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Kids with ADD/ADHD can have a tough transition to middle school
Special to The Seattle Times
"Entering middle school, my son suddenly hit a brick wall."
Wendy Karboski's 13-year-old son has attention deficit/hyperactivity disorder. Go to any conference or support group about ADHD and you'll hear many personal stories that begin this way.
School-related problems often suddenly escalate when ADHD kids hit middle school. The transition can be stressful for the best of students, but for a child with an "invisible" disability such as ADHD, it can be traumatic unless parents, teachers and the students themselves team up to address problems before they escalate. Without intervention, there's plenty that can go wrong:
Staying organized is a pipe dream for the ADHD student in a school setting with multiple classes. The necessary skills — keeping planners; filing papers; and remembering whatever books, binders and implements are needed for class or homework — don't develop naturally. In ADHD kids, these are skills that must be taught. Without them, grades suffer and self-esteem plummets.
ADD Resources: 253-759-5085 or addresources.org
CHADD — Children and adults with attention-deficit/ hyperactivity disorder: 800-233-4050; www.chadd.org.
• South King County CHADD: 206-264-5521; e-mail, email@example.com
• Northwest CHADD: 206- 622-2127; e-mail firstname.lastname@example.org
www.nwchadd.org (for list of chapters throughout Washington)
Resources for teachers: www.addinschool.com/
The ADHD Information Library: www.newideas.net/
Teens with ADHD: www.chrisdendy.com/
About Attention Deficit Disorder: http://add.about.com/
ADDitude magazine: www.additudemag.com/
"Teenagers with ADD: A Parents' Guide" (Chris A. Zeigler Dendy, M.S., Woodbine House, $18.95)
"Teaching Teens with ADD & ADHD" (Chris A. Zeigler Dendy, M.S., Woodbine House, $18.95)
"A Bird's-Eye View of Life with ADD and ADHD: Advice from Young Survivors" (Chris A. Zeigler Dendy and Alex Zeigler, Cherish the Children, $19.95)
"Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood" (Edward M. Hallowell, M.D. and John J. Ratey, M.D., Touchstone, $15)
"Delivered from Distraction: Getting the Most Out of Life with Attention Deficit Disorder" (Edward M. Hallowell, M.D. and John J. Ratey, M.D., Random House, $14.95)
ADHD students are easily distracted , and that means losing track of time. Getting to class on time — several times a day as one must in middle school and high school — can be particularly challenging.
There are lots of new faces in the new, bigger school. Behaving impulsively and missing social cues — both common among ADHD students — often land them in the principal's office or make them targets of ridicule.
ADHD kids look like their peers. They blend in. It isn't uncommon to find educators who consider the disorder an "excuse" for immature behavior rather than the neurobiological disorder it is. Without intervention, teachers and administrators may simply label the child as a troublemaker.
Medical researchers now know that ADHD is caused by deficiencies in neurotransmitters in the central nervous system.
"What we know about ADHD is that it's been with us a long time," says Dr. Peter Jensen, director of the Center for the Advancement of Children's Mental Health and Ruane Professor of Child Psychiatry at Columbia University College of Physicians and Surgeons.
"As far back as 100, 150 years ago, people gave clinical descriptions of what we know as ADHD today."
"Over the course of the last 50 years, the terms have changed," he said, "from 'minimal brain damage' to 'minimal brain dysfunction' to 'hyperkinetic disorder' to, ... in the early 70s, 'attention deficit disorder' to, most recently, 'attention deficit hyperactivity disorder.' "
"The terms have changed, but the kids haven't — they have been here throughout," he said.
Jensen and other specialists believe that ADHD affects 3-5 percent of school-aged children worldwide.
It has become much more widely known and accepted in the past 20 years, but many people are still not diagnosed until they're teens or adults. Typically, it's those with the hyperactive element who get diagnosed as early as preschool. Girls with ADHD are often missed because they tend to have the less-disruptive inattentive subtype.
But even with a late diagnosis, there's a lot that can be done to help the young person cope and succeed.
Students with ADHD often have both academic and behavior problems, and the common tendency is to address behavior issues first, says Chris Dendy, keynote speaker at a recent ADD-resources conference in Tukwila. She strongly recommends taking on the academic issues first.
"Succeeding in school is one of the most therapeutic things for a child," she says. "For the ADD child, academic interventions improve behavior, but the converse is not true."
There's a lot parents can do to nurture academic success in ADHD kids and, fortunately, parents who look will find hundreds of books and articles and plenty of other parents to guide them.
Monica Pardee is well-educated about ADHD, having learned many "tricks and coping strategies" over the 12 years since her son Chris was diagnosed. The Auburn mother knows what works best for him. Chris Pardee is doing just fine in the ninth grade, and Monica knows he'll graduate from high school.
ADHD, education and the law
Under IDEA, ADHD students qualify for special education. Schools and parents jointly develop an Individualized Education Program (IEP) for the child, which identifies needs, services that will be provided and expected outcomes. Students may remain in the regular classroom or be placed in special-education classes.
Section 504 is a civil-rights law that essentially seeks to "level the playing field" for people with disabilities — everything from constructing ramps to overcoming access issues to modifying teaching or evaluation methods. Students with ADHD often have 504 plans to accommodate special needs in the regular school setting. Though each student is different, accommodations might include:
• Seating in the front of the classroom or near teacher's desk
• Providing a duplicate set of texts for home
• Establishing regular communication between teachers and parents
• Modifying assignments
• Allowing more time for tests
To initiate an IEP or a 504 plan, a referral is needed — by a teacher, other school staff member, a parent, a doctor or even a tutor. The school/district then considers whether to perform an evaluation. Some districts may decide a child is eligible for special education based on a doctor's ADHD diagnosis — getting a private medical diagnosis can speed up the process. If school authorities deny an evaluation or decide a child who has been referred is not eligible, parents can challenge the decision starting with the school principal, then the school-district's 504 coordinator (every district must have one), then the district superintendent, then the U.S. Dept of Education, Office for civil rights. If no agreement is reached, parents may take the case to court.
"You are your child's best advocate," she says. "Never, ever give up." Pardee is keen to share her experiences to pave the way for others. Her advice:
Get on the same page: Act one, Pardee says, is often getting the father on board. Men take longer to accept that their child may need medication and/or ongoing help. A strong family team supports the ADHD teen both at home and school — if the parents are not in agreement, the child's needs are less likely to be met.
Tom Dendy shared the microphone with his wife at the Tukwila conference. He told his own story about learning to accept his son Steven's ADHD. After constant fighting over academics, he said, Steven's mother finally suggested the boy get counseling. Tom Dendy's response: "You want me to pay someone $100 an hour because our son's too lazy to do his homework?!"
Only when Steven attempted suicide did Dendy accept that his son needed professional help. Now he's reaching out to other fathers.
Give medication a good try: Because ADHD is a medical condition, medication is one of the primary therapies, but trial and error may be necessary.
"Over 80 percent of ADHD individuals will respond favorably to the stimulant medications, methylphenidate (Ritalin/Concerta) and amphetamines (Adderall)," says Dr. Ted Mandelkorn, a pediatrician who practices in Mercer Island and has developed expertise in diagnosis and treatment of ADHD in people of all ages.
Not everyone with ADHD responds to the standard ADHD medications, but those who do — along with their families — agree it works wonders. And the impact on school performance can be dramatic.
"When we found the right medication, Chris noticed right away," Pardee says. "He said, 'Mom, I can think!' "
Make yourself known at the school: Parents (and students) will benefit by getting involved at school early on and knowing who's who. Pardee is on a first-name basis with her district's superintendent. When a problem arises, she goes straight to the top. She lives in a small district, which can be an advantage, but she says it's possible to navigate the red tape in a larger district, too. Get involved, she says. "Go to school-board meetings; get to know administrators; get involved in the classroom." The more players you know, the better position you'll be in to promptly address problems.
Educate the child: Students with ADHD need to be able to advocate for themselves. In order to do this, they must understand ADHD and its impact on learning. There's nothing Pardee hides from her son regarding his special needs. In fact, Chris joined our interview, and offered his own views on medication and events at school:
"I did fine in school until I hit middle school," Chris says, "and then I got harassed, bullied and got my head banged against poles."
Create a home routine: Pardee and Chris have established routines for everything from teeth-brushing to math homework. Since starting and finishing tasks is so difficult for people with ADHD, routines are a good way to teach the critical cognitive skills needed for school success: organizing, starting and finishing work, and planning.
Chris wants to be a motorcycle mechanic. His post-high school goals keep him on target and keep him working hard at science, math and the rest.
Educate teachers about ADHD: Proactive measures such as introducing the child to teachers can be an efficient way to help both teacher and child. By the time the child reaches high school, many parents of ADHD kids can be burned out on meetings with teachers, but it's important to keep renewing the commitment to the child's success.
At the start of each semester, Pardee prepares a "success pack" for each of Chris' teachers, an idea she adopted from an ADHD workshop. Included is a letter signed by her and her husband introducing Chris — his hobbies, goals, medical condition. She explains that his ADHD is not an excuse and that he's capable of behaving and performing as expected. She then provides all her contact details and asks to be notified immediately of any problems at school.
ADD or ADHD?
hyperactivity disorder is the official term for both, according to the Diagnostic and Statistical Manual IV, the bible of the mental-health profession. However, many professionals have a problem with the "H" when the person they are treating is not hyperactive, so they choose to use the term ADD (attention deficit disorder).
The DSM IV lists three major categories of ADHD; they're paraphrased here as they apply to teenagers in school:
1. ADHD, Predominately Hyperactive- Impulsive Type
These teens are often disruptive in the classroom, have difficulty concentrating, don't seem to listen or obey rules and may talk excessively and interrupt others.
2. ADHD, Predominately Inattentive Type
These are the kids who might be labeled ADD.
They are the "daydreamers." They are often slow to start and complete their work; easily distracted, forgetful and tend to lose things; may have spoken or written language problems (for example, difficulty taking notes); and may also have impulsive traits (fidgeting, getting up out of their seats).
3. ADHD, Combined Type, Hyperactive and Inattentive
These teens have all of the major symptoms of hyperactivity, impulsivity and inattention.
Still, Pardee can't relax; she's come to learn that advocating for Chris is a "full-time job." Chris' latest report card had this comment: "initiative needs to improve."
"Yes, this is from a veteran teacher who is very well aware of Chris' ADHD and has been present at his 504 meetings [meetings about making accommodations for Chris' needs]!" exclaims Pardee.
With limited resources, schools can be slow to respond when a child has special needs. Pardee says: "Once I took the time to research and learn exactly what Chris' rights are, and was able to sound somewhat confident in what I was saying, I was finally taken seriously."
One step at a time
While many families start planning for college or post-high school early in high school, a high-school diploma itself is often the grand prize for the ADHD student. Not that planning for the future isn't important — it is more than ever — but families with ADHD simply learn to take one step at a time.
While expectations may follow a different timetable or need to be revised, identifying interests (and goals) is critical, since people with ADHD are easily bored.
Today, Tom Dendy's son Steven is married with two children and the general manager of a manufacturing plant. Tom Dendy presented a brief survey of his academic career: graduation from high school, a year of college earning straight D's, working as an apprentice in the printing industry, getting an ADHD diagnosis and returning to college.
"Steven went back to college with two things going for him: Ritalin and a major in printing management — he wanted to major in something he had an interest in."
Tom continued: "In his major, he made all A's and B's. In fact, Steven is proud of the fact that he graduated from college with a higher GPA than his sister. Now she graduated in four years, where it took him six, but ... "
But the most surprising thing for Tom is the immaculate condition of Steven's yard and garage. "There is hope," Tom emphasizes. "Steven came a long way, didn't he?"
The world is full of successful people with ADHD, including David Neeleman, CEO of JetBlue Airways, who has become something of an ADHD "poster child" in his role as honorary chairman of the nonprofit organization Smart Kids with Learning Disabilities, Inc. Neeleman believes ADHD can even be an advantage in that it gives individuals "fearless innovation."
There is a future beyond missing assignments, failing tests and detention.
Melinda Tsuchiya is a freelance writer and the mother of a son who has ADHD. Her e-mail is: email@example.com.
Copyright © 2006 The Seattle Times Company