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ADHD–A Family Matter

One in every four children with ADHD has a biological parent who is similarly affected according to Dr. A.J. Zametkin of the National Institutes of Mental Health, Bethesda, Maryland. His excellent review of the family history of attention deficit disorder appeared several years ago in The Journal of the American Medical Association. Dr. Zametkin discussed a family in which 3 generations of males had significant symptoms of ADHD.
The youngest was diagnosed first and treated successfully with medication. On review, it was obvious that his father had attention and organization dysfunctions which continued to interfere with his life as an adult. He was also treated successfully with medication beginning in his forties. Further questioning suggested strongly that the paternal grandfather had symptoms of ADHD. (Zametkin A, JAMA 273:1871-1874, 1995)

Editor’s Note: This study, although from several years ago, points out the importance of discussing the family history when evaluating a child with attention problems or learning disabilities. Strong family patterns do exist. And this is not the first time a parent has learned of his or her own attention deficit after having had a child evaluated.

Over the decade and a half since this study was published, research into the cause of ADHD has shown that heredity is the most dominant factor determining the presence of ADHD. Those of us working with children with ADHD often see families in which the one or both parents will say, “You know when I was a child I was just like my son. I had the same problems. In fact I still have those problems to some degree.”

The Power of Positive Relationships

Our chance of success in parenting is greatly increased as we positively meet the normal, healthy needs of our children for love, acceptance, meaning, and mastery. As these needs are met our children will be less tempted to seek a place for themselves through deviant, undesirable behavior.

Our children need to know that we love them in spite of what they do. Our love and concern as parents is not conditioned on their behavior. By honestly accepting our children and liking them while not necessarily accepting or liking their behavior, we keep the door open to change and growth. Love is, and has always been, the most powerful force in the world.

When it comes to relating to children, patience is a virtue but is not always easy to express.

“Stop acting like a child,” I overhead one frustrated mother say to her six-year-old. Although I could understand why this mother erupted in such frustration in the middle of the supermarket, her remark mirrors our frequent inappropriate expectations of our children. Much of the behavior of children that is so frustrating to us as adults is simply our children being, well, children.

To be effective as parents, we need to have some idea of what is appropriate behavior for our children’s age and stage of development and not attack them for things they cannot help. A young father got very angry with his three-year-old son for using a paper cup as a football during a formal reception. Actually this was pretty normal behavior for a toddler who was ignored in the midst of all the adult activity.

Another mother was frustrated because her thirteen-year-old daughter ran to her room  slamming the door when her mother disapproved of the dress she was wearing. Actually, such pouting and anger are quite typical of the adolescent. We need to remember that children are uniquely children —growing organisms who have not yet reached perfection. Punishment of the child for things he or she cannot help or does not understand will only create frustration, confusion and, likely, rebellion.

We often use up so much energy nagging and correcting our children that we have little energy left to relate to them in positive ways. This is particularly true with ADHD children. In the happy families I have known, however, the interactions have a positive tone and direction. In angry, unhappy families, most interactions have a negative tone. This is one area where all of us as parents can work toward a better record. We can tip the balance in our families in a more positive direction by applying some of the following principles to our relationships:

Listen to the child. Listen without interrupting or correcting. Listen to just hear what he or she has to say.

Do something the child likes. For some this may be reading and talking, others playing touch football, others working on a craft project, or repairing the car.

Give the child some space. Let the child do his or her own thing as long as the activity does not infringe on the rights of others. We are saying, in essence, “I trust you to make some choices for yourself about what you will do with your time.”

Avoid conflict when possible. Conflict, at times and to some degree, is inevitable. While most parents seek to avoid conflict, some seem to delight in having a head on collision with their children. However, both parents and children gain when potential conflict is avoided. A power struggle only creates hostility and negative feelings which hurt everyone. When you do need to draw the line and establish a limit, do so firmly and quickly with as little verbal combat as possible.

Look for the child’s good points. Everyone has some gift. Everyone does something well. Everyone has some redeeming features. The sparkle is there if we only look for it. Ours will be a much happier family if we look for each other’s talents rather than each other’s faults.

We set limits firmly and consistently but without anger. Even as we seek to understand our child, we remember we are the parent. We need to let our child know clearly what our expectations are. If the line between expected and inappropriate behavior is blurred, the child tends to push until they have some sense of where the line is.

As parents we teach through relationships. We show our children what love is by loving. We teach forgiveness by forgiving. We teach honesty by being honest. We cannot substitute things for affection. Often adults have been heard to say, “I received everything I needed form my parents except the love and understanding I needed most.”

The child with ADHD draws criticism and negative feedback like a magnet. Relationships in the family often mushroom into a back hole of negativism. Parents find themselves constantly correcting, redirecting, and limiting. The child too often responds in sullenness and more self-defeating behavior. It takes effort to reorient the family atmosphere to a more positive spin. But it can be done.

Structure of Time and Place

Most children as well as adults, when left on their own, eventually will fit their daily routine into some sort of pattern that allows them to function successfully. Due to their internal disorganization, however, children with ADHD fail to do this effectively. They have difficulty focusing on a goal and aiming at it. Their increased susceptibility to distractions makes it difficult for them to stay focused on what is important at any given time.

The more unstructured, disorganized and distracting the environment, the more the child is disorganized and disoriented as to his goals. This, in turn, leads to confusion and frustration which leads to more disorganized, unsuccessful behavior. Thus in an unstructured, unregulated environment the child is caught up in a spiraling web of deteriorating behavior. The more inconsistent and unpredictable the environment, the more disorganized the child’s behavior becomes. This then induces more disorganization and inconsistency in his environment. The downward spiral of confusion and frustration goes on and on…and on.

An environment that calms, organizes, and structures the child’s life is one of the primary steps in a strategy for success. The following techniques are basic:

1. The first step is to provide a dependable time structure to the child’s day. Some elements

of this are:

a. Getting up the same time every day.

b. Regular daily schedule.

c. Regular routine for school, play naps, etc.

d. Regular time for homework.

e. Regular bedtime.

Such a regular, dependable routine does several things for the child. Each planned activity presents him or her a framework on which he can hang his day. The set routine gives him short‑term goals to work towards. The time structure acts like handrails on the stairs which help the child keep his behavior more goal-directed. Having certain activities to do at specific times makes him less likely to wander off into distracting, bothersome behavior.

In implementing such a time structure, the parent first decides on what would be a desirable daily pattern that fits the parents, as well as the child’s, needs. At this point, it would be helpful to sketch out the daily schedule. The parents need to make sure the key elements (getting up, meals, school, bed time) are such that they can enforce them consistently. They then discuss the schedule with the child.

The parents do not have to make a big production out of this scheduling task. They might simply say something like this: “This is going to be our schedule. Let’s discuss it.” If the child is old enough, the schedule can be written and posted in his room or some other conspicuous place. An older child (seven or eight or older) might participate in determining the contents of the schedule. Once the schedule has been determined, the parent enforces it consistently, but gently.

This does not mean that the family must live a totally monotonous, unchanging life for the sake of this one child. But the day‑to‑day routine of the child should be as consistent as possible within the family’s power to make it so. Certainly, there will be times when a break in the routine is needed. When change in this regular routine is necessary, however, it helps to prepare the child ahead of time and clearly state what you expect of him or her.

2. The next step is the structure of place.

“A place for everything and everything in its place,” is more than a motto for the person with ADHD. It is a necessity. A search for a lost baseball glove can be a frustrating experience for a normal ten‑year‑old. But for a ten-year-old with ADHD, it can be a disaster, ending in an emotional explosion. Such problems can be prevented by helping the child organize his world (at least his room and his belongings) so that there is a place for everything.

This could involve other elements such as:

a. A regular, non‑distracting, place to do homework.

b. Labels on drawers and shelves to help the child locate the contents. (Some parents have successfully used color codes on drawers and shelves.)

c. In strange new surroundings, such as on vacation, new school, or visiting friends, it helps to take the child on a tour and show him the layout and locations of important particulars of the area.

These are simple steps but can make a big difference in the life of the child with ADHD—and that of his parents.

Successful Coping Strategies for Adults With ADHD

Many adults with ADHD (Attention Deficit/ Hyperactivity Disorder) have become successful academically and professionally. They have enhanced their success by employing a variety of strategies that help them cope with the bothersome symptoms of ADHD

A few years ago, Dr. Robert Wells, Ph.D., studied  strategies practiced by successful men and women with ADHD. He found that those who were more successful in their education and career were more likely to do the following:

Set up rituals to get through repetitive tasks.

Use lists to retain large amounts of information

Control impulsive behaviors by writing down their thoughts and talking them over with

some one.

Choose jobs which have a variety of different tasks each day and that allow them to be in

charge of themselves and their time but that still have structure and quotas.

Learn to delegate.

Some of the individuals listened to “white noise” in the background to help them concentrate. “One guy had the rule of three: He only allowed himself to work on three things at once,” said Dr. Wells, Director of Pediatric Research at Valley Children’s Hospital in Fresno, California.

Many of the less successful subjects could not identify any strategies they used to avoid distractions, to retain information, or to make them feel successful. Only nine per cent of the variability in success could be attributed to differences in intelligence, Dr. Wells added.

Editors Note: This technique of studying adults who have successfully compensated for their developmental challenges would seem to be an area of fruitful study. We do know that many individuals find success and happiness. It helps to know what tools they use to compensate.  As we now know, few, if any, people “outgrow” their ADHD. But they can learn compensatory tools as the subjects of this study point out.

Affirming Creativity in Children With ADHD

The seeds of creativity are planted in the child from creation. But these seeds must be watered and nurtured if they are to grow to their full potential. Creativity can be enhanced or discouraged depending on the way we as parents and teachers react to the child’s initiatives.

So give some of the ideas listed below a try. These easily implements actions will help foster creative thinking and nurture a love of learning on the part of the child. Once you get started, you can add to this list out of your own experience.

1. Help the child chose a topic to write about. Suggest a word length and make it short so as to stay within the child’s attention span. You don’t want to discourage or frustrate him or her. This exercise develops the ability to follow directions. Consider dressing the writing up as a magazine article by encouraging the child to choose pictures she can cut out and paste illustrating the narrative.

2. Using a recorder to develop a story. You can start telling the story. Make it up as you go. It doesn’t have to be perfect. At an exciting point stop and ask the child to pick up the narrative and add to the story. At this point you add more to the story line but quickly give the child a chance to jump back in. Later replay the tape and discuss the story.

3. Explore the backyard or school grounds with a magnifying glass. Have the child make a list of what he finds. Assist him or her in looking up the discovered items in an encyclopedia or on the internet.

4. When the child asks you a question, don’t automatically give an answer. Respond with, “What do you think?” Treat the answers with respect even when you may add or correct information.

5. While driving, begin a “What if?” game. Start with a sentence such as, “What if you went to school one day, and the teacher said you were all going on a trip in a submarine?” Let the child continue adding all the “what ifs” she can imagine. Once the story gets going, prompt the child for more details. Ask why, how, who, when, etc?

6. Don’t belittle or treat lightly any question. As Lucy said to Charlie Brown, “There are no dumb questions, only dumb answers.” For some questions you will have no answer. A good response is simply, “I don’t know. What do you think?” And then add, “Let’s look it up. Where do you think we might find an answer to that question?”

7. Have the child color, draw, or paint any picture he or she wants. Then tell a story about it.

8. Introduce your child to the computer. De-emphasize games; rather, show him or her how to use the computer to accomplish tasks. For instance, help the child to learn basic word processing and encourage them to write stories. Help them to use the thesaurus and spell check. Realizing that there is more than one way to say something is liberating.

It may come as a surprise to some to realize that many children with ADHD are bright and creative. Their distractible, and distracting, behavior frequently disguises these positive qualities. One theory would suggest that while the ADHD child easily misses details due to inattention, his wide-ranging and rapidly moving focus allows him to make true “leaps of logic” and discover new ideas.

The kinds of activities listed above are “attention-giving” activities which help the child with attention deficits and learning disabilities overcome some of their natural randomness.

ADHD and Reading Disability

It is well-known that boys and girls with ADHD (Attention Deficit Hyperactivity Disorder) often underachieve in school. While the symptoms of short attention span and impulsiveness, and disorganization will affect academic performance, it has also been suspected that there is an increase incidence of true learning disability, especially in the area of reading, in children with ADHD. Now a study reported in the October issue of Pediatrics provides evidence that ADHD and reading disability often do exist together.

In this report from the Mayo Clinic, the medical and school histories of over 5000 boys and girls were evaluated. Three hundred and seventy-nine of these children fulfilled the criteria for ADHD. Compared to boys and girls without ADHD, those with ADHD were significantly more likely to be male. The incidence of reading disability was twice as high in children with ADHD as in those without ADHD symptoms. Girls with ADHD were more likely than boys with ADHD to have reading problems.

This large study confirms that there is an increased risk of reading problems in children with ADHD. In light of this, the study authors point out the importance of evaluating children with ADHD for reading disability and providing remedial help to those who need it.

In the ADHD Strategies for Success Book, we point out that the Number 3 step in effective management is Educational Intervention. We state, “Most children with attention deficits will usually have specific educational needs—needs which will require varying levels of evaluation and individualized instruction and/or classroom modification.

While many children with ADHD have no evidence of language-based learning disability, there are many in which ADHD and a learning disability co-exist. I have seen children who have gone for years without treatment for their ADHD because all their academic problems were blamed on their language dysfunction. The attention problems and poor organization were thought to be secondary. On the other hand, I know of children who have not received serious evaluation of their reading and spelling under-achievement because their poor grades were blamed on their attention deficit disorder.  When a child has been diagnosed with either ADHD or language processing dysfunction, the child should be carefully observe for evidence of the other condition.

Association of ADHD to Obesity

A large of study of over 12,000 people in the U.S. has suggested an association of ADHD and obesity in children and young adults. In an analysis that controlled for age, sex, race, ethnicity, education, depression, alcohol use, smoking, and physical activity, survey participants with ADHD had a significant 63% increased risk of being obese compared with those without these symptoms. People with only inattention (ADD) had a smaller increase risk of 23%.  In the study, the more intense and widespread the symptoms of hyperactivity and impulsiveness, the worse the obesity risk.

The study did not evaluate the reasons for this association of ADHD and obesity. However, one of the characteristics of ADHD is impulsiveness. It is possible impulsive eating, maybe related to increased stress of coping with ADHD symptoms could contribute to the increased risk. Further study is needed to get a better picture of the cause of the obesity and how to prevent it. Also it would be of interest to know if optimum treatment with medication and cognitive behavior therapy would reduce this risk. I suspicion is that it would to the degree that intervention helped in the control of impulsiveness.

Rise in Prevalence of ADHD in Children

A new government study finds that nearly one in ten children has some form of ADHD. This is a significant increase from a few years ago. ADHD, or attention deficit hyperactivity disorder, makes it hard for kids to pay attention and control impulses and organize tasks.

The new estimate comes from a survey released by the Centers for Disease Control. The study found that there has been an increase of about 22% in ADHD since 2003. The researchers calculate that about 5.4 million children have ADHD.

The cause of this increase is uncertain although the researchers speculated that it may be due to better screening by schools and doctors—and just a general increase in awareness of ADHD by the general public. Whether these new estimates are accurate or not, they do point to the significance of ADHD. Over the years, repeated studies document that ADHD is the most common developmental disorder affecting children. Attention Deficit Disorder is a frequent reason why a child may under perform academically or be seen as having behavior problems.

Another important fact pointed out by this study: It is critical that children with ADHD be recognized and accurately diagnosed because, thankfully, there are reliable and effective methods of management and treatment. (See additional articles on this website.)

Guidelines When Seeking Help for the Child with ADHD

When faced with a child who  attention deficit disorder or is under performing in school or having trouble with behavior, parents need to seek help and advice from experienced professionals representing various disciplines.  And there are many competent helpers available–educators, psychologists, physicians, therapists who have a wealth of experience working with children with ADHD.  However, parents need to be careful in seeking help. Some signs to watch out for are as follows:

1. Any one offering a complete or, quick, cure for ADHD. So far I have not found any “quick fix” for developmental problems such as ADHD or learning disabilities. Help is certainly available but it involves time, effort, and cooperation of many people. When fad treatments are latched onto, time as well as the family’s resources, are often wasted.

2. Anyone pushing a method of treatment not known to the school personnel, your physician and other professionals in the community. You can be sure that your child’s teacher, principal and counselor as well as your pediatrician are interested in what the community has to offer for ADHD diagnosis and treatment. If there is someone or some program around which can help, one of these people you trust is likely to be aware of its existence. They are not likely to recommend a program that is worthless and expensive.

3. Anyone who pushes just one form of therapy for ADHD. The strengths and weaknesses of each underachieving child is unique. No one treatment is a panacea for each of them. Most children will benefit from a variety of interventions through special education, behavioral management, and maybe medical treatment. Most competent professionals will be open to any possibly effective technique.

Good luck in finding good help for your child with attention and learning challenges (more…)

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