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ADHD and Handwriting

Even in this day of thumb-driven Twitter shorthand, handwriting continues to be a critical and needed skill. Legible, coherent handwriting is a signal measure of academic success and still plays an important role in formal and informal communication.


Educators and other professionals working with children with Attention Deficit Hyperactivity Disorder (ADHD) have observed that many of these children have significant problems with handwriting.


A recent study coming out of the Centers for Disease Control and Prevention (CDC) documents the relevance of these observations. This research, led by Slavica Katusic of the Mayo Clinic was published in Pediatrics (September, 2011). The study included 6,000 children—all those born in Rochester Minnesota between 1976 and 1982 and who was still living there after age 5.


Katusic and her co-workers evaluated school and medical records to see which children showed signs of ADHD, as well as how well they performed on writing, reading and general intelligence tests over their school career. A total of 379 children fit the criteria for ADHD. About 800 children scored poorly on tests of writing abilities, and most with writing problems had reading difficulties as well.


Writing problems were much more common in both boys and girls with ADHD, with close to two-thirds of boys with ADHD having problems with writing. That compared to one in six of their peers without ADHD. In girls, 57 percent with ADHD had a writing problem, compared to less than 10 percent without ADHD.


There are several reasons why children with ADHD may have problems in writing. Handwriting is a very complex task that involves cognitive activity and motor activity at the same time. A high level of mental coordination and sequencing is required—tasks that individuals with ADHD have difficulty with. Also, memory and planning problems may affect the writing process. The impairment in sustained attention experienced by children with ADHD causes them to loose track of what they are doing and they will tend to make careless errors and get confused about what is to come next in the phrase or sentence.t is my observation that when kids with ADHD are appropriately treated with medication, improvement in handwriting can be dramatic. In fact, improvement in handwriting can be one of the more objective, observable markers of effective treatment.


Kids who have problems with handwriting sufficient to interfere with their ability to express what they are learning can be allowed, even encouraged, to use other means of communicating what they are learning. For instance, a student may be allowed to give a report orally rather than in writing. Certainly in middle and high school the student can be encouraged to develop word processing skills and permitted to prepare homework and even classwork using the word processer. At the same time the student will need ongoing instruction and practice in handwriting. For some ADHD students, their handwriting will never be optimal but should be functional by high school.

At the same time, intentional instruction in handwriting skills is needed. The ADHD child may not develop perfect handwriting but writing skills can be enhanced with intervention. It is appropriate to help them be the best they an be in this area while compensating in other subjects. For instance their grade in science or math should not be knocked down due to messy or slow handwriting.


Long term observation does suggest that the writing problems do get a little better with increasing m

Study Shows Slower Brain Growth in Children with ADHD

All the key symptoms of ADHD (Attention Deficit/ Hyperactivity Disorder) reflect an underlying lack of mental organization and self-monitoring. It is as if a traffic light at a very busy intersection has gone awry, directing the traffic in a random and disorganized manner—sending the vehicles off in all directions at the same time. And, in fact, something like that occurs in the brain of a person with ADHD. The part of the brain responsible for organizing, sequencing and controlling mental activity is simply not working on a level appropriate for the child’s age. It is as if there is “a developmental lag,” resulting in an immaturity brain chemistry and resultant function. Over the years clinicians who care for children with ADHD observed this lag, but could not identify any anatomical changes to account for this developmental lag

Now recent research backs up the view that there are biological underpinnings in brain anatomy and chemistry which results in the symptoms of ADHD. Dr Phillip Shaw of the National Institute of Mental Health recently reported data which suggest the presence of physical changes in the brain of individuals with ADHD. Dr Shaw and his collogues used scans to measure the cortex thickness at 40,000 points in the brains of 233 children with ADHD and 233 control children who were developing normally. The results showed that brain thickness was normal in ADHD children in most parts of the brain including the sensory and motor cortex. However, there was a delayed growth of thickness in the frontal cortex where most of the control functions reside.

These results are exciting for clinician as well as parents and teachers. To begin with this study provides strong evidence that ADHD is a biological/neurological condition. The symptoms are real; they are not figment of the imagination. The finding that there is a delay in brain growth that catches up in time is compatible with the long term observation that ADHD symptoms get better with age. They may not go away completely, but ameliorate with chronological maternity. This offers us all-parents, teachers, clinicians—a basis for hope for continuing healing and over time. Given time, physical maturation of the brain catches up resulting in the lessening of symptoms.

Try a Family Night


Strong families do not just happen. We must work at it. There are many ways to enhance family communication and appreciation of each other. What works for one family may not work effectively for another. But one technique that has been helpful to many families who are trying to survive in the hurried pace of today, is family night. A scheduled family night can help us put the family in its rightful place along with all other commitments which makes demands on our time and energy.

Your family night plan will reflect your family’s personality, needs, and structure. Following are some general guidelines to consider.

1, Make the activities age-appropriate. Provide activities that everyone can and will participate in. The process is more important than the product. The activities must be meaningful for your children. Avoid judging the meaningfulness of the activity by adult standards. The goal is to simply have fun.

2. When possible plan it for the same time each week and protect it. This means no phone, TV, or visitors unless it is planned for in your activity. Relatives and friends will learn to respect your family time if you do. If you are interrupted by a phone call, kindly explain your family night philosophy and suggest an alternative time when you can return their call.

3. Involve older children in helping younger ones with some of the activities. This practice will foster the older children’s sense of independence, responsibility, and achievement. It will enhance the younger child’s sense of respect for the older sibling.

4. The activity truly becomes a family-oriented one rather than one guide only by adults.
5. Provide variety and balance in your weekly activities and make your plan before the night arrives. Use seasonal emphases or build on the teaching opportunities which develop during the week. Include games, songs stories, creative arts, trips, adventure.

6. Limit your outside commitments on the family day in order to store up energy for your family.

Here are a few ideas for family night:

Read children’s books on different subjects. Draw pictures about what you read.
Have a game night. Different family members get to pick which games to play.
Make homemade get well card to send to a sick friend or relative
Make gifts for birthdays or Christmas
Cook a meal together
Have a picnic
Talk a walk about the neighborhood
Video members of the family performing
Make a giant family sundae or homemade ice cream

Now use your creativity and come up with your own ideas.

ADHD and Creativity

Children with ADHD are impulsive, easily distracted, and disorganized. It has been suggested that creativity is related to a more adventurous, nonconforming, and impulsive cognitive style. Therefore, some clinicians have suspected that children with ADHD may demonstrate superior creativity as a part of their condition. Some have even proposed that increased creativity is an actual benefit of ADHD.

Methylphenidate (Ritalin) and other stimulants are commonly prescribed as a part of the treatment of ADHD. One desired outcome is to decrease impulsiveness. Some workers have suggested, therefore, that treatment with methylphenidate could inhibit the creativity of children with ADHD to the degree that it does decrease impulsiveness.

Jean Funk, PhD. and associates at the Medical College of Ohio evaluated this hypothesis. Using an accepted test of creativity (Torrance Tests of Creative Thinking), they compared 19 boys with ADHD with 21 control boys. The boys with ADHD were tested with and without medication and compared to the controls.

No significant differences were noted in levels of creativity between the controls and the subjects with ADHD. Also, no differences were noted in the ADHD boys with and without medication.

Two significant conclusions can be drawn from this study. First of all, elementary age boys with ADHD are neither more or less creative than boys without ADHD. Also medical treatment with methylphenidate did not affect the creativity of school aged boys.

Editors Note: I would not expect the treatment with stimulants to decrease creativity. Creativity is characterized by “divergence thinking”, or the ability to produce more than one of several possible “correct” answers. Impulsive children are prone to produce many repetitious, usually incorrect, responses. In fact, it is conceivable that correct medical treatment could allow a child to be more creative to the degree that such treatment allowed the child to “stop, look, and listen” to his real creative instincts.
Additional study on this subject with larger groups of children of more diverse ages is needed to settle these questions about creativity more completely.

Consider These Sports for the Child with ADHD

Certain sports are better suited for the ADHD child than others. Baseball, for example, is usually not an ideal choice. The slow pace and the need for well-developed motor and eye-hand coordination skills make it difficult for many children with ADHD .Stuck in left field, the ADHD child is likely to be off chasing a butterfly when the fly ball comes whizzing his direction.

Some of the more suitable sports for the child with ADHD are:

Soccer. Soccer serves as a good building block for other sports because it enhances speed, endurance, and leg strength. It is relatively safe. Too, the hyperactive child does not look much different form other children on the field. Most communities have summer and fall soccer programs and communities in warmer climates have soccer programs year-round. Most children genuinely enjoy soccer; it is now the second largest sport for children in the United States.

Swimming. Swimming, with or without competition, is a good choice for many children with ADHD. The explosiveness of swimming is well matched to the impulsiveness of ADHD. Being a solitary sport, it does not require close cooperation with a large number of teammates as is necessary in the more traditional team sports.

Also swimming is an excellent activity for children with coordination problems. Motor skills needed for swimming seem to be different from those needed for activities on land; a clumsy child can actually be a good swimmer. Swimming, too, seems to enhance over all motor coordination. I have know many ADHD children who were able to experience success in competitive swimming when they failed at all other sports.

Martial Arts. Tae Kwon Do and Karate have proven effective outlets for many ADHD children. Such martial arts are probably the most enjoyable sport after soccer.

Parents sometimes question this use of the martial arts fearing that they may over-stimulate the child or aggravate aggressiveness creating serious social problems. But this does not seem to happen often.  The martial arts are  among the  most therapeutic programs for children with  focus and organizational problems. Another benefit is that children can start as young as 6 or 7 years of age. These sports are beneficial because they involve structure, rules, rituals, a stop-and-think attitude. No techniques are taught until the child has learned to stop, listen and think. Classes are usually small. The techniques are monitored carefully, and it is emphasized over and over that these activities are sports and are not be used for any aggressive play. Students who disobey the rules are likely to be expelled from the class. The martial arts teach and develop control of mind and body. Such control, of course, is the basic need of children with ADHD.

A key component for healthy management of the child with ADHD is involvement in sports. It is important, however, that the sport be matched to the skills and interests of the child.

Teens with ADHD and Driving

It goes with the territory. All adolescents are at some increased risk of distracted driving. Those with ADHD are especially vulnerable. This fact was reinforced by a study published in the JAMA Pediatrics recently. “ADHD appears to impact specific driving behaviors,” according of Cincinnati Children’s Hospital researcher, Megan Narad, one of the authors of this study. “Both maintaining a consistent speed and central, consistent lane position require constant attention to the road and one’s surroundings,’ she added.


Such sustained attention is difficult for the person with ADHD.
The study involved adolescents aged 16 and 17 years with or without ADHD participating in a simulated driving class which monitored driving under various conditions. In conclusion, the study clearly demonstrated that both ADHD and texting while driving present serious risks to driving performance of teens.

Other studies have pointed out that teen drivers with ADHD are 8 times more likely to lose their license, 4 times more likely to be involved in a collision, 3 times more likely to sustain a serious injury and 2 to 4 times more likely to receive a moving vehicle violation. These risks are not surprising considering that the core symptoms of ADHD are inattention, impulsivity, and hyperactivity—all conditions that affect focus and concentration.


One encouraging finding in other studies is that treatment with stimulant medication at optimum levels improve driving performance of teens with ADHD in a significant way. Thus teens with ADHD who are driving should take their prescribed medication on a regular basis without holidays.


Other suggestions that can help the teen drive more safely are the following commonsense precautions:

Always wear a seatbelt
Never drink and drive
Never drive while sleepy
No cell phone use while driving
Pay attention to surroundings—be aware if traffic is slowing, etc.
Select a radio station or recording device (CD or MP3 player) before starting the trip
Know ahead of time the directions to your destination
No speeding, follow all traffic signs
Minimize night time driving
No tailgating
Inform parents of your destination and return time.

Other studies suggest that teens with ADHD may need more intense driver education. Also with many teens with ADHD, delaying driving for a year or two thus allowing more time for maturity to develop would be wise.

Classroom Strategies: Assisting the Child with ADHD

The Teacher’s Challenge

I have great admiration for the dedicated teacher. And most teachers I know are teaching because they love children and like being around them. They have a sense of satisfaction when they see their students learn, grow and succeed.

On the other hand, they are frustrated and personally defeated when one of their students fails to achieve and succeed. Thus the presence of a learning-disabled or hyperactive student in a class tends to stir up a mixture of reactions in a conscientious teacher. He or she wants to help, but are thwarted by lack of time, too many students or a lack of materials or training. This easily leads to frustration and hopelessness.

One fourth-grade teacher spoke not only for herself, but also many colleagues, when she discussed a learning-disabled child in her class. “Jimmy is a puzzle. I want to help him but I’ve been frustrated at every turn.”

This brief article cannot offer solutions to all the problems involved in teaching the learning-disabled child. The information presented here is a potpourri of tried and proven techniques which have been gleaned from experienced teachers. Hopefully, they will make the job of teaching the child with ADHD or learning disabilities a little less frustrating and more rewarding for you and the children in your class.

From long experience, we know that children with hyperactivity and attention deficits function much better in an organized, structured atmosphere. Not only does such an atmosphere allow the child to function more efficiently in the present, it also encourages him to internalize this imposed organization so that, in time, the child becomes more self-controlled.

The following suggestions regarding classroom management have been derived from the available literature, current research findings, and clinical observations. The goal of these strategies is to help the child internalize control of attention, impulsiveness, and activity, thus improving work habits and general behavior. The methods are designed to help the child develop more conscious control. Each teacher will not, and should not, employ each and every technique presented. This is simply a sampling of practical techniques which can help with certain problem behaviors. The teacher can pick those he or she thinks may work for him or her with the child in question.

Classroom Strategies Useful With ADHD Children

Seat the student near the teacher’s desk in a reassuring non-threatening way.

Call the student’s name before addressing him or asking him to recite.

Stand near the child when giving instructions so as to capture his focus.

Reduce the visual stimuli in the child’s visual field (place construction paper over windows, eliminate posters, pictures, etc.) Lighting should be of medium intensity, no flickering or bright lights.

A child with ADHD will often have difficulty finishing work. Give shorter assignments with immediate feedback of results. Multiple short assignments work better than one long assignment.

Work from small units to larger units in the quantity of work required, the complexity of the task, and time required to complete tasks. Shorten assignments.
Start with easily accomplished tasks. Build assignments in terms of length and complexity.

Break assignments and experiences into smaller units. Gradually increase quantity and complexity of timed units.

Use a multi-sensory approach to allow rehearsal of the material such as speaking orally, writing down key words, drawing pictures, etc. Have a child repeat orally the material to be committed to long.

Provide an opportunity to express motor restlessness in appropriate ways such as when appropriate allow the child to work standing or moving about .

Adequate physical education that allows for gross body movement without involving competitive sports can be helpful.


Yes, there are no easy answers to treating and teaching children with attention deficits. These children are often lovable and attractive, while at the same time frustrating and exhausting to the teacher. One or two such children in a regular classroom without help for the teacher can be stressful for everyone. Open, free communication between teacher, parent, physician, and educational diagnostician is of critical importance if success is to be realized.

While the institution of a well-structured, organized environment at home and school will allow many hyperactive children to function reasonably well, others will need additional modes of therapy such as medication or a prescribed behavior modification plan. However, the teacher is always a key member of the management team.


(Additional teaching strategies is found in the book, ADHD Strategies for Success by Dr. Grant(

Encouraging Responsibility In Teens

“I can’t decide if my eighth grade son is normal or not,” a mother reported.” At times he acts so irresponsibly. But, then, at other times, he can be so mature. I do want him to assume more responsibility for himself. But he does have to prove to me that he can make right decisions consistently.”

One of our major tasks as parents is to help our teens grow into more responsible, mature thinking and behavior.

One of the problems common to children with ADHD, however, is their apparent lack of responsibility. Their lack of organization and impulsive control often results in behaviors and attitudes that exaggerate the lack of responsibility and maturity.

In order for us who are parents of teens to maintain our own emotional balance, we need to be reminded of some basic facts. The rate at which teens mature varies greatly from person to person and from year to year. One fourteen-year-old may seem vastly more responsible than his peers, another much less so. Typically, a teen may get “hung-up” for a while at some stage and make little progress toward being responsible for chores, school work, or emotional control. As hard as it is for us at such times, we need to be patient, accepting our teen where he or she is emotionally and give him or her time to develop. We should set reasonable rules while not getting overly distraught over these plateaus in our teen’s development.

I remember one fifteen-year-old boy who was notoriously irresponsible about his chores and homework. He was casual about his music lessons and he was not interested in assuming responsibility in the youth group or other activities. His parents were concerned but did not panic. They consistently set rules on his behavior and outlined specifically what chores he was to do and told him exactly what would happen it the chores were not done—and, most importantly, what “good things” would happen if the chores were done without complaint. At the end of his fifteenth year he attended a camping program sponsored by his church. He participated in the activities, listened attentively to the camp leaders. On returning home, his whole attitude changed. He began to do his homework without being pushed and took more responsibility for his chores. Now a college student, his parents are rightly proud of him.

Observing this young man’s progress reminded me that most teens will make it to maturity, albeit at their own pace, if we give them guidelines but also allow room to grow. One way we help our teens learn responsibility is to give them increasing freedom to make decisions for themselves as they show the ability to handle such responsibility.

Some teens will need more supervision and guidance than others and for a longer period of time. It is imperative for parents to continue to be present in their teen’s life, to model appropriate attitudes and actions, and to set appropriate limits. (Yes, limits are still needed during the teen years.)

The teen, however, should be given small doses of freedom which are increased as his actions permit. For example, the teen can, within limits, be allowed to buy his or her own clothes and other basic necessities, to make some choices about friends, entertainment, and what to do with his or her free time.

One father started giving his fifteen-year-old daughter an allowance sufficient for her to buy her clothes and other needs such as make-up and accessories. She was allowed to make her own decisions as to what to buy. If she were imprudent and spent her allowance before the end of the month, she might have to go without something she really wanted for a while. This particular girl handled her responsibility well and is now working to help pay her way through college.

Some teens could not handle this degree of autonomy at 15 or 16 but maybe could respond to a smaller dose of independence. We need to realize that our teens will make mistakes and will make some wrong decisions. But that is not all bad. As it was with us, they will learn some of their best lessons from their mistakes. If we do not give them an opportunity to fail, they will have difficulty learning how to succeed. Periodically, we should re-evaluate the rules that we set for our teen. We should talk with them about their progress, or lack of it. We should praise them when and where we can.

Although we may need to revise the rules from time to time, we should always be firm but gentle. In discussing rules it is helpful to review these points:

1. We should give our teens reasons why a given rule is necessary.

2. We should give them a chance to openly discuss rules that they agree or disagree with.
3. We should discuss which rules should be discarded and why.

4. We should decide what new rules should be made and why.

5. We should discuss which existing rules should be changed and why.

6. Most of all, we parents need to trust our teens. They need to know that we believe in them and that we trust them. We also need to clearly let them know what the rules are and what the consequences of irresponsible behavior will be. But we also let them know that we believe that they are capable of thinking and acting responsibly.

Teens, like everyone else, become what they believe others think of them. We, then, can expect the best.

Does ADHD Ever Go Away?

Just a few years ago it was thought that children with Attention Deficit Hyperactivity Disorder out-grew their symptoms by adolescence. However, by the early 1980’s the clinical evidence made it clear that this did not always happen. While some children appeared to “outgrow” their functional problems by the teen years, many had persistence of symptoms which continued to interfere significantly with their life. In addition, it was obvious that these children benefited from continued medical, psychological, and educational intervention into the teen years. Additional clinic data then pointed to the persistence of ADHD into adulthood. An important study was that by Weiss et al. (Psychiatric status of hyperactive as adults, J Am Acad Child Psychiatry 24:211-220, 1985) which reported that 66% of children with ADHD had persistence of some symptoms into adulthood.
Over the past decade, well-documented research more clearly delineated the life-cycle of attention deficit hyperactivity disorder and the various factors influencing resolution or persistence. Joseph Beiderman, M.D. and associates shed additional light on these issues in a study published in the Journal of American Academy of Child and Adolescent Psychiatry (March, 1996, vol 35:3, page 343-351).
In this well-controlled study 119 boys, aged 6 to 17 years, with ADHD for four years following diagnosis were evaluated. At the four year follow up, 85% of children with ADHD continued to have the symptoms characteristic of ADHD. Fifteen percent had remitted completely. Of those who had remitted, one half did in childhood and one-half in adolescence. These researchers documented several factors associated with persistence of symptoms. These significant factors were:

A strong family history of ADHD

nstable family life (A psychosocial adversity)
      The existence of conduct, mood, and anxiety disorders.
This well-done study helps clarified the extent to which ADHD persists into adolescence and the factors influencing such persistence. It also pointed out factors in the child=s life which, if they are present, need to be treated in order to increase the chance of a favorable outcome. Subsequent studies confirmed these earlier findings.
These studies reaffirmed what experienced clinicians have known for a good while: that most children with ADHD get better by late childhood or middle school but some still have symptoms into late adolescence. Thus parents, teachers, and physicians should work closely together to monitor children with ADHD as they progress into puberty. If it appears that the child is gaining appropriate organization and control, treatment, including medication, can be phased back. If the child is having signs of any of the complications mentioned in this article, aggressive evaluation and treatment planning will be needed.

Sleep-Disordered Breathing and ADHD

Sleep-Disordered Breathing and ADHD

A large, population-based study demonstrated that early in life sleep-disordered breathing symptoms had a strong relationship to behavior in children later in life. Children with sleep-disordered breathing developed more behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships when compared with children without sleep-disordered breathing. Findings suggest that children with sleep-disordered breathing symptoms may require treatment as young as one year of age to prevent increased tendency for behavior problems.
“This is the strongest evidence to date that snoring, mouth breathing and apnea can have serious behavioral and social emotional consequences for children,” reported Karen Bonuck, PhD, one of the researchers and professor in the Family and Social Medicine Department at Albert Einstein College of Medicine.
In the study, parents completed surveys reporting on children’s snoring, mouth breathing and witnessed apnea at ages 6, 18, 30, 42, 57, and 69 months of age. More than 11,000 children were followed for more than 6 years. Parents then completed the Strengths and Difficulties Questionnaire when the children reached 4 and 7 years of age. The questionnaire has five scales: inattention/ hyperactivity; emotional symptoms (anxiety and depression); peer problems; conduct problems (aggressiveness and rule breaking); and a social scale (sharing, helpfulness and other factors). Researchers controlled for 15 potential confounders, such as socioeconomic status, maternal smoking during the first trimester of pregnancy and low birth weight.
Researchers found that children with sleep-disordered breathing were 40% to 100% more likely to develop neurobehavioral problems by age 7 years, compared with children without breathing problems. The worst symptoms were associated with the worst behavioral outcomes, and hyperactivity was most affected among the neurobehavioral domains examined, according to the researchers. “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures,” said Bonuck. Bonuck K.

This report published in the Journal, Pediatrics, points to one specific condition that can cause, or at least worsen, symptoms of ADHD. In evaluating a child for ADHD, the examiner should look for signs of sleep-disordered breathing with the medical history and physical exam. Causes of sleep-disordered breathing can be allergic rhinitis, large tonsils and adenoids, or congenital abnormalities of the upper airway. Essentially all of these are treatable with surgery or proper medication.
Sleep-disordered breathing is certainly not the cause of ADHD but one of many factors that can affect the expression of this common developmental problem in children.

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