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Developmental Assessment & Intervention CenterPLLC |
“Our only goal is to help children and adults fulfill their potential.”
–Dr. Risa Tabacoff, founder & director, DAIC
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| Untangling the Myths About Attention Disorder By PERRI KLASS, M.D. A version of this article appeared in print on December 14, 2010, on page D5 of the New York Times. As recently as 2002, an international group of leading neuroscientists found it necessary to publish a statement arguing passionately that attention deficit hyperactivity disorder was a real condition. In the face of “overwhelming” scientific evidence, they complained, A.D.H.D. was regularly portrayed in the media as “myth, fraud or benign condition” — an artifact of too-strict teachers, perhaps, or too much television. In recent years, it has been rarer to hear serious doubt that the disorder really exists, and the evidence explaining its neurocircuitry and genetics has become more convincing and more complex. Even so, I’ve lately read a number of articles and essays that use attention (or its lack) as a marker and a metaphor for something larger in society — for the multitasking, the electronic distractions, the sense that the nature of concentration may be changing, that people feel nibbled at, overscheduled, distracted, irritable. But A.D.H.D. is not a metaphor. It is not the restlessness and rambunctiousness that happen when grade-schoolers are deprived of recess, or the distraction of socially minded teenagers in the smartphone era. Nor is it the reason your colleagues check their e-mail in meetings and even (spare me!) conversations. “Attention is a really complex cognitive phenomenon that has a lot of pieces in it,” said Dr. David K. Urion of Harvard, who directs the learning disabilities and behavioral neurology program at Boston Children’s Hospital. “What we’re specifically talking about in kids with attention deficit is a problem compared to age- and gender-based peers in selective attention — what do you glom onto and what do you ignore?” Moreover, the disorder occurs along a broad spectrum, from mild to extreme. Boys are more likely to be hyperactive and impulsive, girls to be inattentive. (One reason many girls don’t get an official diagnosis is that those with the inattentive form may be well behaved in school, but still unable to focus.) “There’s a lot we still don’t know,” said Bruce F. Pennington, a professor of psychology at the University of Denver and an expert on the genetics and neuropsychology of attention disorders. “But we know enough to say it is a brain-based disorder, and we have some idea about which circuits are involved and which genes.” Imaging studies of people with attention deficits have shown a consistent pattern of below-normal activity in the brain’s frontal lobes, where so-called executive function resides. And scientists are focusing on the pathways for dopamine and similar neurotransmitters active in the circuits that pass information to and from the frontal lobes. Low levels of activity in specific circuits may help explain the seeming paradox of using stimulants like Ritalin to treat children who already seem overstimulated. In many children with A.D.H.D., these drugs can help the circuits function more normally. “If you have a deficit in dopamine, it’s harder to concentrate on goal-oriented behavior,” Professor Pennington said. “The psychostimulants change the availability of dopamine in these same circuits.” Although recent research has identified environmental factors that may increase the likelihood of developing the disorder, it is thought to have a stronger genetic component. Dr. Maximilian Muenke, chief of the medical genetics branch at the National Human Genome Research Institute, said that among identical twins, if one has A.D.H.D., the second has an 80 percent chance of having it as well. (Among fraternal twins, the comparable figure is 20 to 30 percent, the same as for any siblings.) Dr. Muenke’s group published a paper last month identifying a gene, LPHN3, that is associated both with the disorder and with a favorable response to stimulants. But no one thinks that just one gene is responsible; just as attention is a complex phenomenon, so are the genetics of attention deficits. When I asked Dr. Muenke whether genetic studies could someday play a role in treating the disorder, his reply was cautious. He spoke of eventually predicting which children will respond to specific medications, sparing families the frustration of switching from one medicine to another with no relief. He sounded more hopeful about the long-term prospects. “I truly believe in the long run we will be able to develop personalized medicine for a child with A.D.H.D.,” he said, adding that when the specific underlying cause or causes are known, “this child will have a very specific treatment, whether this treatment is behavioral treatment alone or medication,” and the medication will be tailored to the child. Perhaps eager to make clear that A.D.H.D. is far more than a metaphor for the distractions of modern life, scientists love to point out examples that date to well before the term was invented. Dr. Urion invoked Sir George Frederick Still, the first British professor of pediatric medicine, who in 1902 described the syndrome precisely, speaking of a boy who was “unable to keep his attention even to a game for more than a very short time,” and as a result was “backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be.” Dr. Muenke brought up “Der Struwwelpeter“ (“Slovenly Peter”), the 1845 children’s book by Heinrich Hoffmann, which contains the story of “Zappel-Philipp,” or “Fidgety Philip.” (One English translation was done by Mark Twain, that great chronicler of boys.) The circumstances of modern life can give rise to the false belief that a culture full of electronics and multitasking imperatives creates the disorder. “People have this idea that we live in a world that gives people A.D.H.D.,” Dr. Urion said. Of course one shouldn’t drive and text at the same time, he continued, but for “a harbor pilot bringing a huge four-masted sailing vessel into Boston Harbor, paying attention was a good idea then, too.” |
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We've Got Issues-
Children and Parents in the Age of Medication -by Judith Warner In this manifesto for change, New Yo
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College Board Changes Affect Students with Learning Disabilities
Parents take note: Back in September 2003, two important changes by The College Board, which provides the SAT as well as the PSAT and AP tests, took effect changing how colleges view students with learning disabilities. First any students who take the SAT’s (Scholastic Aptitude Test) with testing accommodations, such as extended time, will no longer have their scores "flagged" for colleges indicating that the "scores were obtained under special conditions". The admirable idea is to create a level playing field for those students with learning disabilities and prevent colleges from discriminating against them. Accommodations are granted to those students with learning disabilities who demonstrate a need based on psycho-educational testing and teachers input. A learning disability is defined as a significant discrepancy between a child’s ability (or IQ) and his school performance. Such students may need a little extra time on tests, not because they’re not as bright as other students, but because their brains process information differently. Many children receive some accommodations throughout their academic careers. Often this makes the difference between frustrated, under performing children with low self esteem and well adjusted, happy, high performing ones. This change is great news and long overdue for students with learning disabilities, which make up 6% of the national student population. At present only 2% of students seek test accommodations from the College Board. This low number may be partially due to concerns about the past flagging of scores and fears that schools might be hesitant to accept them. Now perhaps more students with learning disabilities will request and receive proper and appropriate SAT accommodations. The second important change concerns how such accommodations are granted. Comprehensive psycho-educational evaluations older than 5 years will no longer be accepted. On the national level, public and private primary grade schools use varying criteria for assessing and granting accommodations to students. One such accommodation is called a 504 which is given to students who do not fit the classification of Special Education, but have learning difficulties and therefore receive some modifications in their school program. These modifications can include extended time for testing, a structured learning environment, modified homework or any other modification that will help the student to succeed. But the College Board exams are all nationally standardized and therefore eligibility for accommodations must also be nationally standardized. Students who have been receiving accommodations at their school for less than 4 months will not be eligible to receive test accommodations on the SAT. They can however go through the SAT Appeal Process and challenge it. Even students with long term accommodations at their school are not guaranteed accommodations for the SAT. All students requesting accommodations for the SAT must submit documentation to the College Board at least 5 weeks prior to the SAT test date and for those going through the Appeal Process a minimum of 7 weeks is needed. Documentation required for SAT testing accommodations must: 1) State the specific disability; 2) Be current (within three years; one year for psychiatric disability); 3) Provide relevant educational, developmental and medical history; 4) Describe the comprehensive testing and techniques used to arrive at the diagnosis (including evaluation dates and test results with subtest scores from measures of cognitive ability, academic achievement, and information processing); 5) describe the functional limitations supported by the test results; 6) Describe the specific accommodations requested; and 7) Establish the professional credentials of the evaluator, including information about license or certification and area of specialization. |
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rk Times blogger Judith Warner (Perfect Madness: Motherhood in the Age of Anxiety, 2005, etc.) examines the argument that Americans are overmedicating their children.
A groundbreaking guide for parents that combines the latest brain research with the best classroom practices to reveal scientifically savvy ways to improve your child's success in school.