Attention Deficit Disorder and The Social Working Blogging Grad Student

Children born to low-income families are more likely to be diagnosed with learning disabilities (Cortiella 2014). That means they are less likely to have access to services that would treat their learning disabilities, and their community would be less likely to have access to the services that would inform and reduce the stigma surrounding their disability . This puts this population at a high risk as students with learning disabilities are more likely to be held back in school, suffer from low self-esteem, and are at a higher risk of dropping out, depression, and drug use. Many critics argue that the overrepresentation of low-income and minority students in special education is often the result of racial bias and lowered expectations for youth in school systems across the United States (Boyd 2015).

Advocacy for children and adolescents with ADHD or any other learning disability is a key component in helping communities better understand, and treat these disorders. Creating new services, and optimizing existing ones could help families and schools in low-income communities better understand and address the issues related to learning disabilities among youth. When thousands of children fall into the cracks, or are the targets of discrimination by peers and teachers, investing more into understanding and treating learning disabilities could greatly improve the outcomes of thousands of students, and lower rates of dropouts, incarceration, and mental health issues (Cortiella 2014).

To continue treating learning disabilities as we do now is to continue letting a large number of people struggle without support, and at risk of higher negative outcomes . It’s important that programs are created that address the inequalities that exist in treatment and understanding of learning disabilities, especially as it applies to marginalized communities in the United States.

Not only are the diagnoses of learning disabilities higher, but the research shows that many children in low-income families are diagnosed with learning disabilities than their wealthier counterparts. Evidence suggests that racial biases in school administrators and teachers leads to diagnoses of learning disorders in students that may either not need them, or be misdiagnosed (Boyd 2015).

Being that children born to low-income families are more likely to suffer from some form of learning disability and less liable to receive actual services meant to treat the disability (Boyd 2015). This difficulty in accessing and affording appropriate services puts low-income families at a higher disadvantage in comparison to their wealthier counterparts. Considering that low-income families are less likely to report developmental concerns to a professional because of stigma and lack of access, it makes it much less likely that an appropriate intervention will occur within a school setting (DOH, 2016).

Because ‘learning disability’ is an umbrella term for any condition that causes difficulty in acquiring knowledge about an individual’s’ peer group, there are many conditions that fall under this label. The New York City Mayor’s Office for People with Disabilities (DOH 2016) has a page with a list of resources for parents and adults who are in need of various services, from evaluation to treatment of various learning disabilities. For example, there is a link to the “A.D.D. Resource Center,” (ADDRC 2016) which provides evaluation, coaching, and information for students seeking support for A.D.D. (ADDRC, 2015). Though this information is a good start, it is certainly not common knowledge, nor is the diagnostic process always that easy, as only one in five parents reported sharing their concerns with a professional (Doh 2016). It is all the harder for low-income families, for whom less than one in ten report voicing concerns to a professional.

This would accentuate the need for creating new services and optimizing ones that we currently have in order to help families and schools in low-income communities to better serve adolescents in their schools. As of right now the services that exist are usually hard to find, and exist in places that are too expensive and too far from the population that may need them.

    Addressing this issue would mean taking advantage of the resources that already exist, and using the success of programs doing work to address these issues as models moving forward. The Department of Education provides funding for organizations that work within the field of mental health and youth (LD Advocates Guide 2012). Communities and individuals looking to direct services would do well to look to these organizations as examples.

Here in New York City, for example, there exist a few organizations that help to advocate for children diagnosed with learning disabilities or other mental health issues. Advocates for Children of New York, for example, has been providing legal services and protection for youth diagnosed with learning disabilities for decades (Advocates for Children of New York 2016). As an organization, they defend many minority and low-income youth who may face discrimination for their learning disabilities, or unfair treatment as a result of their diagnoses.

Providing low-cost or free legal representation for students could work as a huge first step towards helping families gain access to the services they need. It also helps set precedent for families and advocates working to challenge school districts or systems that may be operating unfairly targeting learning disabled or minority students.

Advocacy groups would also do well to tap into other existing services that can support youth and their families that have been diagnosed with a learning disorder. Understood.org has partnered with the National Center for Learning disabilities disseminating nationwide resrouces that youth and parents to self advocate, and become plugged into organizations that can provide support (NLCD Impact Update 2016).

The resources provided are crucial to empower individuals to understand the laws and systems that are at work within their own individual communities. It includes checklists for families to follow when talking with teachers about individualized education plans, as well as indispensible information about resources that exist. The website provides links to organizations and other programs that offer funding and support to individuals looking to advocate for their communities (NLCD Impact Update 2016).

These resources empower parents and youth to engage with their schools and communities to help curb the rising rates of diagnosis with the declining rate of funding for special education services for youth with learning disabilities. It helps them connect to the financial resources and support that already exists within the United States.

Being that many communities and populations are at greater risk of being diagnosed with learning disabilities, and receive fewer services, it is important to know where the resources are, and how to access them. Helping connect these communities to the resources should be a priority for advocates at this time, especially as the policies and services surrounding this issue stands to change within the next few years. In some places, like New York City, organizations exist that help connect these families to the resources they need. Other states and communities, however, may lack many of the organizations that may provide the legal resources that they need.

LD Advocates Guide. (2012, July). National Center for Learning Disabilities. Retrieved                                                December 13, 2016, from               http://ncld.convio.net/site/DocServer/ncldadvocatesguide.pdf?docID=245

Cortella, C. (n.d.). The State of Learning Disabilities: Facts Trends and Emerging Issues. Retrieved November 09, 2016.

Department of Education. . School Quality Guide 2013-2014 MS 223. Washington, DC: U.S. Government Printing Office. Retrieved September 20, 2015, from the World Wide Web:http://schools.nyc.gov/OA/SchoolReports/2013-14/School_Quality_Guide_2014_EMS_X223.pdf

Boyd, D., Lankford, J., Loeb, S., Rockooff, J., Wyckoff, J. (2008).  The narrowing gap in New York City teacher qualifications and its implication for student achievement in high-property schools.  The Journal of Policy Analysis and Management 27, 793-818.

Advocates for Children of New York | Home. (n.d.). Retrieved December 13, 2016, from http://advocatesforchildren.org/

Cortiella, C. (2014). The State of Learning Disabilities.

NCLD’s Impact Update (2016, November 8). Retrieved December 13, 2016, from http://www.ncld.org/archives/blog/nclds-impact-update-fall-2016

“What was on Television when you went to sleep last night?” said my first grade teacher. I was suddenly brought back to the present and tried to think of something to say “uhm… I don’t know.”

“You look tired, I was wondering when you went to sleep last night.”

She had asked me this numerous times before. Truth is I wasn’t watching Television; but I also wasn’t sleeping. I was looked tired because at night I wouldn’t sleep but lay in bed imagining my room was a boat making it’s way across the ocean, and the thought would make me so excited there was no way I could sleep.

While my teacher was concerned about my sleepiness and seeming unwillingness to pay attention, I had no idea why this was a concern. I was too preoccupied with the thoughts and daydreams running through my head.

Fast forward 20 years and here I am in grad school, still making sense of my ADHD diagnosis. Some have said that attention deficit hyperactivity disorder is not really a deficit of attention but a difference of attention. It’s more than just having a difficult time focusing in class, it’s also being able to focus intently on the things that do interest us.

I tell my story because I think I can use it as an anecdote for how we relate to ADHD (or other learning disorders) can help us re-frame our relationship to the disorder. Many people with ADHD, like myself, learn how to cope by learning different ways to relate to the disorder.

For myself, thinking of it not as a deficit, but as a difference in attention has helped me tremendously, and is what led me to social work. Many people have their own ways of articulating their disability, be it through art, dance, writing, sport… for me it was always through books and science. I remember reading that  research and theories in evolutionary psychology have suggested that the prevalence of ADHD traits across all cultures could signify that it even had an evolutionary purpose during our species evolution in hunter gatherer societies, and that the symptoms we see today our just an example of how our evolution no longer matches our reality (Browden 2014). It helped me to better see myself not as lacking what everyone else had, but as simply having something that was maybe a little bit different.

I’m not out to to knock modern education per se, but it is to say that as it is, it only caters to a particular learning style.

Learning to relate to my ADHD differently has played an enormous role in my ability to graduate college, learn two new languages, finish Peace Corps and make it through grad school… so far.

In order to do this, however, I have had to rely on creating systems that work for me. Just as each individual has to work to find the methods that work for them. Because I cannot tolerate stimulants well, I have had to rely on CBT based practices and a strict diet and exercise plan. I can say that for me, it helps, but it’s no silver bullet.

Understanding my diagnosis is a work in progress. But believe it or not, I really believe that having ADHD helps me in my work immensely. I think that when I take the time to articulate the experience for myself, and empathize with the experiences of others, it helps me to better recognize the symptoms of learning disabled youth in my practice. It has helped me to better understand that there may be more going on underneath the surface than any of us can realize.

Learning to embrace the various personality traits of ADHD don’t help me as well in the classroom, but they do help me when writing lesson plans on the fly, or facilitating group sessions at my field placement. When talking with people who have ADHD you will find these stories time and time again.

They struggle in one area, but excel in another.

However listening to someone with a learning disability is what is most important. Especially children and adolescents who have not yet understood, or developed a relationship with their learning disability, if they have even been diagnosed. Having the words to go with my own experience was like being thrown a lifesaver while drowning. It helped me escape the feelings of inadequacy that many learning disabled youth feel.

This is why I write this blog, and this is my advice to myself, and to anyone working with youth and adolescents:

Listen first, and be patient. The goal should not be to help them sit still in the classroom, but to understand what it is that may be going on underneath the surface. Those with differences in cognition only need help in finding where it is that they belong, and what it is that they have to give to the world.

Cognitive Behavioral Therapy or CBT, is a form of cognitive restructuring. In the treatment of ADHD it can help children, adolescents, or adults change the way that they think about their behavior, an how they act upon it. It can help them better process their emotions, and regulate their behavior.

CBT can be an effective treatment in addressing the problems with inattention and emotional processing in adolescents as well as children. However not all forms of CBT are alike¹. Because the learning styles of children and many adolescents tend to be different, it is important for a good therapist to keep this in mind when administering CBT ². Studies have found that while CBT can be effective for treating inattention and organization, it can be more difficult to treat impulsivity in adolescents.

For some age groups, there is evidence to suggest that the way that CBT is administered can have an impact on the effectiveness that it has.

One study done with school age children found that CBT based play therapy had a ‘significant impact’ on the presentation of children’s perceived symptoms according to both parents and teachers³. This would go hand in hand with existing literature that finds that children and adolescents do best working in environments that cater to their unique learning styles. That is, learning environments that present a wide array of stimuli geared towards a diversity of students².

Group therapy and parent child therapy can also have an impact on the overall well being of the child or adolescent, and improve outcomes across various dimensions. These allow the child the emotional and social support and understanding that they may need when navigating school and relationships 4. Adding these interventions and how they are conducted would be an essential component of this project.

When looking for a therapist, it would be important to talk with them about the methods that they use, and the experience that they have working with children and adolescents.

1. J. Allison He, Kevin M. Antshel Cognitive Behavioral Therapy for Attention Deficit / Hyperactivity Disorder (ADHD) in College Students: A Review of the Literature Cognitive and Behavioral Practice, Available online 18 June 2016,

2.Brand, S., Dunn, R., & Greb, F. (2002). Learning Styles of Students with Attention Deficit Hyperactivity Disorder: Who Are They and How Can We Teach Them? The Clearing House, 75(5), 268-273. Retrieved from http://www.jstor.org/stable/30189757

3. Abdollahian, E., Mokhber, N., Balaghi, A., & Moharrari, F. (2012). The effectiveness of cognitive-behavioural play therapy on the symptoms of attention-deficit/hyperactivity disorder in children aged 7–9 years. ADHD Attention Deficit and Hyperactivity D

4. Morin, A. (2014, May 5). Treatment Options for ADD. Understand.org. Retrieved October 22, 2016, from https://www.understood.org/en/learning-attention-issues/treatments-approaches/treatment-options/treatment-options-for-adhd.

Many parents and loved ones often share concerns about the use of pharmaceuticals and the treatment of Attention Deficit Disorder. The listed side effects of stimulant medications (the most commonly prescribed) can be rather daunting.

Also, there are many children and adolescents who, for various reasons, cannot or will not use pharmaceutical interventions, and will instead look to other interventions, such as diet and exercise.

For those choosing this path; there are things to consider before taking on a change in diet or lifestyle for the purpose of treating ADHD.

Things to Consider:

The link between diet, exercise, and ADHD is not studied nearly as much as pharmaceutical interventions, and the results are rarely as definitive as they are for other interventions ¹. Most of the results from the studies presented are modest at best, and may require a larger commitment of time and resources.

It is VERY important, that you speak with your doctor beforehand about any changes that might be made in the diet of a child or adolescent with ADHD. It is important to remember that diet and exercise is good for all children and adolescents, regardless of whether or not they have been diagnosed with ADHD, and that the inclusion of this intervention would be best served an addition to, not a replacement for a more evidence based treatment plan.

What Does the Research Say?

The research that does exist for diet and exercise is modest, but there is cause believe that a change in lifestyle could have an impact on the symptoms of ADHD.

Exercise:

Movement and physical exercise has been linked to a reduction in symptoms of ADHD ². 30 minutes to an hour of physical exertion can help reduce symptoms of inattention and excitability that is often a hallmark ADHD.

One study showed that taking into account WHERE the exercise takes place makes a difference as well. Spending time outdoors and in nature, that is away from urban areas, showed a clinically significant reduction in the symptoms of ADHD according to one study³. It was found that the same exercises done outdoors as opposed to indoors, or in an urban setting were much more significant in reducing the symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448497/

Diet:

When it comes to diet, there is little evidence that could be called ‘definitive’ in terms of their effectiveness. Although some research has shown that the addition of Omega 3’s to the diet of a child or adolescent could have an impact on symptoms of inattention¹. Reducing the amount of sugar and carbohydrates that an adolescent consumes within the day may also have an effect.

Conclusion:

As an intervention, diet and exercise would be best utilized as being used in addition to other interventions. The current literature shows that there may be at least some modest gains in regards to both diet and exercise, but it is not conclusive.

And as always, speak with a physician before making any changes to a child or adolescents lifestyle.

1. Millichap, J. G., & Yee, M. M. (2012). The Diet Factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics, 129(2), 330-337. doi:10.1542/peds.2011-219
2. 2. Berwid, O. G., & Halperin, J. M. (2012). Emerging Support for a Role of Exercise in Attention-Deficit/Hyperactivity Disorder Intervention Planning. Current Psychiatry Reports, 14(5), 543-551. doi:10.1007/s11920-012-0297-4
3. .Kuo, F. E., & Taylor, A. F. (2004). A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence From a National Study. Retrieved December 12, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448497/