ADD would outgrow those problems by the time they were about 14 years old, if not before. That view made sense because for several decades ADD was seen as just hyperactive behavior, not as a problem with attention and EF. Often, though not always, hyperactive symptoms of ADD do go away as one gets older. But longer term studies have shown that for about 70-80 percent of those with ADD, their attentional symptoms tend to persist into adulthood, even if hyperactive problems have remitted. We published an earlier study of 157 high IQ adults with ADD. The design of that research was almost identical to this recent study of kids with ADD and the results were very similar. For many, the EF impairments of ADD persist into adulthood.

Despite the persistence of ADD, many of those affected experience less impairment from ADD symptoms as they get older. Three reasons may contribute to such improvement: for many with ADD, junior high, high school and the first few years of university are the most difficult. This is because these are the years when one is required to cope with the widest range of academic tasks with the least opportunity to escape from the ones you're not that good in. When one gets further along in education or employment it is often possible to specialize in work that is more interesting and which one can do reasonably well, without carrying so much of a burden of more challenging tasks. Second, imaging studies have shown that the course of brain development in adolescents with ADD is very similar to that of their age mates, except in a few specific regions of brain that are essential for executive functions. Individuals with ADD tend to catch up in development of these delayed regions of brain crucial for EF about 3 to 5 years behind their peers. This may account for some students who do poorly in high school and early college, then return to more advanced education a few years later and are very successful.

A third factor that helps many with ADD to improve their impaired executive functioning is treatment with appropriate medication. For about 80 percent of those with ADD, executive function can be improved significantly with a carefully managed regimen of medication approved for treatment of ADD. Medications cannot cure ADD, but, just as eyeglasses can improve vision when worn, for most individuals, regardless of IQ level, medication treatment for ADD can significantly improve executive functioning when it is appropriately used.

How To Make a Visit to the Dentist Less Scary for Autistics, Aspergians, Sensitives and Any Anxious Person Advice for sensitive patients, dentists, and medical office designers

Published on August 25, 2011 by Rudy Simone in Aspergirls

Sensory issues are part and parcel of the autistic and aspergian experience, but we're not the only sensitives in the world ("The Princess and the Pea" was written in 1835, folks!) Today I had to go to the dentist for an exam and cleaning and was inspired to write this blog. I've been meaning to do it for ages; since a visit to a dentist in upstate NY three years ago. I asked him to hand me a toy that he had for kids so I could squeeze it to help me deal with my anxiety. I thanked him and explained, kind of apologetically, that I had Aspergers and he replied, "Don't worry, I'm used to dealing with all sorts of crazy folks." Lesson Number One, my fellow Aspergians: Never apologize for having AS. Be polite, yes, but apologetic, Never!

This article is aimed at the patients-but it is also aimed at the professionals who run/own these practices.

To the auties, aspies, sensitives and anxious folks: you will be poked, prodded, blinded by the light, scraped, suctioned and maybe even subjected to some of the worst music ever heard by human ears. Take heart, there are things you can do to ease the pain to the point of being almost painless.

    Don't forget your squidgy toys...if you don't bring them, the dentist might not have them, and if you are over the age of twelve you might be embarrassed to ask if they have any of these things in their cupboard.

    The lead bib that that they throw over you during x-ray time is similar to the weighted vests and shoulder bibs they make specifically for autistics. Ask to keep yours on after the x-ray is over and before the worst part begins--the cleaning. The heavy bib very comforting, like Temple Grandin's squeeze machine. You could even ask for it at the beginning, during the examination itself, when the dentist uses that little tiny metal claw that looks like it belongs on the arm of a Tinkerbell-sized Captain Hook.

    Ask if you can wear sunglasses. It'll keep you from having to completely close your eyes which might cause you to fall asleep and make dentist angry (we wouldn't want that). They'll also keep you from having to look dentist in the eye. For the first several dental visits of my life, I made eye contact with my dentist the whole time, causing him I'm sure, to think that I was either a nutter or a giant flirt. The office might have blinds or busy wallpaper patterns or bothersome lights, so the sunglasses will help you with that as well.

    You probably cannot wear an Ipod since you need to hear the dentist's directions (turn your head, open wide, etc.) but perhaps, you could ask if they mind if you wear either noise canceling headphones or perhaps just keep one earbud in your ear so you can have control of the tunes.

    Lastly, do not be afraid to ask for numbing cream for the cleaning, even for the exam. The basic stuff won't cost extra and really does help if you have a low pain threshold or are afraid of possible pain and are on hyper-alert. The cream will wear off by the time the exam is over.

Okay, the rest is for you dentists. You think you have created the coolest, most state-of-the-art office for your patients, but you are probably not thoroughly understanding the needs of your autistic, sensitive, or high anxiety patients.

Visually: high contrast wallpaper, e.g. black and white, might contain some groovy pattern to you, but might be so disorienting to an aspie that they get dizzy and even throw up, especially if they've had any sort of laughing gas or muscle relaxer. Even slatted blinds can drive us nuts. I got up out of my chair today at the dentist, ostensibly to look at the view (which was gorgeous) but also to raise the blinds--the lowered, slatted position created a dark and light, almost flickering pattern which can be painful to the autistic brain. And God forbid, Dr. Dentist, if you must use fluorescents, make sure they are the full-spectrum kind which contain the same colors as natural light and NOT flickering.

Doctor, do let the patient keep the bib and offer it at the beginning. It's a virtual hug that makes us feel more secure.

Tactile things, such as a squidgy toy, furry pillow (since grown ups won't want to be seen cuddling Tigger) are also good stress relievers.

Ask the patient if they would prefer to wear goggles in the beginning, not just when the polishing starts and the pink stuff starts to fly. I have been hit in the eye by my own tartar during the manual cleaning and believe me, I found it pretty gross. Get and offer tinted goggles. We don't like extended eye contact (if any) so if we keep our eyes closed, don't be offended.

And please, don't ask us questions while we are sitting there like horses at auction having our teeth and jaws examined. We respect and need what you do, but there's nothing more embarrassing than trying to answer questions while drooling and slurring.

Think about having a choice of music. While you have to be happy too, asking us if we prefer jazz, pop or classical give us some control even though you've chosen the Cds or stations.

Aspies talk to each other, in their communities and online and if you are known for having a sensory-friendly environment, you will have an edge over your competitors. And perhaps there will be more Aspies with shiny white teeth walking around, smiling a little more.

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