One thing was clear: 3 months after the rats stopped receiving Ritalin, the animals' neurochemistry largely had resolved back to the pre-treatment state.

Use of the attention deficit/hyperactivity disorder (ADHD) drug Ritalin by young children may cause long-term changes in the developing brain, suggests a new study of very young rats by a research team at Weill Cornell Medical College in New York City.

The study is among the first to probe the effects of Ritalin (methylphenidate) on the neurochemistry of the developing brain. Between 2 to18 percent of American children are thought to be affected by ADHD, and Ritalin, a stimulant similar to amphetamine and cocaine, remains one of the most prescribed drugs for the behavioral disorder.

"The changes we saw in the brains of treated rats occurred in areas strongly linked to higher executive functioning, addiction and appetite, social relationships and stress. These alterations gradually disappeared over time once the rats no longer received the drug," notes the study's senior author Dr. Teresa Milner, professor of neuroscience at Weill Cornell Medical College.

The findings, specially highlighted in the Journal of Neuroscience, suggest that doctors must be very careful in their diagnosis of ADHD before prescribing Ritalin. That's because the brain changes noted in the study might be helpful in battling the disorder but harmful if given to youngsters with healthy brain chemistry, Dr. Milner says.

In the study, week-old male rat pups were given injections of Ritalin twice a day during their more physically active nighttime phase. The rats continued receiving the injections up until they were 35 days old.

"Relative to human lifespan, this would correspond to very early stages of brain development," explains Jason Gray, a graduate student in the Program of Neuroscience and lead author of the study. "That's earlier than the age at which most children now receive Ritalin, although there are clinical studies underway that are testing the drug in 2- and 3-year olds."

The relative doses used were at the very high end of what a human child might be prescribed, Dr. Milner notes. Also, the rats were injected with the drug, rather than fed Ritalin orally, because this method allowed the dose to be metabolized in a way that more closely mimicked its metabolism in humans.

The researchers first looked at behavioral changes in the treated rats. They discovered that — just as happens in humans — Ritalin use was linked to a decline in weight. "That correlates with the weight loss sometimes seen in patients," Dr. Milner notes.

And in the "elevated-plus maze" and "open field" tests, rats examined in adulthood three months after discontinuing the drug displayed fewer signs of anxiety compared to untreated rodents. "That was a bit of a surprise because we thought a stimulant might cause the rats to behave in a more anxious manner," Dr. Milner says.

The researchers also used high-tech methods to track changes in both the chemical neuroanatomy and structure of the treated rats' brains at postnatal day 35, which is roughly equivalent to the adolescent period.

"These brain tissue findings revealed Ritalin-associated changes in four main areas," Dr. Milner says. "First, we noticed alterations in brain chemicals such as catecholamines and norepinephrine in the rats' prefrontal cortex — a part of the mammalian brain responsible for higher executive thinking and decision-making. There were also significant changes in catecholamine function in the hippocampus, a center for memory and learning."

Treatment-linked alterations were also noted in the striatum — a brain region known to be key to motor function — and in the hypothalamus, a center for appetite, arousal and addictive behaviors.

Dr. Milner stressed that, at this point in their research, it's just too early to say whether the changes noted in the Ritalin-exposed brain would be of either benefit or harm to humans.

"One thing to remember is that these young animals had normal, healthy brains," she says. "In ADHD-affected brains — where the neurochemistry is already somewhat awry or the brain might be developing too fast — these changes might help 'reset' that balance in a healthy way. On the other hand, in brains without ADHD, Ritalin might have a more negative effect. We just don't know yet."

One thing was clear: 3 months after the rats stopped receiving Ritalin, the animals' neurochemistry largely had resolved back to the pre-treatment state.

"That's encouraging, and supports the notion that this drug therapy may be best used over a relatively short period of time, to be replaced or supplemented with behavioral therapy," Dr. Milner says. "We're concerned about longer-term use. It's unclear from this study whether Ritalin might leave more lasting changes, especially if treatment were to continue for years. In that case, it is possible that chronic use of the drug would alter brain chemistry and behavior well into adulthood."

This work was funded by the U.S. National Institutes of Health.

Co-researchers included Dr. Annelyn Torres-Reveron, Victoria Fanslow, Dr. Carrie Drake, Dr. Mary Ward, Michael Punsoni, Jay Melton, Bojana Zupan, David Menzer and Jackson Rice — all of Weill Cornell Medical College; Dr. Russell Romeo of The Rockefeller University, New York City; and Dr. Wayne Brake, of Concordia University, Montreal, Canada.

Source: news release issued by Weill Cornell Medical College.

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The depression symptoms listed here, may signal that you, or someone you love may be depressed.

Depression is one of the world's oldest and most common ailments. It can have both physical and psychological symptoms. Millions of Americans are estimated to suffer from depression, a condition so widespread that it has been dubbed "the common cold of mental illness."

Even so, depression is widely misunderstood. Myths and misconceptions have led many people to believe things about depression that simply are not true. Depression is associated with many symptoms and not everyone has the same ones. Some people have many symptoms of depression, while others may only have a few. The depression symptoms below may signal that you or someone you love may be depressed:

1. Appearance - Sad face, slow movements, unkept look
2. Unhappy feelings - feeling sad, hopeless, discouraged, or listless
3. Negative thoughts - "I'm a failure," "I'm no good," "No one cares about me."
4. Reduced activity - "I just sit around and mope," "Doing anything is just too much of an effort."
5. Reduced concentration
6. People problems - "I don't want anybody to see me," "I feel so lonely."
7. Guilt and low self-esteem - "It's all my fault," "I should be punished."
8. Physical problems - Sleeping problems, weight loss or gain, decreased sexual interest, or head aches
9. Suicidal thoughts or wishes - "I'd be better off dead," "I wonder if it hurts to die." Seeking Help for Depression

Seek help for depression if you:

• Are thinking about suicide;
• Are experiencing severe mood swings;
• Think your depression is related to other problems that require professional help;
• Think you would feel better if you talked with someone; or
• Don't feel in control enough to handle things yourself.

Finding Help for Depression

• Ask people you know (your physician, clergy, etc.) to recommend a good therapist;
• Try local mental health centers (usually listed under mental health in the telephone directory);
• Try family service, health, or human service agencies;
• Try outpatient clinics at general or psychiatric hospitals;
• Try university psychology departments;
• Try your family physician; or
• Look in the yellow pages of your phone book for counselors, marriage and family therapists, or mental health professionals.

(Source: Center for Disease Control, Clemson Extension)

For the most comprehensive information about Depression, visit our Depression Community Center here, at HealthyPlace.com.

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Studies have shown that children with ADHD are at higher risk of depression and other mood disorders.

Several well-conducted studies have shown that rates of depression are significantly higher in children with ADHD than in other children. This is concerning because children with ADHD and depression, in addition to experiencing greater distress in the present are likely to have greater difficulty over the course of their development.

One prominent theory is that the relationship between ADHD and depression may result from the social/interpersonal difficulties that many children with ADHD experience. These difficulties can lead important others in the child's life to develop negative appraisals of the child's social competence that are communicated to the child during the course of ongoing negative social exchanges. With increasing age, these negative social experiences and others' negative appraisals can adversely affect children's view of their social competence, which, in turn, can predispose them to develop depressive symptoms. An interesting study published in the Journal of Abnormal Child Psychology was designed to test this theory (Ostrander, Crystal, & August [2006]. Attention Deficit-Hyperactivity Disorder, Depression, and Self- and Other Assessments of Social Competence: A Developmental Study. JACP, 34, 773-787.

Additionally, in children with ADHD, the existence of a comorbid condition, such as depression, is correlated with greater likelihood that the symptoms will persist into adulthood. As the child moves from adolescence to adulthood, the predominant symptoms of ADHD tend to shift from external, visible ones to the internal symptoms.

Mood disorders: Mood Disorders include Major Depression, Dysthymia (Chronic low-level depression) and Bipolar Disorder (Manic Depressive Disorder.) These are present in many individuals with ADHD. Usually, depression starts later than the first onset of the ADHD. There has been some debate about the incidence of Bipolar Disorder in individuals with ADHD. Some might say that rapid mood shifts and frequent irritability are characteristics of ADHD. Others diagnose a rapid-cycling mood disorder. Recurrent major depression is more common in adults with ADHD than in non-ADHD adults. However, one must also be aware that depression can be a side effect of stimulants and several other medications. Because stimulants have been known to exacerbate depression and mania, one should usually treat the mood disorder before treating the ADHD.

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Depression is not uncommon. Unfortunately, many walk around with untreated depression. Here's what you need to know about taking care of depression.

Let us get rid of some myths about depression right away. Depression is not a sign of weakness. It is not a lack of character or courage. Abraham Lincoln and Winston Churchill are two of the many historic figures known to have suffered from serious depression. Well-known and highly respected figures from all walks of life are among the millions of people who experience depression.

Being depressed is not uncommon. The most common complaint of people who seek counseling is that of feeling depressed. In fact, it is estimated that over six million people in the United States need professional help for depression.

If you think you are depressed, or someone you love is depressed, here are some steps to take that may help.

Taking Care of Depression

In those cases where a difficult life situation has led to depression, self-help steps can be taken to control it.

Face Up to Depression

Guilt and denial waste energy and do not help solve the problem. Acceptance of the depression relieves pressure.

Recognize the Problem

If your depression is the result of a loss, try to identify the exact time when the loss and feelings of depression began. What was the cause? Why did it happen? What do you need to do now?

Take Action

Often depression responds to structure. Combine structured activities with opportunities to release the turbulent feelings that often accompany depression.

• Get busy doing things you previously enjoyed. Don't cut yourself off from family and friends. Attend activities with others even if you don't feel like talking.
• Stay active. Counteract the physical slowdown of depression by exercising (examples: walk, jog, bowl, play tennis).
• Watch your diet. Include raw vegetables and fruits to increase your energy level.
• List ways you can let go of your depression.
• Listen. Tapes offer a relaxed way to listen to helpful information. There are excellent "self-help" videos available through libraries, book stores, and special catalogs.
• Read. There are many self-help books and pamphlets that can help you understand your emotions and give suggestions on overcoming problem areas in your life.
• Answer these questions:
  • Do I really want to change?
  • What benefits do I get from being depressed?
  • What does it do for me?
  • What payoffs would I get if I let go of my depression?
  • If I were not depressed, what would I be doing?

Seeking Help for Depression

Seek help if you:

• Are thinking about suicide;
• Are experiencing severe mood swings;
• Think your depression is related to other problems that require professional help;
• Think you would feel better if you talked with someone; or
• Don't feel in control enough to handle things yourself.

To find help:

• Ask people you know (your doctor, clergy, etc.) to recommend a good therapist;
• Try local mental health centers (usually listed under mental health in the telephone directory);
• Try family service, health, or human service agencies;
• Try outpatient clinics at general or psychiatric hospitals;
• Try university psychology departments;
• Try your family physician; or
• Look in the yellow pages of your phone book for counselors, marriage and family therapists, or mental health professionals.

Sources: Center for Disease Control, Clemson Extension

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Depression is defined as an illness when the feelings of sadness, hopelessness, and despair persist and interfere with a child or adolescent's ability to function.

Though the term "depression" can describe a normal human emotion, it also can refer to a mental health illness. Depressive illness in children and teens is defined when the feelings of depression persist and interfere with a child or adolescent's ability to function.

Depression is common in teens and younger children. About 5 percent of children and adolescents in the general population suffer from depression at any given point in time.

Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Teenage girls are at especially high risk, as are minority youth.

Depressed youth often have problems at home. In many cases, the parents are depressed, as depression tends to run in families.

Over the past 50 years, depression has become more common and is now recognized at increasingly younger ages. As the rate of depression rises, so does the teen suicide rate.

It is important to remember that the behavior of depressed children and teenagers may differ from the behavior of depressed adults. The characteristics vary, with most children and teens having additional psychiatric disorders, such as behavior disorders or substance abuse problems.

Mental health professionals advise parents to be aware of signs of depression in their children.

If one or more of these signs of depression persist, parents should seek help:

Frequent sadness, tearfulness, crying
Teens may show their pervasive sadness by wearing black clothes, writing poetry with morbid themes, or having a preoccupation with music that has nihilistic themes. They may cry for no apparent reason.

Hopelessness
Teens may feel that life is not worth living or worth the effort to even maintain their appearance or hygiene. They may believe that a negative situation will never change and be pessimistic about their future.

Decreased interest in activities; or inability to enjoy previously favorite activities
Teens may become apathetic and drop out of clubs, sports, and other activities they once enjoyed. Not much seems fun anymore to the depressed teen.

Persistent boredom; low energy

Lack of motivation and lowered energy level is reflected by missed classes or not going to school. A drop in grade averages can be equated with loss of concentration and slowed thinking.

Social isolation, poor communication

There is a lack of connection with friends and family. Teens may avoid family gatherings and events. Teens who used to spend a lot of time with friends may now spend most of their time alone and without interests. Teens may not share their feelings with others, believing that they are alone in the world and no one is listening to them or even cares about them.

Low self esteem and guilt

Teens may assume blame for negative events or circumstances. They may feel like a failure and have negative views about their competence and self-worth. They feel as if they are not "good enough."

Extreme sensitivity to rejection or failure

Believing that they are unworthy, depressed teens become even more depressed with every supposed rejection or perceived lack of success.

Increased irritability, anger, or hostility

Depressed teens are often irritable, taking out most of their anger on their family. They may attack others by being critical, sarcastic, or abusive. They may feel they must reject their family before their family rejects them.

Difficulty with relationships

Teens may suddenly have no interest in maintaining friendships. They'll stop calling and visiting their friends.

Frequent complaints of physical illnesses, such as headaches and stomachaches

Teens may complain about lightheadedness or dizziness, being nauseous, and back pain. Other common complaints include headaches, stomachaches, vomiting, and menstrual problems.

Frequent absences from school or poor performance in school

Children and teens who cause trouble at home or at school may actually be depressed but not know it. Because the child may not always seem sad, parents and teachers may not realize that the behavior problem is a sign of depression.

Poor concentration

Teens may have trouble concentrating on schoolwork, following a conversation, or even watching television.

A major change in eating and/or sleeping patterns

Sleep disturbance may show up as all-night television watching, difficulty in getting up for school, or sleeping during the day. Loss of appetite may become anorexia or bulimia. Eating too much may result in weight gain and obesity.

Talk of or efforts to run away from home

Running away is usually a cry for help. This may be the first time the parents realize that their child has a problem and needs help.

Thoughts or expressions of suicide or self-destructive behavior

Teens who are depressed may say they want to be dead or may talk about suicide. Depressed children and teens are at increased risk for committing suicide. If a child or teen says, "I want to kill myself," or "I'm going to commit suicide," always take the statement seriously and seek evaluation from a child and adolescent psychiatrist or other mental health professional. People often feel uncomfortable talking about death. However, asking whether he or she is depressed or thinking about suicide can be helpful. Rather than "putting thoughts in the child's head," such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems.

Alcohol and Drug Abuse

Depressed teens may abuse alcohol or other drugs as a way to feel better.

Self-Injury

Teens who have difficulty talking about their feelings may show their emotional tension, physical discomfort, pain and low self-esteem with self-injurious behaviors, such as cutting.

Early diagnosis and medical treatment are essential for depressed children.

Depression is a real illness that requires professional help, self-help, and support from family and friends.

Comprehensive treatment often includes both individual and family therapy. Although there are some real and frightening concerns about antidepressant medication, most mental health professionals continue to recommend their use.

There are several ways to get referrals of qualified mental health professionals, including the following:

• First, check with your insurance company for any limitations.
• Talk to family members and friends for their recommendations. If you participate in a parent support group, such as Because I Love You and ToughLove, ask other members for their recommendations.
• Ask your child's primary care physician or your family doctor for a referral. Tell the doctor what is important to you in choosing a therapist so he or she can make appropriate recommendations.
• Inquire at your church, synagogue, or place of worship.
• Call the professional organizations listed on this page for referrals.
• Network the resources listed on your state's Family Help page.
• Look in the phone book for the listing of a local mental health association or community mental health center and call these sources for referrals.

Ideally, you will end up with more than one therapist to interview. Call each one and request to ask the therapist some questions, either by phone or in person. You may want to inquire about his or her licensing, level of training, their expertise, approach to therapy and medication, and participation in insurance plans and fees. Such a discussion should help you sort through your options and choose someone with whom you believe you and your teen might interact well.

For the most comprehensive information about Depression, visit our Depression Community Center here, at HealthyPlace.com

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Q. Can bipolar disorder mimic ADHD with depression, or vice versa? Can lithium work with ADHD? Or do we have a strange mix of disorders in our genetics? It seems that these disorders are similar but diagnosed differently, and people wind up on different medications, such as Ritalin (Methylphenidate) for some and lithium (Eskalith) for others.

A. The relationship between attention deficit hyperactivity disorder (ADHD) and bipolar disorder is not quite clear. There have been some studies showing no relationship, others showing that bipolar disorder is unusually common in children or adolescents with ADHD. There are also some individuals who, by the luck of the draw, end up with both disorders -- a state termed "comorbidity." This refers to the chance occurrence of two conditions, without implying any genetic or physiologic similarity. Some clinicians have speculated that ADHD is a kind of "precursor" to later development of bipolar disorder, but this has not been proven. There is some symptomatic overlap between ADHD and individuals with hypomanic symptoms, such as unusual amounts of motor activity and tendency to be overexcited and "rub people the wrong way."

How to Tell The Difference Between Bipolar Disorder and ADHD

Untreated, both ADHD and bipolar individuals often end up "self-medicating" with alcohol or other substances of abuse, leading to more disturbed behavior and mood swings. In theory, someone with rapidly recurring unipolar major depression and ADHD might seem to mimic bipolar disorder, appearing superficially to fluctuate between depression and hypomania (which is less severe than mania). However, the true bipolar patient with hypomania usually shows a constellation of signs and symptoms of an elevated mood state, such as excessive spending, grandiose ideas, increased sexual or social activity and decreased need for sleep. It would be the rare ADHD individual who would show two or more of these at the same time.

Moreover, ADHD is constant--it doesn't come and go in the way that bipolar disorder does. Family history can be an important clue. If there is a family history of clear bipolar disorder, that helps make the diagnosis. Also, individuals with ADHD will usually improve with Ritalin. The patient with bipolar disorder (in the hypomanic state) will worsen, often going into a full-blown manic state. There is no credible evidence that I know of showing that lithium is effective for ADHD, though it may help patients with both bipolar disorder and ADHD.

For the most comprehensive information about Depression, visit our Depression Community Center here, at HealthyPlace.com.

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Here are some typical myths that still exist regarding attention deficit hyperactivity disorder:

MYTH: Attention Deficit Hyperactivity Disorder (ADHD) doesn't really exist. It's simply the latest excuse for parents who don't discipline their children.

Scientific research tells us ADD is a biologically-based disorder that includes distractibility, impulsiveness, and sometimes, hyperactivity.

MYTH: Children with ADD are no different from their peers; all children have a hard time sitting still and paying attention.

The behavior of children with ADHD must differ greatly from their peers to be considered for the diagnosis of ADHD. The characteristics of ADD that appear between ages three and seven, include:

Poor Social Skills

It's also typical for children with add/adhd to exhibit poor social skills. Among the most common difficulties are:

• Reciprocity: (waiting one's turn, non-dominating participation, appropriately entering an ongoing conversation)

• Handling Negatives: (criticism, accepting a "no" to a request, responding to teasing, losing gracefully, disagreeing without criticizing)

• Self Control: (handling peer pressure, resisting temptations)

• Communication: (understanding and following directions, answering questions, appropriate conversation, being an alert listener, showing empathy)

• Winning people over: understanding boundaries, honoring the boundaries of others, being courteous, doing favors, being thoughtful, lending, sharing, showing interest in others, showing gratitude, giving compliments. (2)

While these children often have poor social skills which alienate them from peers and make them appear distant to teachers, the good news is that they can learn these skills. However, they must be consciously taught and consciously learned. Children with ADHD don't pick them up along the way, as the average child normally does.

Mentoring from an older child, group or individual counseling, and parental instruction in very short sessions conducted in an encouraging atmosphere, are effective ways to teach social skills. Group counseling can be particularly effective as children can role play their skills while gaining feedback and encouragement. (3)

Other Issues to Be Aware Of

ADHD children are poor at deciphering other's feelings, as well as their own feelings. They don't effectively read body language or facial expressions. They may say something harsh or blunt and have no idea they've hurt someone's feelings. They may interrupt and monopolize conversations, and they may appear bossy. (4)

Teenagers with ADHD/ADD are more likely to get into trouble at school by misbehaving, being defiant, or skipping school. Dr. Russell Barkley found in studies that they have significant problems with "stubbornness, defiance, refusal to obey, temper tantrums, and verbal hostility toward others". (5)

"Many ADHD children are aggressive and noncompliant with the requests of others. Their impulsivity and overactivity may cause them to physically interfere with others, even when they have no intent to harm. The ADHD child's attentional difficulties, as well as other factors, may cause them to seem deaf to the commands of teachers and parents and lead to noncompliance with even the simplest request."(6)

Their failure to develop and maintain successful relationships results from an inability to: (7)

1. express ideas and feelings

2. understand and respond to the ideas and feelings of others

3. evaluate the consequences of behavior before speaking or acting

4. adapt to situations that are unfamiliar and unexpected

5. recognize the effect of behavior on others

6. change behavior to an appropriate response to adjust to situation

7. generate alternative solutions to problem situations

8. clueless behavior combined with a quick temper, poor impulse control and disruptive

9. behavior in group situations leads to peer rejection.

The student's cognitive, behavioral, social and emotional age equivalents are approximately 2/3 the student's chronological age.(8)

Other typical behaviors include:

• Constantly touching others

• Difficulty reading or following written or verbal directions

• Risk-taking behaviors

• Grabbing things from other students

• Talking to others during quiet activities

• Drumming fingers, tapping pencil

• Excessive running and climbing

• Playing with objects

• Shifting from one uncompleted activity to another

• Throwing things

• Is easily over-aroused by disorganization in classroom, loud noisy situations and large crowds

Some of the most difficult situations may occur in the hallways between classes, in the cafeteria, at P.E., and on the school bus. Students often complain about being teased, embarrassed and touched by other students in these unrestricted situations. Changes in routine increases stress and can produce overarousal, anger, and anxiety.

Not all children with ADHD will exhibit all the above symptoms and behaviors. However, it's not unusual to see a child exhibit many of these difficulties over a period of time.

From current research, behaviors appear to progressively deteriorate as the child grows older if appropriate intervention doesn't take place during the early years of school. These children need a team effort, both at home and at school, to reduce unwanted behaviors and replace them with positive behaviors. It isn't the parents' problem alone. Everyone must pull together to understand and work with this disorder.

The most important subject for these children is Social Skills, and unfortunately that's not a widely offered "course". Without social skills and the ability to get along within the larger community, the rest of a child's education is diminished. These children need help not punishment, training not isolation, encouragement not rejection. They have many unique talents to build upon if we just look for them. They tend to be creative, resourceful, intuitive, inventive, sensitive, artistic, and anxious to please. Let's work together to bring out the best in them.

Notes

(endnote 1) ATTENTION DEFICIT DISORDER: Beyond the Myths," developed by the Chesapeake Institute, Washington, D.C., as part of contract #HA92017001 from the Office of Special Education Programs, Office of Special Education and Rehabilitative Services, United States Department of Education. " The points of view expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Education." (This booklet is widely distributed by CH.A.D.D.)

(endnote 2) Taylor, John F. "Hyperactive/Attention Deficit Child", Rocklin, CA: Prima Publishing 1990

(endnote 3) Taylor, John F. "Hyperactive/Attention Deficit Child

(endnote 4) Dendy, Chris A. Zeigler. "Teenagers with ADD, A Parents Guide", Bethesda, MD, Woodbine House, Inc., 1995

(endnote 5) Barkley, Russell A. "Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment ", New York: Builford Press 1990

(endnote 6) New Mexico State Department of Education, "Attention Deficit Disorder Practices Manual", 1993

(endnote 7) Dornbush, Marilyn P., and Pruitt, Sheryl K. "Teaching the Tiger: A handbook for Individuals Involved in the Education of Students with Attention Deficit Disorders, Tourette Syndrome or Obsessive-Compulsive Disorder". Duarte, CA: Hope Press 1995

(endnote 8) Barkley, Russell A. "New Ways of looking at ADHD", Lecture, Third Annual CH.A.D.D.Conference on Attention Deficit Disorder, Washington, D.C. 1990.

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(Don't leave home without them!)

It's not difficult to address your child's needs at an Individualized Education Plan (IEP) meeting, so long as you're thoroughly prepared. Learn all you can about ADHD and any learning disabilities involved. Do some reading and research on what interventions are likely to produce positive results.

If you believe your child's disability seriously impacts academic success, you have the right to ask, in writing, for a full educational evaluation. If your child qualifies, then special services can be provided. If the qualification falls under the Individuals with Disabilities Act, then your child will have a written Individualized Education Plan, or IEP, prepared for him/her.

A team, comprised of various school officials, experts, and you will prepare the IEP. As parents, you are members of that team and your opinion is as important as any other team member. In fact, the federal government acknowledges, you are truly the expert on your child with knowledge no one else has. Go to the table well-informed and ready to lay some options of your own. Know what can work and decide what options won't be acceptable. Then review your child's evaluations and prepare to write a parent attachment. Normally, you'll request an opportunity to read this attachment at the beginning of the IEP meeting.

Understand your child's last multi-evaluation results.

Assuming your child has already been tested for the level of his learning skills, it's important for you to understand what those scores actually mean. If you need help with that, here's an excellent article on the subject.

Don't pay attention to "composite" scores, or "averages". With disabilities, you need to be concerned about scattered, or individual, scores. Pay attention to every low score. Even if you don't understand everything about every subtest, write down all those low scores and your questions about each one. "What does this particular test measure? What does that result mean to my Johnny and his teacher in the classroom? What is the likely impact?" Again, do not be distracted by discussions of "averages".

The First Document: Write your own version of your child's PLPs or Present Levels of Performance.

Get out the last Individualized Education Plan, or IEP, and place it next to the evaluation. Is every need in the evaluation reflected in the IEP? Are the recommendations in the evaluation reflected in the IEP? Now--after taking a minute for gnashing your teeth and groaning, it's time to get to work fixing things up.

Hopefully, you're familiar with the term "Present Level of Educational Performance" or PLP or PLOP. It describes, in measurable terms, where your child is performing in his/her areas of need. Those measurements are usually scattered throughout an IEP and are sometimes subjective.

I was especially impressed (cynicism here) with the PLP that read "Johnny's English is better. He's doing real good." If your child's performance in any area can't be measured in numbers, it's subjective. Make sure the evaluation comments are measurable and written into the PLP in all areas where special ed help is needed. If the school hasn't given you more recent objective,measurable, information, take the measurements from the last evaluation. Go to the meeting with the same kind of measurable information you expect from the school.

The U.S. Dept of Ed has demonstrated an alternative way of writing PLP's.

I tried it and was amazed at how it kept parents, and the rest of the team, focused on the whole child and his/her needs. While the district writes the actual PLP, you can certainly write your own and just call it A Picture of Joanie, for example. I recommend this description be at the very top of the parent attachment.

Try writing a long narrative about your child.

Take pen in hand, think about your daughter or son, get a picture in your mind, and start writing. Describe his/her disposition, personality, (shy or out-going, laid-back or sensitive, etc.), likes, dislikes, sensitivities, medical conditions that impact education, and level of self-esteem. Work in those measurable test results, showing a need for help in those areas.

Write about the strengths, be they in art, hands-on mechanical skills, writing, storytelling, etc. End with the dreams of where your child sees him/herself in 10-15 years; whether college is in those dreams, or a vocational-technical school, or if there's a need to get training out in the community while still in high school. You'd be surprised at the answers even second grade children with disabilities give to these questions. They can show great faith in the future, and sometimes awesome maturity at a tender age.

Now see if you can whittle those three pages down to one. Stick to the basics, other than one good emotional paragraph because, after all, you ARE the mom or dad and your emotional feelings can have an impact on the rest of the team members.

Come on, give it a try. Usually, parents really enjoy this exercise once they start writing. When finished, you'll have the first of the two documents completed. And, oh yes, don't forget to attach a picture of your child. That way, team members remember they aren't just dealing with a black-and-white sheet of paper, but a real, live human-being.

The second document is what I call a Parent Attachment. This document reflects all your specific concerns and your judgment of what your child needs. The plain truth is, if you're having to resort to these strategies, obviously your district hasn't served your child's needs. So it's important to get this down in writing.

I find that when a parent is well-informed about what's needed, it's much easier to get those needs met. It shouldn't be that way, but I understand the reality out there in many situations. Frequently, if the school doesn't point out a need, it's not going to be in the IEP. Hopefully, you'll have done some research on what can help your child's particular disabilities. With access to the net, an abundance information is now available.

Title

The following brief example is just to give you the idea of how these documents work together.

"A Picture of Joanie:" Your own PLP

Joan is a happy, outgoing, 12 year old with an average I.Q. and a tremendous interest in art and a great love of animals. She attends to tasks reasonably well, and takes pride in a job well done. She has acceptable fine motor control, but does have serious difficulty with large motor control. Her awkwardness has caused her embarrassment in front of her peers who do not appear to understand her disabilities.

Her self-esteem is quite low and she worries about people staring at her. She's performing at the 4th grade level in math, having made a whole year's progress this year with the extra teacher assistance and computer-assisted assignments.

Her reading level is at 2nd grade level, with difficulties in decoding, encoding, but some strength in comprehension. She particularly enjoys social studies because there's more movement and less paperwork than in other classes. With more hands-on activities, she's not so pressured by her deficit in reading.

Oral assignments and oral tests have encouraged her also. Joanie dreams of one day owning her own car, having a job, and moving to an apartment. She would like to volunteer at a zoo and work with animals when she's grown up. She dreams of going to college and getting a degree in animal husbandry.

Sample Parent Attachment

Joan Doe's IEP Meeting, (Date)

These are our concerns regarding our daughter's education:

1. Joan's walking gait causes numerous problems physically. Request physical therapy continue, at least 1/2 hr./week.

2. Her self-esteem is poor, and we request special emphasis be placed on her area of strength which is art. We request the district actively support a mentorship for her next year in this area, either in school or in the community. We will support that program in any way we can.

3. We also request a counselor who can help Joan deal with peer teasing. Her obvious reading deficit also sets her apart from peers. We are asking for intensive instruction by a teacher trained in multi-sensory teaching who can help Joan make true progress in reading. If the district doesn't have someone with these qualifications, we ask the district to provide a qualified tutor to teach her reading during the school day.

4. We would like to offer our assistance in helping to put on a seminar for the whole student body on disability sensitivity. Public education will hopefully build support for Joanie and others with disabilities.

5. Joan's learning style is both visual and kinesthetic; however, we have yet to see these methods intensively employed in teaching her. Joan does learn differently, but she's entitled to a teacher who knows how to reach her. Multi-sensory teaching is good for all students and we believe it's a reasonable request and necessary for her academic success.

6. Joan's I.Q. is in the average range and there's no excuse for her not to be making measurable, substantial progress. We expect all short-term objectives will be tested with measurable instruments and progress will be reported to us on a quarterly basis. We are willing to take responsibility for reminding the teachers of these meeting dates.

7. Homework may need modification if the time involved is more than 1 1/2 hours a night.

Get the idea? Now you can go into the meeting armed with both a total picture of your child, reflecting all the strengths and needs. You also have a written list of requests that you have pondered over and had plenty of time to work on in an unpressured, non-stressful environment. You'll feel much more in control, as you can focus on these two papers in front of you. Be sure to ask the leader of the meeting, before it starts, to let you lead off by reading your Parent Attachment. Otherwise, it can get lost in the shuffle. Once you read it out loud, and every person has a copy in front of him, you can always come back to it later on.

Do not sign anything, or leave the meeting, until you can check off every point you have written down. Was each item addressed? Was a decision made regarding each item?

Sometimes, one of your items becomes moot when something grand and wonderful happens, and you can actually cross it off and initial as "no longer needed". (Yes, I actually see that happen.) In fact, once you start using this method you'll likely see a lot less resistance than before. These poor folks often see "irate" parents, and they know how to handle that, because an irate parent is not in control of the situation. When you can come into the meeting with your priorities written down in a businesslike manner, then you'll begin to feel in control and will know you are a driving force at that meeting.

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The only way a child with special needs is going to be fully successful is with the cooperation of parents, school personnel, service providers, and, of course the student. Hopefully, things run smoothly and everyone is satisfied with the child's placement and progress. However, parents of a child with a disability know that bumps are likely to pop up along the road to academic success.

It's comforting to know that our education law has built-in protections to see that the necessary services are available to children. State regulations must, at the very least, meet the minimum federal regulations. They can be more, but not less, than the federal regs.

The Individuals with Disabilities Education Act, or IDEA, was reauthorized in 1997 and the new regulations have been published. (Note that Appendix C has become Appendix A.) Parents easily overlook this appendix which provides very practical answers to frequently asked questions regarding the law.

If your child isn't successful in school, he/she has the right to be evaluated and, if needed, have special services provided. You're entitled to ask for an evaluation to determine why your child isn't successful. Watch out for school officials using the phrase, "She or he will grow out of it." Children do not outgrow disabilities.

If you learn the basics of the law, and you use careful documentation procedures, you can truly be empowered as an important member of your child's education team. You should also know that your active participation in all educational decisions is expected under the new law.

You also need to be aware that schools may not use "the budget" or "conserving resources" as a reason to withhold services. This information is important under the new law, as school districts can now co-mingle special ed funds and regular ed funds, whereas before the two had to be accounted for separately.

This is good news and bad news. The good news is that districts which are making a positive effort to bring children with disabilities into the regular classroom with the needed supports and services for each child will have more flexibility when it comes to paying for those items. The bad news is, it can offer a district without that intent a way to perhaps shirk its responsibility to children with disabilities by just placing them in a regular ed class without providing the training, support, and expertise the teacher may need to be successful. So the good districts may get even better and the poor districts may have even less accountability.

It's up to you, as a parent, to get everything promised in writing and follow up on a regular basis to see if those promises are fulfilled. If your child is receiving special education services, this is accomplished through a well-written IEP (Individualized Education Program).

Hopefully any conflicts you have can be resolved on a local level, ideally within the school itself. If the first step doesn't work proceed on to the next level, always documenting what you are told. Remember, time is never, and I repeat never, on the side of the child. You have only 12 years to get that public education. Those years go by very quickly.

If you believe words are falling on deaf ears, there are several logical steps that will almost always lead to successful resolution of a problem:

• You have gone to the teacher who cannot offer a resolution.

  If your child is receiving services under IDEA, or accommodations under 504, I recommend calling for a meeting of team personnel directly involved with your child's education. It's been my experience, that at this point, any issue can be resolved if the team is focused on the needs of the child and the appropriate supports needed by the teaching staff are in place.

• If there's obvious disagreement at a team meeting, then write a Letter of Understanding and make an appointment to personally visit with the Director of Special Education. Take along any input from the teacher and pertinent testing or medical records.

  If your child hasn't received any special services, you may request the school- based assessment team meet to review the progress or problems. Ask for a timeline, or it can take a year for this team to try a number of interventions before referring to Special Ed for evaluation.

• If they say "there's no problem," and you know your child is not progressing as their peers are, take any input from the teacher and any pertinent records, i.e. medical or psychological records, directly to the Director of Special Education.

  If such a meeting isn't possible, or would be too long in coming, send a copy of any documentation you have collected along with a letter of concern to your State Department of Education. School administration can give you that address and phone number. You can also find it on the net. Include any "Letters of Understanding" you have written to local personnel. Hopefully, the State can intervene and may offer mediation.

• Mediation is strongly encouraged, but it's important to know you don't have to accept mediation. You have to use your judgment on how long you've been trying to resolve the differences, how much more time your child can afford to be without services, and whether you believe the district will act in good faith following through on recommendations that come out of mediation. Mediation is supposed to take place promptly, and I would ask for a timeline on it. It certainly can be a way to clear up many misunderstandings, as long as the district is willing to carry through on recommendations and you are willing to carry through in your supportive responsibilities.

  My experience, so far, has been that if both parties were really acting in good faith, you wouldn't have to have gone to the State in the first place. Hopefully with the new IDEA guidelines the decisions of mediation will be more binding.

• If you do not feel mediation might resolve the issues you have the right to file a formal complaint with your State Department of Education. They can give you the guidelines for filing. Usually it's a fairly short letter stating explicitly that you are filing a formal complaint against your school district on behalf of your child. State in a numbered list exactly what your concerns are. This keeps you focused. You do not want to generalize in this letter. It also enables the state to address all concerns precisely as you list them. Include copies of all correspondence, evals, IEP's, 504's, pertinent medical evaluations, etc.
  
  The clock starts ticking as soon as the State receives your complaint. By law, they have 60 days to resolve your complaint, although in my experience they do it much more quickly than that. They will recommend mediation and should advise you, however, that you do not have to accept mediation. They should advise that you may postpone the complaint, drop the complaint, or ask for an investigation which means the 60 deadline for resolution goes into effect.

• It is important to include all your issues in the initial complaint, as any new issues added later can start the 60 day clock ticking all over again from the beginning.

Hopefully, by following healthy, effective communication procedures and keeping good documentation you will never have to file such a complaint. However, the complaint process is still viewed as a friendly way to resolve issues drawing on the technical assistance and expertise that State level personnel possess. It doesn't involve lawyers or any legal expenses. The only cost is paper and return-receipt-requested postage.

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Fortunate is the child with ADHD whose teacher is flexible, innovative, and consistent in providing reminders and organizational tips. This child will have a head start in gaining academically and socially, with increased self-confidence and self-esteem. There are a number of tips that can make life easier for both student and teacher. You, as the parent, can suggest these tips and request they be written in an IEP if your child needs them.

The teacher can be a tremendous influence on how peers view your child. However, teachers as well as others often hold misconceptions and bias towards children with ADHD. Your child is entitled to teachers who have a basic understanding of the disability. Teachers should be provided any training necessary to acquire the tools and strategies necessary for your child's academic and social success. Such training and understanding can be gained in a reasonably short time at any number of high powered workshops held nationwide each year. You have the right to request teachers receive such basic training. With education come understanding and competency, as well as tolerance and respect for the child who learns differently. Indeed, I believe tolerance, mutual respect, and self-respect are the most important elements of a child's education.

If your child has a teacher who is set in the "old ways," has a "my-way or no-way attitude," and views ADHD simply as an excuse for poor performance, I would head right to the principal and request a change of teachers immediately. You do have the right to expect someone with a genuinely positive attitude towards your child.

Successful teaching techniques for the child with ADHD are helpful for all students. It's pretty hard to fault visual reminders, peer tutoring, breaking tasks down into manageable units, use of computers, allowing controlled movement, and a providing a refuge when needed. (We all need that at times. Teachers hopefully have their lounge for short breaks.) If a teacher feels that your child would then have privileges others would not, you might suggest that such techniques be made available to the whole class.

Let's talk about some of these modifications and accommodations.

Great Classroom Accommodations for ADHD

Allow for extra movement. When given a choice, no ADHD child of mine ever sat at a table with feet on the floor to study homework. Indeed, when they had to study in a setting that didn't allow movement, their performance declined. I've seen classrooms where children are allowed to sit on low tables, or even under the tables, to read and write. The room was relatively quiet and orderly, even though there were a number of children with impulsivity and hyperactivity. You see, when the impulsivity and hyperactivity is accommodated, it tends to diminish with such accommodations.

Build a quiet corner. A soft rug, some beanbag chairs, make-due foam pillows in a back corner offers a more natural setting for leisure reading.

Study carrels offer privacy and personal space when needed. Carrels can be placed against the back wall or folding individual carrels can be constructed of hardboard and placed on the student's desk. Student can decorate as desired.

Preferential seating. ADHD students may perform better when seated near the teacher and where visual distractions are reduced. Others are so self-conscious when seated up front, it actually diminishes their performance. This has to be an individual call.

Have an escape hatch for this child. Children with ADHD don't filter incoming information as most people do. You know how you have a certain boiling point beyond which there's no return, until you blow your anger? Children with ADHD usually have a very low boiling point.

Additionally, the overload of sensory input from the natural noises and activities in a classroom can really aggravate the situation. Imagine how you'd feel if you were left in a room with a dozen TV's all blaring forth at the same time on different stations. Children with ADHD often can't distinguish between important incoming information and unimportant information. It all comes in at a feverish, screeching pitch when there's a lot of activity and noise. It's easy for them to totally lose control and no one else around them understands why.

By learning the danger signs, teachers and parents know when to intervene before a youngster loses it. This works at home, as well as at school. Build in breaks for these children if you see the frustration building. For teachers, send the child for a drink, let them sort papers for you by your desk, offer a wet paper towel to wipe their face, anything to give a bit of relief and to redirect them. Losing 5 minutes of teaching time may gain you several hours in the long run.

Home-school communication log. This has been the most valuable tool for staying on top of things. Teachers who haven't used such a log sometimes are apprehensive about the time involved, but once they get used to it, they find it makes life much easier.

As the parent, you accept the responsibility for seeing that it gets into the backpack for school. One person at school accepts responsibility for seeing that it's in the backpack to go home. At no time is this log ever used punitively to write unpleasant opinions or observations. It may include, and should include, encouraging notes from both parent and teachers. It can log any unusual concern and ask to visit with the other party. It can track unfinished homework and timelines for upcoming homework. Teacher and parent design it to fit their needs.

An extra set of books at home. Many parents and teachers are unaware that a child with organizational or impulsive difficulties has the right to have an extra set of curriculum books at home. If a child is distractible and forgetful and getting poor grades for unfinished assignments because books are left behind, ask for this accommodation. I know of a junior high that has recently provided this service for all its students. Life is much easier for everyone.

Classroom Strategies to Help ADHD Kids

Provide a structured setting. Children with ADHD function more successfully with well defined routines.

These children very often fall apart if their routine is suddenly changed or interrupted. Nowhere is this more apparent than when the class has a substitute teacher. In fact, we often find it necessary and helpful to define within a child's IEP what supports will go into place when there's a substitute teacher. It's helpful to assign an inhouse adult who knows the child to inform the substitute of any special needs and to assist when necessary.

Structure shouldn't be at the expense of novelty and innovative teaching techniques. A child with ADHD craves novelty and new ways to learn. Repetition can be extremely difficult to impossible, i.e. worksheets and writing spelling words over and over.

Give a warning shortly before a change of activity will take place. Since they can hyperfocus on an activity of interest, they can be easily frustrated when pulled away suddenly without warning. They often have difficulty transitioning from subject-to-subject.

If you use a reward system, stickers and charts are most likely meaningless to this child. Children with ADHD seem to be born entrepreneurs. A tangible reward, something the individual child enjoys, is much more successful. One team was horrified to learn a teacher had been giving a child a candy bar twice a week as part of working with unacceptable behaviors. The mom just laughed and said "she'll do anything for chocolate, good going!" You see, the teacher's carefully chosen reward was meaningful to the child and had resulted in turning around some really negative habits over the course of that semester.

Children with ADHD are particularly vulnerable to overexcitement and lack of structure at times of transition between classes, at lunchtime, and before or after school. It may be necessary for such a child to pass at a different time, have close supervision, and be redirected if off-task. These are peak times for them to get in trouble for shoving, shouting, speaking out of turn, etc. They don't do well with waiting in line due to both impulsivity and/or hyperactivity. There are creative ways to work around such problem times, but the team needs to brainstorm together on the setting, the time of the repeated problems, and what personnel need to be involved to provide supports.

Children with repetitive behavior issues could be considered for a positive behavior plan and possibly an alternative discipline plan. Through such interventions, they're most likely to learn more appropriate behaviors. These plans can also prevent arbitrary and often unconstructive punishments handed down by personnel not knowledgeable about the child. Write in specific responses for common behavior issues.

Don't ever depend on a child with ADHD to independently ask you for help. They're usually very, very painfully aware of their shortcomings and want to hide them, not showcase them by physically approaching a teacher to ask for assistance. However, if you approach them discreetly, they're most likely to be very grateful for help. A visual cue understood by teacher and student can be helpful.

Children with ADHD often only process about 30% of what they hear. Repeat, repeat repeat. Say it, write it, draw it, sing it, whatever you can think of to present instructions in varying ways. Ask to have the student repeat what he hear you say.

Timed tests can be counterproductive for the child with ADHD who is easily distracted and who doesn't have a built-in sense of time. Frequently, uch tests don't allow this child to demonstrate what he or she actually knows.

More Classroom Tips for Teachers

This child craves praise and encouragement more than the average child. Even if the successes are small, encouragement pays off in higher self-esteem and self-confidence.

Help discover the hidden talents and strengths of the child. Building on the strengths in childhood can build a great foundation for work and leisure in the adult years.

Be aware that the typical child with ADHD has poor social skills and doesn't read nonverbal communication well. They can easily misread a situation. Role playing after the fact can help this child see how a situation might have played out. Asking, "How do you think you might do things differently next time?" can lead to improved problem solving skills as well as improved social skills. This is an excellent exercise for both home and school.

Work with the parents to establish consistent rules and similar rewards. This also demonstrates to the child that you're working with the parents and communicating with them.

Pairing an ADHD child with another student can sometimes assist concentration and organization. Peer tutoring can work wonders helping the child with ADHD stay focused. Sometimes just the nearby presence of a successful student assigned to help can make all the difference in the world. This also encourages the development of social skills.

Passing out a prewritten assignment list can help not only the ADHD child but also children with other disabilities to successfully complete homework. Emphasis on responsibility is shifted to the actual assignment rather than on poor organizational skills, visual perceptual skills, or dysgraphia, (a handwriting disability).

Novelty, novelty, and more novelty. Children with ADHD will not stay on task with repetitive activities. Their worst nightmare, (and teacher's in the long run) is worksheets. Unless it's reinforcing a new concept, they should be eliminated. Individual projects, work centers, an art project, research on the computer, all can reinforce learning areas in a way that will benefit all children. When given the opportunity, these children can come up with some powerful, creative, resourceful projects.

Close communication between home and school. Neither teacher nor parent can afford to let little problems that repeat themselves go unresolved. Little problems have a way of growing into gigantic problems that can damage relationships. Both parties must shoulder the responsibility of keeping the other informed.

Any list of rules for the child with ADHD should be simple and short. Pick your battles carefully. If a child is faced with too many rules, you're likely to get noncompliance to most of them. The child simply can't focus on all of them at the same time. It's amazing the progress that can be made if the focus is on small steps rather than giant leaps with these children. It's critical to keep in mind that the typical child with ADHD is about 30% behind his peers in emotional and social maturity. Because so many of these children are very bright, it's easy to forget their limitations.

Always be sure to have eye contact with this child before giving specific instructions. Some children can't handle close eye contact, and in this case a predetermined signal between student and teacher can be enough to focus attention.

Children with ADHD respond well to positive interventions and discipline strategies rather than punitive interventions. Since punishment only heightens an already over-stimulated brain, it's self-defeating in the long run.

If a child has an IEP and is receiving special ed services, the IEP document is now required to address what extra services and supports you, as the teacher, need in order to be successful with that child. That requirement is a result of the 1997 IDEA Amendments, which is the reauthorization of the Individuals with Disabilities Education Act. You should not hesitate to take part as a member of the IEP team and let them know if there is an area of concern, and how they can help you address those needs or concerns. You should also be able to rely on all team members, particularly your team administration member LEA for support and guidance when you need it. A good IEP will have those details listed in writing, so you'll know who in special ed is directly responsible to assist you.

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