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Wednesday, August 17, 2016


Kristi Rose has been lucky enough to travel the world, but now as a wife and mother, she's resigned to traveling to the grocery store. When she's not practicing as a pediatric occupational therapist she's watching people and wondering about their story. Learn more about Kristi at her website/blog. Today she’s here to discuss a topic that worries many parents: ADD/ADHD.

This school year it's likely one of you will be called into a teacher conference or meeting and told your child has attention problems. Last year, I was the one called in. But I had an advantage.

I'm a pediatric occupational therapist and for most of my eighteen years of experience I've practiced in schools or early intervention (birth to three programs). I've seen the rising rates of kids being called ADD/ADHD, and it's frightening. Even more so that many kids are being misdiagnosed and unnecessarily medicated.

DISCLAIMER: I'm not telling you NOT to medicate your child. But hope to provide additional information so that you can get to the root of your child's issue and address that—a solution that may not require any medication whatsoever.

When my son's teacher gently introduced the attention issue, I told her I didn't believe her. Is my son a little...quirky. Yep. Does he daydream? You bet. And to make matters worse, he didn't like her or the school. So he wasn't invested. He did finish the year (2nd grade, mind you) on honor roll for the entire year, awarded student of the month, given a best manners and good friend award.  Sorry folks, that's not the hallmark of an ADD/ADHD kid.

But how did I know this? Why didn't I take him to the doctor? What do you do if this happens to you? I'm going to share my years of experience and action plan with you.

My son's school decided recess wasn't necessary. Sometimes they got to go out to play; most times they were given extra computer time or LEGOS for their "recess". Until a child is given a minimum of two recesses a day for 15 minutes or longer (by recess I mean outdoor unstructured play), it's not fair to even consider attention as an issue. Children are NOT getting the essential motor breaks they need for proper development. Is this happening to your child? If so, how can one say there is an attention problem? Everyone would have a hard time with sitting at a desk for 7.5 hours with only breaks to go to lunch, the bathroom, and whatever special they have that day. Where is the child's opportunity to 'reset'?

Let's start with facts:
Because the exact cause remains unknown for ADD/ADHD, how can we assume medication is the correct answer when we often overlook other possible conditions that could be affecting your child's performance? Many that are unaffected by medication.

Here's an example: a child who hasn't fully integrated a primitive reflex may have daily interference of that reflex. One is called MORO—it's the startle reflex. Your child starts the day in a good place but once at school, maybe the bell is very loud or the announcements are drawn out and super loud. This could be startling (MORO) and trigger a child’s flight or fight response. Once this is triggered, the child is at a heighten state of anxiety. Chemicals are released in the brain, and breathing is shallow and rapid. Who can focus when your heart is racing and you have the urge to run? Even worse, most children who experience this have no strategy to get 'out' of that state, much less identify how they feel. This can be addressed with a home program created by an OT but is often mistaken for ADD/ADHD or behavior problems.

Also, did you know that through the age of seven, many of the sign and symptoms of ADD/ADHD are identical to the signs and symptoms of any of the following:
~Vision related learning disorder
~Sensory processing disorder
~Or (my favorite) simply a typically developing nervous system.

I find that interesting, don't you? Yet, our referrals for attention issues are rising.

You are your child's best advocate and I hope you like mysteries because if you get called into a meeting like this or already have, you'll find that there is no easy answer. You'll have to become a detective and try to root out the issue.

In our case, my son has anxiety, which does affect him everyday. He also has a vision issue called Hyperfocus (which doctors are like, "yeah, that's ADD but my vision doctor is like "no, it's not. It's Type A personality), and there's something sensory going on. It's been three years since I noticed these things and we still haven't gotten to the bottom of it. So just know moving forward that this is a long process and that schools have been sued so many times that they progress with hesitation. Sometimes they're afraid to troubleshoot. You can't always count on them.

So, what do you do if you're sitting at a meeting about your child, and this is the discussion at hand? Begin your investigation. Remember, you are looking for root causes because this is serious. Your child's self esteem and academic success are at risk.

Ask your school/teacher:
~Is your child allowed to fidget? (twirl hair, chew pencils etc)
~Are they allowed to stand to do work after sitting for long periods?
~When/what time of the day do you see them the most distracted?
~Do they have friends?
~Are they a good friend?
~Does their desk face where the teacher does most of her lecturing, or is he turned somehow?
~If they get recess, what does it look like? One teacher thought letting kids play on the computer was recess. Nope, sorry. Not the same thing. I hope they are getting more than one recess a day.
~How much computer time do they get? Regardless of what mainstream media might say about computer time, it's affecting your kids. It affects their posture, their vision, and their social skills. 20-minutes a day should be the limit. I have a hard time sticking to that, but I can see the impact when my kids go over. Some kids get angry (like mine). But overall, it could be something as simple as reducing the amount of blinking your child (Hyperfocus) is doing which affects overall attention.
~Do they understand the routine of school or do they feel stressed by it?
~Does your child have anxiety?
~Ask yourself this: To what extend does this 'concern' interfere with you child's ability to be a happy, well-rounded kid? Do they have friends? Are they making good grades? Do they sleep at night? If you find a place where you pause, give it more thought. All kids have their quirks, but to what degree does that quirk affect them? Look at all setting. Do you also see these concerns in different places?

Because this issue is complex, listing everything to consider would be very lengthy. Seek out a pediatrician or developmental pediatrician who is willing to work with you. Make sure they aren't quick to diagnosis and are willing to go on this journey with you. Let me give you some examples of what needs to be considered: what was their birth history, how is their diet, do you have a predictable and steady home life? (No judgment there. We move every few years, and it's hard on my kids, but we have a daily schedule that is very predictable).

Once you have more knowledge from the school and you want to pursue possible intervention-start here:

1. Take your child to have his eyes examined by a certified optometrist of visual disorders (FCOVD). This is a regular eye doctor who can look beyond whether your child can see far or see near, but also how the brain interprets visual information. You can find one in your area (and more information) at this website: http://www.covd.org. Make sure you tell the docotor what the school's concern is. (If you have a kindergartner why not start the school year out right by seeing a COVD doctor? My kids go every year before school. The exams are usually covered under regular eye exams.)

2. Did your child have chronic ear infections? This could impact lots of areas, including attention skills and the sensory system. Consider having an audiology screening/evaluation.

3. Consider having an occupational therapy evaluation. You'll want to look for someone who focuses on sensory processing, preferably trained in the Astronaut Program and visual learning issues. It's not enough for an OT to understand sensory issues, but that addressing them begins with determining if primitive reflexes are still interfering with your child's ability to be as successful as they can be. The well-trained OT can address these issues:

~poor attention
~difficulties interacting with peers and limited play skills
~challenges with transitions or changes in routine
~difficulty communicating (both verbal and non-verbal)
~struggles with sleep, bowel and bladder control, and eating
~trouble following directions
~challenges perceiving and navigating space
poor timing and sequencing of motor skills
difficulties with irritability, mood
~difficulties with regulating their energy level (i.e. too low arousal or hyperactive)
~postural insecurity (fear of heights, playing on playground equipment)
~abnormal responses to various sensory stimuli (sounds, touch, taste, pain)
~poor praxis and motor planning: coming up with an idea, planning, and completing the task
~difficulty responding to sounds and verbal directions

4. Look at your child's diet. Is it balanced? Are there issues with allergies, sleeping, bowel, and food varieties? Consider seeing an allergist. (This is tough one because kids are picky. Please note, my kids have a terrible diet, so I feel your pain).

If you go through these channels, you should, hopefully, have answers and a plan. It won't be a quick fix and likely not an easy one. But, in my opinion, neither is medication. Make sure you work with your school. Tell them what you are doing and why. My dream is that this would become standard practice before kids are given medication, but that can only happen when we share our knowledge.

Good luck. I hope if you find yourself in this situation, I've helped you somehow. Since I don't know you or your child I can only offer these as suggestions. You ultimately decide what's best for your family.

Here are a list of resources that I access frequently:
Vital Links (Sheila Frick) (The blog on her site is a treasure trove of information.)


Recommended Books:

Meryton Matchmakers: Lottie Pursues Bill
A Modern Variation of Pride and Prejudice

Pastry chef Lottie Lucas wants more than friendship with her childhood playmate Bill Collins. Despite being a pastor and marital counselor, Bill has never given any serious thought to settling down--but that was before his family and colleagues starting pressuring him. Lottie sees an opportunity to finally move out of the friend zone and recruits her friend, Elizabeth Bennet, to assist.

Part owner of Meryton Matchmakers, Elizabeth is confident her company's personalized services will be the key to bringing Lottie and Bill together. Unfortunately, her sole financial backer is just as sure that computerized matchmaking algorithms are the way of the future and has sent William Darcy to convert Meryton to a fully automated online business. Darcy's algorithm says Lottie and Bill are not a match. Elizabeth must prove she's a better matchmaker than a machine to save her livelihood, and a whole lot of happy ever afters.

1 comment:

Kristi Rose said...

Thanks for hosting me :-) I appreciate you letting me jump up on my soap box.
Happy middle of the week@