Davidson Institute for Talent Development
This Tips for Parents article is from a seminar hosted by Melanie Crawford, Ph.D., who addresses the assesment, understanding and treatment of ADHD and learning disabilities.
Assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) and Learning Disabilities (LD)
To help determine if your child has ADHD/LD, it is recommended that you seek a comprehensive evaluation of your child from a child neuropsychologist or clinical psychologist who specializes in neuropsychological assessment. In general, and evaluation for ADHD/LD should include a diagnostic interview, an intellectual assessment, tests of academic achievement, phonological processing skills (especially if the child struggles with reading or spelling), neuropsychological tests (e.g., tests that assess executive functioning, attention, motor skills, language, memory, visual-spatial processing, etc.), as well as parent, teacher, and self-report rating scales. Many evaluators also conduct a classroom observation of your child. In addition, the professional assessing your child should provide you with a feedback conference (where you go over the results of the testing) as well as a written report with treatment recommendations.
The primary deficits associated with ADHD are inattention, hyperactivity, and impulsivity. There are three subtypes of ADHD: primarily inattentive, primarily hyperactive/impulsive, and combined type. Most children with ADHD belong to either the inattentive subtype (showing mostly symptoms of inattention) or the combined type (demonstrating both inattention and hyperactivity/impulsivity).
Children with ADHD (regardless of subtype) often have deficits in executive functioning. Executive functions are a set of cognitive abilities that control and regulate other abilities and behaviors. Executive functions are necessary for goal-directed behavior. They include the ability to initiate and stop actions, to monitor and change behavior as needed, and to plan future behavior when faced with novel tasks and situations. Children with executive function deficits have problems organizing their materials as well as their behavior. They often act without thinking, have trouble getting started on assignments, and demonstrate difficulties keeping track of more than one or two steps at a time.
While some children with ADHD do show symptom improvement as they get older (especially with symptoms of hyperactivity/impulsivity), many children with ADHD continue to struggle with executive function skills throughout adulthood.
Treatment of ADHD
Research has shown that the most effective treatments of ADHD involve both therapy and stimulant medication. However, combined treatments are only slightly more effective than medication alone.
Medication: Most pediatricians and family doctors feel comfortable prescribing and managing stimulant medication in relatively straight forward cases of ADHD. However, it is recommended that parents seek consultation with a child psychiatrist to determine if medication is appropriate for their child.
Interventions at Home: Children with ADHD generally benefit from additional environmental structure and behavioral management techniques. Problematic behaviors and their antecedents should be carefully defined and additional environmental structure provided to assist in the development of more adaptive behaviors (which also need to be carefully defined). In general, it will be important to isolate a behavior of particular concern, develop strategies in conjunction with your child that will help him/her be successful in a situation, and then provide him/her with frequent recognition of his/her successes. However, because parenting a child with ADHD can be very challenging, it is often recommended that parent s work with a therapist in order to learn behavior management strategies, reduce family stress, and improve the child’s overall functioning.
Interventions at School: Children with ADHD typically benefit from accommodations/interventions within the school setting. For example, children with ADHD often require support in implementing time-management and organizational strategies. Breaking down large or long-term tasks into smaller, more manageable parts will increase the likelihood of task completion and reduce the sense of being overwhelmed. An assignment sheet or organizational notebook can also serve as an essential tool in helping children with ADHD keep track of their work. Children with ADHD often demonstrate difficulties keeping track of more than one or two steps at a time. Providing a written checklist of steps required to complete a task can serve as an external memory support. It is also often necessary to repeat instructions or new information for children with ADHD so that they may increase the amount of information captured. Children with ADHD should be paired with teachers who have experience in working with children that have attentional disorders as well as expertise in behavior modification. Children with ADHD also tend to function more effectively in classrooms that are well organized and have a predictable classroom routine.
Social Skills Training: Social skills deficits are also common for children with ADHD. Children with ADHD often benefit from formal social skills training focused on helping them develop strategies for emotion regulation, friendship skills, skills for understanding thoughts and feeling, conversation skills, as well as social problem solving skills. This therapy is often best implemented in the group setting where your children would have the opportunity to practice newly acquired skills with peers as well as meet other children with similar difficulties. However, social skills training may also be implemented within the context of individual therapy.
Special Considerations for Gifted Children: The ability to sustain focused attention does not necessarily increase with IQ. It is particularly important that highly gifted children be placed in an academic setting that engages them. Otherwise, their lack of stimulation and boredom may be confused for inattention. In addition, children who are intellectually gifted can often seem more intense, impatient, and sensitive than other children their age and this can sometimes be mistaken for a behavioral disorder such as ADHD. Thus, intellectual ability should always be assessed and considered when making the diagnosis of ADHD.
Additional Resources: The following books are useful for understanding more about ADHD and learning strategies to cope with it: Taking Charge of ADHD: The Complete Authoritative Guide for Parents, Revised Edition, by Russell Barkley and The Source for ADD/ADHD by Gail Richard. In addition, Children and Adults with Attention Deficit Disorders (www.chadd.org) is an organization that provides valuable information and support for parents of children with ADHD.
Specific Reading Disability (Dyslexia): Children with dyslexia have a deficit in phonological processing (ability to recognize sounds and their sequences in words), which affects the ability to learn and automate letter-sound correspondences. This results in slowed progress in reading and spelling. Children with dyslexia often benefit from intensive remediation that incorporates explicit, semantic phonics-based instruction. Techniques such as guided oral repetitive reading and speed drills as well as sight word list practice can be helpful in improving reading fluency (rate and accuracy). Several appropriate programs are available such as the Great Leaps program (greatleaps.com) and Read Naturally. Overall, it is recommended that the programs used conform to the theoretical guidelines outlined by the National Reading Panel (Put Reading First; The Research Building Blocks for Teaching Children to Read), which is available for download at http://www.literacytrust.org.uk/.
Specific Math Disability (Dyscalculia): Specific math disability is recognized as a specific learning disability. However, problems with math can often be a sign of another learning disorder. For example, children with ADHD often have trouble following the steps needed to complete a multi-step problem such as long division. Children with dyslexia commonly have problems with rote memory, which makes it difficult to memorize math facts (e.g., times tables). Problems with math that is visual-spatial in nature (e.g., fractions and geometry) can be a sign of something called nonverbal learning disorder (NLD).
Nonverbal Learning Disability: NLD is a disorder in which an individual shows markedly stronger verbal conceptual abilities than his/her nonverbal reasoning, motor, and spatial skills. Children with NLD typically have the most difficulty with the perception, organization, output, and conceptualization of nonverbal and spatial information. They often find handwriting and other visual-motor tasks problematic. Some aspects of math (especially those that rely on spatial understanding) are often difficult. Many children with NLD show excellent achievement in basic reading and spelling, but find comprehending the material (e.g., understanding the “big picture”) more difficult. Because novel situations require the rapid analysis of large amounts of nonverbal information, children with NLD often have difficulty with novelty and perform better in situations in which they understand the routine. Because they may over-attend to language information and fail to grasp the subtleties of nonverbal cues, social interaction difficulties are also very common. Treatments for NLD involve social skills training as well as school accommodations/interventions focused on improving nonverbal, spatial, and motor skills.