Steven Korner, PH.D. Licensed Psychologist

Information Alerts

Attention Deficit Disorder: Is It Really a Deficit and Really Attentional?

Homework: The Big Struggle

When Your Child Is Not Making It At School

Mirror, Mirror on the Wall: The Power of Reflected Appraisals

LDNOS: A DIAGNOSIS WHOSE TIME HAS COME

Attention Deficit Disorder: Is It Really a Deficit and Really Attentional?

Attention Deficit Disorder (ADD), a syndrome characterized by inattention, hyperactivity, and impulsively, has received increased professional and public interest. For clinicians, the rising number of children and adults diagnosed with ADD is of concern. Research suggests that ADD is a non-specific and heterogeneous group of disorders for which multiple etiologies have been proposed. As such, the etiological factors may vary with different subgroups. Consequently, the prevailing treatment focus (i.e. combining stimulant medication with educational management, behavior modification, and parenting training) may be too narrow or not specific enough for different subtypes of the disorder. Given the fact that many children (and even adults) present with some of the symptoms of ADD and that ADD is co-morbid with several other disorders (i.e. oppositional defiant disorder, conduct disorder, depression), the danger of viewing ADD as homogeneous and treatable with a non-specific therapeutic approach is significant.

A more constructive and promising approach to conceptualizing and treating attentional disorders is the area of self-regulation. For example, recent research suggests that there is little evidence that attentional capacity itself is different in individuals with ADD. It appears, however, that the regulation of attentional capacity is the problem.

Individuals who have the developed capacity to regulate their emotions (particularly the negative ones like frustration, anger, irritability) are better able to attend. While genetic and constitutional factors always play a part, contextual variables like the match between parent and child have been virtually overlooked. We all have observed what happens when either the parent or the child are not a good match for each other. When this occurs, parent and child do not function as a team. As a result, the task of internalizing the psychological skills to tolerate and constructively channel the kinds of stimulation and contact encountered in everyday life does not go well. Instead, parents and children reciprocally under or overstimulate each other, resulting in frustration, anger, and repetitive patterns on non-constructive behavior.

Treatment approaches that pay attention to this lack of match and provide parents and children with an increased capacity to tolerate and digest internal and external stimulation will find increased ability to regulate attention as a byproduct.

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Homework: The Big Struggle

Getting kids to do their homework probably ranks high on the list of challenges parents face on a daily basis. A quick glance at the bookstore shelves and newspaper columns reveals that there has been much advice dispensed about helping parents to help their children complete their homework. The purpose of this piece is not to reassemble the known information, but to attempt to address the obstacles faced by parents and kids in trying to apply what is known.

Childrens' reasons for not doing their homework range from finding the homework difficult to feeling it is boring and not worthy of their time. Some (the aspiring attorneys) claim that being assigned homework after a full day of school is unfair and cite their constitutional right to refuse. Avoiding homework often inspires creative thinking like forgetting to bring home the assignment, erasing the assignment in the notepad (this reguires a very good eraser!), or swearing that it was done and either the dog ate it (see the new ad for Dell computers with a big canine on it), a friend or sibling took it, or the teacher lost it.

The greatest obstacle to successfully navigating homework refusal is emotional regulation. Childrens' refusals will often evoke negative emotions in parents who just want their kids to "Do it!" (This is an admirable wish which is often counterbalanced by the childs' wish that parents just leave them alone to do homework when and if they choose). Managing the emotional responsiveness of adults and children to one another is complicated by the time pressures of daily life, and worries about earning poor grades in our competitive world.

The most important goal for parents when dealing with homework struggles is to find a way to preserve the relationship with their children. Today's assignment will come and go, but a positive relationship with one's child is an absolute necessity in the long haul as parenting is a lifelong task.

Parents may wish to consider the following:

1. Attempt to investigate the source of childrens' objections with a curious rather than a critical ear; (This may need to be done at a time where neither parent nor child is pressured to do anything);

2. Consider the idea that childrens' refusals constitute an indirect communication of something important that they are unable to say in a straight forward way;

3. Find a way to help children to say what is not being expressed directly. This may include getting professional help if parents' efforts prove unsuccessful.

4. One 1-3 above is accomplished, then commonsense advice (i.e. providing structure, a quite place, a time, etc.) can be more easily utilized.

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When Your Child Is Not Making It At School

Helping children to be all they can be with respect to their school performance requires that parents, children, and professionals work together to remove any emotional obstacles to learning. In fact, when children are underachieving, the first step in resolving the problem is to make a careful assessment of the distinction between an actual limitation in skills and emotional factors which interfere with maximizing the skills that do exist. For example, many children with academic difficulties also manifest problems in the regulation of their emotions. Some may be very aggressive while others may be overly shy, withdrawn, and inattentive. Success in school (and in life) may be achieved when children are able to constructively harness their emotional energy and channel it in the form of such positive traits as initiative, persistence, curiosity, and assertiveness.

Disregulation of emotions, however, may lead to the creation of resistances to learning and performing. While it is sometimes difficult to determine whether emotion disregulation was the cause or result of learning problems, building and maintaining children's self-esteem and their will to bear the slings and arrows of attending school for more than a decade is key.

Here are some helpful hints for parents when your child is just "not getting it" at school:

1. DON'T PANIC -children who are having learning difficulties are probably already frustrated and embarrassed by their problems. Seeing panic, doubt, and criticalness in the face of a parent only makes matters worse.

2. TRY NOT TO BE CRITICAL -it is difficult to keep perspective when your child is hurting. Do not assume that they are unintelligent or doomed to be failures for life.

3. GATHER INFORMATION about the nature of the difficulty from your child and the teacher. If you are considering having your child evaluated (which may either be a constructive step or a response motivated by one's panic), be certain that the individual who assesses your child knows children and the kinds of psychological interference which may block learning.

4. IMPLEMENT REALISTIC STRATEGIES to help your child. Since the preservation of your relationship with your child is essential (if both of you are to survive at least 13 years of schooling), enlist the aid of professionals (i.e. psychologist, educational tutor) wherever appropriate so your time with your child can be positive time.

Talk therapy for children may prove beneficial. Frustrations children experience at school that are proactively addressed may actually enhance children's existing potential to learn.

Mirror, Mirror on the Wall: The Power of Reflected Appraisals

Children develop a sense of self via the process of internalizing the reflected appraisals of significant others (i.e. parents, teachers). Like a mirror, the faces of those charged with the task of caring for and teaching evolving children may reflect back either a sense that everything is okay or something is amiss. Adults who consistently exhibit a sense of worry regarding a child are unknowingly communicating that worry which, in turn, becomes a part of that child’s core identity. Children who are regularly exposed to reflections of worry, frustration, anger, or disappointment will internalize those feelings about themselves, resulting in low confidence, self-esteem, and, in the extreme, depression. Of course, we all may experience, at times, these kinds of feelings about children. Adults responsible for the care and growth of children are not expected to be perfect or infallible. However, the principle of the “good enough” parent/teacher stipulates that we more often than not reflect constructive feedback to kids. Children who receive positive reflections more often than not will develop a sense of identity that is characterized by feeling “good enough” vs. one of feeling not good enough.

What factors determine the direction of reflected appraisals? Here, we must consider the contributions of temperament and induced emotions. Each of us is born with a temperament that dictates the following important characteristics: activity level; mood; adaptability; sensitivity to stimulation; rhythm (i.e. how regular we are about eating, sleeping, etc.). A dilemma arises when adults and children have significant differences in temperament as this will result in a lack of chemistry or poor goodness of fit. For example, a very active child will tax the patience of a more sedate adult. When there is a lack of a match in the child/adult dyad, there is a more likely chance that the reflected appraisals will be negative. In essence, adults who expect children to be like them will be disappointed by the lack of match and consistently reflect that disappointment, inducing in children a feeling of falling short.

Yet, it is highly likely that adults will experience at some time or in some way a lack of match between themselves and their children. What can be done to shield children from our own sense of disappointment or frustration? The answer is not a simple one. It involves tolerating intolerable feelings (i.e. “My child is too short, not smart enough, not an athlete, etc.”) and differentiating between “real” deficits vs. perceived ones. Once we are able to tolerate what we view as deficits, we can avoid reflecting back the negative by a process of emotional dialysis-removing the toxic emotions that drive negative reflections. We can then use the information regarding any “actual” vs. perceived deficits/weaknesses to support children by imparting compensatory strategies for those areas that will pose an obstacle to their pursuit of success and happiness.

This is a tall order. However, it is possible to achieve. Children who can dig into their core and find internalized reflections of being good enough will prove to be resilient and have the inner strength to rise to the challenges in life we all will inevitably face.

LDNOS: A DIAGNOSIS WHOSE TIME HAS COME

How are students to access appropriate accommodations at school when testing does not reveal scores that rise to the DSM IV TR threshold of a Specific Learning Disorder? In fact, there are many individuals who exhibit difficulties in the areas of executive functioning and information processing who are performing at or even above grade level. Yet, their learning is affected by cognitive processing, executive, and organizational deficits. Historically, the absence of a substantial discrepancy between ability and achievement meant that a student did not have a learning disability. The new IDEA will eliminate the need for this discrepancy when diagnosing a learning disability. This change will correct a longstanding dilemma that exists for many students who are learning impaired, but the differences between their cognitive ability and academic achievement scores are not great enough to be considered a bona fide learning disability.

Learning Disorder Not Otherwise Specified (LDNOS) is being considered as a means to accurately describe this group of students who do not meet the criteria for any specific learning disability (i.e. math, reading, and written expression). They may have sub-threshold difficulties in one or more academic areas or their cognitive processing deficits in areas like working memory, processing speed, or auditory or visual processing precede or are associated with learning disorders. This is being proposed by Yalof and Domingos in their Division of School Psychology article where they make this important point: “…academic skills are really a byproduct of neuropsychological processes [like the ones mentioned above], creating a somewhat arbitrary distinction between the skill as a concept (i.e. reading) and the underlying neuropsychological processes from which that skill is derived.” That is, the processing skills which are often deficient for these students are the foundations upon which their academic skills are built. For example, the syndrome of nonverbal learning disorders (NVLD) about which I wrote in an earlier update will qualify as one in which LDNOS may be the accurate diagnostic entity. Let’s say that a student has difficulty with math, but tests reveal no discrepancy between math ability and performance. Students with NVLD may have difficulty with visual processing, organization, and concept formation, causing them to have problems with encoding and visually manipulating numbers. They may also have trouble with accurately tracking columns of numbers or placing decimal points in the right place. Similarly, students with working memory impairment will have difficulty encoding, consolidating, and retrieving information when they need it. All of these possibilities and others may be present even when no discrepancy between ability and achievement exists. A thorough evaluation can identify when these processing deficits exist and LDNOS can accurately describe and qualify them for the accommodations they are entitled to by law.