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One of the challenges associated with ADHD and ADD is “executive functioning”. I have talked about this before. This like so many other things is a confusing element to ADHD but one that I feel is really important to be aware of and necessary to understand the challenges of your child holistically. In fact, many experts in the field of ADHD/ADD are starting to suggest that ADHD be re-conceptualized as an “executive disorder” and deemphasize the focus on hyperactivity and attention. Problems with executive functioning are not limited, however, to only those with ADHD or ADD. Executive dysfunction sometimes is the only problem and sometimes is part of a larger problem.

The easiest way to think of executive functioning is that it is the administrative or managerial part of the human brain. Executive functioning has to do with organization, planning, self-control, and time management, for instance. Like anything else, any individual with executive functioning issues will have areas of strength and areas of weakness within the broad spectrum of executive functioning.

The reason I am writing this blog post is not only to raise awareness of executive functioning or dysfunction but also to state that executive dysfunction requires teaching, support and practice in order to be effectively addressed. There are things that you can do to help your child in the short term and there are processes to help teach them how to handle different situations and opportunities. Supporting your child in the areas of executive functioning is often required into high school and college. Like anything else, better executive functioning occurs with ongoing practice and support.

For me, one of the hardest challenges I have is gauging what is appropriate and when. I need to keep in mind that we have to understand our son’s strengths and weaknesses overall and to work with those strengths and weaknesses on an ongoing basis. The conquering of certain skill sets can only be achieved with consistent practice and it takes time. Thinking in terms of support of executive functioning in this way has helped me a lot to establish a mindset for myself in helping our son.

I have heard this often in my ongoing research but I feel that it is important to stress that our son is not defined by his challenges. Our son is an amazing child who is fun and funny and full of energy and life. He has his strengths and weaknesses like we all do. All of our efforts are focused on supporting who he is so that he can continue to experience success and grow into a confident young man.

I am just learning about the process of supporting executive functioning. It turns out that we have already been implementing strategies to help our son especially in the area of transitions. For instance, we use the 5 minute warning, 3 minute warning and 1 minute warning for all changes in activity so that he has time to adjust. It turns out that “transitions” fall within the area of “Cognitive Flexibility”. Cognitive Flexibility is defined as the ability to problem solve in a flexible, dynamic way and/or the ability to address new situations. So as we learn more, I will share what I have learned with you.

Until then …. Take care.

One of the things I struggle with as a parent of a child with neurological issues is really grasping everything.  There are times when I feel that I have a handle on things and there are times that I worry about all kinds of issues.  Does he have other psychological and behavioral issues?  Is he suffering from clinical anxiety, does he have ODD, what is immaturity, bad behavior and what is executive functioning deficits?  Sometimes I think I might go mad with all of the questions running around my head!

One term that I have heard fairly often and frequently worry about is ODD, Oppositional Defiant Disorder.  Many parents have not heard about this disorder but it apparently is one of the most common psychiatric problems in children affecting around 5% of the child population.  It also affects a high percentage of children with ADHD … around 30 to 40% of those with ADHD also have ODD. In fact it is exceptionally rare for a child to only have ODD; ODD is commonly associated with ADHD and depression/anxiety.  Oh that lovely comorbidity thing again!!

So what is ODD?  One of the best descriptions I have heard of ODD is by Jim Chandler, MD, FRCPC.  (http://jamesdauntchandler.tripod.com/).  According to Chandler, “ODD is a psychiatric disorder that is really just the far end of the stubbornness spectrum.  The line that divides being just difficult and stubborn from ODD is a set of diagnostic criteria.”

The criteria for ODD are:

A pattern of negativistic, hostile and defiant behavior lasting at least six months during which four or more of the following are present:

• Often loses temper
• Often argues with adults
• Often actively defies or refuses to comply with adults’ requests or rules
• Often deliberately annoys people
• Often blames others for his or her mistakes or misbehavior
• Is often touchy or easily annoyed by others
• Is often angry and resentful
• Is often spiteful and vindictive

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

Now why do I worry about this so much and why am I confused?  I think any parent of child with ADHD probably struggles with getting their child to cooperate with homework, chores and the other necessities of life.  Our son often throws fits and refuses to cooperate.  This is pretty much a daily occurrence.  Are they outrageous, knock down fits?  No.  He occasionally has an outrageous fit but not often.  But why does he throw these everyday fits:

• Is it because some times he gets his way?
• Is it because of executive functioning deficits which cause a low threshold for frustration?
• Is it a side effect of the medication?
• Is it a transition issue?
• Is it because he is exhausted from school?
• Is it signs of ODD?

I think this is the most difficult part of our son’s neurological challenges – not knowing the answers to everyday occurrences.  Am I doing something wrong?  Am I doing something right?  What should I be doing?  And the internal battle of questions rages on and on in my head non-stop.

I decided to do some research into ODD for today’s blog post because it is an area I have been concerned about but have not really had the time to research.  What I found to be the key criteria for ODD is spitefulness and vindictiveness.  This coupled with a blaming others for his or her mistakes or misbehavior are key signs of ODD.  According to Chandler, “the destructiveness and disagreeableness are purposeful.  They like to see you get mad.”  It is this description that turned on the lightbulb for me.  Our son often refuses to cooperate but he is not spiteful or vindictive. He is “oppositional” mostly because he does not want to do what I am asking not because he wants to see me get mad.

To read Jim Chandler full pamphlet on Oppositional Defiant Disorder, please go to http://jamesdauntchandler.tripod.com/ODD_CD/oddcdpamphlet.pdf.  It is a straightforward description with examples that I found to be tremendously enlightening.  Most other sources of information that I found online stuck with the Diagnostic and Statistical Manual of Mental Disorders definition as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.  Most sources of information are very clinical with very few examples.

So I am happy to say that our son’s stubbornness does not seem to fit within the range of Oppositional Defiant Disorder.  Yeah!  Cross that off the list, for now (J).  So now I need to worry if it is a side effect of the medication ….. sigh.

One of the areas where I constantly struggle is helping our son find his areas of talents or what I like to call, his essence. Our children are like my husband and I. We are good at a lot of things but not outstanding at any one thing. We are good athletics, we enjoy music, we like books and politics, we enjoy giving back to the community and so forth. We are not the next Rembrandt, Tchaikovsky, Michael Jordan or Mother Teresa. Nothing is glaringly obvious.

Couple this with the fact that most of the time and effort with our son is currently focused on academics. He is absolutely exhausted when he comes home from school. He works hard, thank goodness, and cooperates with his teachers and, new this year, he actually LIKES school. I have so much to be thankful about. But some days when he gets home from school, he looks like he has been through a war.

We value play time and are mindful of balancing work with play time. But we have over an hour of homework each night and it is very difficult to fit everything in. He does play sports on Saturdays and seems to enjoy it but it is not clear to us that sports is his THING either.

Why do I worry about this so much? Our primary goal with our son with everything we are doing is to develop is self confidence and his self esteem. That is starting to develop academically because we are able to send him to a school when he can learn differently than the mainstream and be successful. I want him so much to experience success in something outside of school that he truly loves.

Getting him to try new things is not easy. He gets anxious and worried about new activities. Often when we start up a new sports season, he has trouble with the first few weeks of the activity – it is a transitioning issue.

Maybe this worry is more about me than him? I just want so badly for something to come easily to him that he truly truly loves … given that he has to work so hard in the other areas of his life.

So this blog post is not a Karen offering a suggestion blog post – it is one where I am reaching out to you for help. Do you have any suggestions or thoughts?

• How do we fit in the time for him to explore his interests?
• When is the right time to pursue drum lessons or karate or whatever else?
• Is maintaining a balance between play time and work time enough for laying the groundwork for future interests?
• Do I need to just chill out and believe that with self-confidence and academic “success”, he will figure it all out?

Would love to hear from you regarding how you enable the “essence” of your child to shine through all of the struggles!!!

MEET CHARLIE OUR GUINEA PIG

As many of you know, having a child with ADHD or working memory issues creates a challenge when trying to get them to take responsibility for multi-instruction tasks. We have had a difficult time getting our son to be independent and to take on responsibility. Some of this is probably our fault. He works so hard with his learning disabilities and ADD that we probably baby him too much otherwise. However, he was begging – BEGGING for a guinea pig. Even though we really did not have ANY desire to have another pet in the house (we have a Havanese dog and a Beta fish), we decided to use the opportunity to teach responsibility and to increase his independence.

At the pet store, we made a very hard deal with my son. He had to take responsibility for caring for the guinea pig with my help. If he did not, then we were going to give the guinea pig away and he was going to have to pay us back for the cost out of his allowance. We emphasized the deal several times and made him repeat it back to us several times before we even bought the guinea pig. So we bought the guinea pig and named him Charlie.

Charlie is very funny and makes all sorts of noises that make us stop in our tracks! He loves to be held, loves to beg for food and enjoys playing both inside and outside in a play area that we bought for him.

The very first Saturday, when it was time to clean out Charlie’s cage, we did get push back from Griffin. I spoke with him to make sure he wasn’t scared or anxious about the task. He was refusing to take care of the cage. So we said that we were going to have to start asking around to see who wanted Charlie and walked away. Sure enough, Griff came into the kitchen to work with me on cleaning up the cage.

We decided to take pictures of Griff taking care of Charlie for two reasons. We wanted to give Griff the opportunity to share his story of responsibility with his class. Since his teacher is deathly afraid of anything rodent like, we decided to make a poster which he is going to share with his class. Second, we use the visual poster as support for Griff when it is time to take care of Charlie. It reminds him of what tasks he needs to do and it is a system that he can use independently without asking for help.

RINSE OUT THE BOTTOM OF THE CAGE WITH HOT SOAPY WATER.

PUT IN FRESH BEDDING.

PUT IN FRESH FOOD.

Visual reminders are a strong means of support for any type of task both at home and within the classroom. It gives a visual reminder and checklist yet is something the child can access independently. You can use any type of pictures when putting together a visual checklist but I find that Griff loves pictures that feature him!!

Griff has been afraid or reluctant in the past to take on tasks on his own. We are finding, however, that with visual checklists, his confidence is growing and that he actually enjoys some of the independent responsibilities he has taken on.

Now if I could only get Charlie to slow down on the pooping ….

THE COMPLETE VISUAL CHECKLIST.

According to discussions I have had with many doctors and therapists, no one should have to suffer through terrible side effects of ADHD medication. There are many medications to choose from and each one reacts differently to an individual’s body chemistry.

Putting your child on medication for ADHD or ADD is not an easy decision or one that should take lightly. I, however, have seen firsthand the power of what the medication can do for a child. It can have absolutely amazing results. I said on a recent post, “It’s almost like his brain is a lock and medicine is the key.” Unfortunately, however, medication is not effective for everyone. Some experts say that medication is not effective for some 20-30% of the ADHD population.

My family had many discussions with doctors and therapists before we decided to put our son on medication. Two critical pieces of advice that we were told over and over again are advice that I feel everyone considering medication for their child should know. First, each child responds individually to each medication and that it will probably take time and experimentation to find the right medication for your child. Secondly, it is absolutely not necessary to tolerate side effects which last for more than a few days.

There are many choices of ADHD medication both stimulant and non-stimulant based. If a child is having side effects from the medication which continue for more than a few days, consult your doctor and try another medication. Do not tolerate side effects – this is what we were told by both our doctor and the many therapists we spoke with which was about ten therapists – all extremely experienced with ADHD.

I have gone on blogs and forums where mothers are detailing the side effects of their child’s medication. STOP. Try something else.

Two side effects that seem to be very common include loss of appetite and sleeplessness. We were fortunate enough to have experienced neither. I have heard that a loss of appetite can clear up on its own after the child’s body has had time to adjust to the medication. However, again, if this is a side effect that persists for several weeks, consider adjusting the medication.

Side effects which should not be tolerated in any form include consistent stomachaches or headaches, tics or emotional problems.

I was actually surprised when I did a Google search on ADHD medication side effects on how few of the resources really stressed this idea of not tolerating side effects. The resources all listed possible side effects and some resources addressed how to deal with side effects but very few actually stated do not tolerate side effects. My feeling is that this is probably some form of CYA (cover your you-know-what).

Again I spoke with several doctors and at least 10 therapists who are very experienced in this area of ADHD medication. There are many medications to try – each one works with a child’s body chemistry differently. Be patient and realize that it may take time to find the right medication for your child. Work with your doctor, consult your doctor but do not tolerate side effects.

I hope this was helpful. Until next time …. Take care.

In this video I share what we have immediately seen with medication for our son’s ADD. It is a testimonial for anyone consider medication for their child.

I wanted to provide you with a quick update on our journey with ADD. As of a couple of weeks ago, we put our son on Adderall on a very low dose. The results have been immediate! Although I agree that ADHD and ADD are overused terms in our society, ADHD truly is a neurological disorder that can respond quite well to medication.

We were lucky. Our son responded immediately to the first medication we put him on. We realize that as he grows, we will probably need to modify or switch medications. Each medication’s efficacy is relative to each individual’s body chemistry.

Our first day that we put him on medication, we immediately noticed that he was much more task oriented than he had ever been; he was highly communicative and his responses to others were much more empathetic. This may sound like a silly example but on the first day of medication, he peeled an entire cucumber by himself and presented it at the dinner table. He had never done anything like that before.

Recently, we went to an open house at his school where we were treated to a recent drawing and writing sample by him. I posted a picture of the drawing and writing sample in last week’s post. I cried. The results are amazing. AMAZING!! I have never seen him draw or write like what he has produced recently. It is almost like the medication is the key unlocking his true potential. He is so proud of the work he is now producing. He seems much more comfortable with school and is actually proud of the homework he does. Recently he did homework with our babysitter and when I came home, he ran up to me to show me his homework!! Now I realize that usually I do his homework with him but to have him actually want to show me the homework he had done is substantial.

Needless to say, the medication is working for us. We did not put our son on medication easily or lightly. We had substantial conversations with doctors, therapists and other parents when deciding whether or not to pursue the medication route. Our results are consistent with what we have heard, if the condition is truly ADHD (in our case ADD), the medication will product results immediately.

We heard one truly amazing story from a mother who was and is absolutely against giving her child medication. However they decided as a family to pursue medication for her child. The mother has tried to take the child off the medication but the child persists and tells her that without the medication he feels foggy. In other words, the children since the age of 7, I believe, has demanded the medication because he is able to function better with it.

I am so happy to share our amazing results. We know that we may have to switch medications as our child grows but for now we are so very happy the medication has provided a key to unlocking our child’s potential.

BEFORE MEDICATION

AFTER MEDICATION

NEED I SAY ANYTHING MORE??

Girls Night Out: An Empowering Discussion about
Women and Aging

Girls Night Out
Thursday, October 1, 2009
6-9 pm
Fairmount Boathouse
#2 Boathouse Row
Kelly Drive
Philadelphia, PA 19130

Wesley Enhanced Living (WEL) will host Girls Night Out, a special evening of lively discussion, savory hors d’oeuvres, cocktails, wine tasting and chocolates on Philly’s renowned Boathouse Row.

As women, we have our plates full when it comes to aging – wrinkles and sagging (ugh!), planning for retirement, caring for aging parents and managing our health. Gather and network with women of all ages for an engaging panel and an empowering roundtable discussion on our relationship with aging.

A Girls Night Out panel discussion will feature leaders in healthcare policy and media. The panel will be emceed by Daily News/Philly.com Columnist Ronnie Polaneczky and will feature Renee Chenault-Fattah, NBC10 News Anchor; Anne Tumlinson, Senior Advisor, Avalere Health LLC and Nathalie Bartle, Professor, Department of Community Health & Prevention, Drexel University School of Public Health.

Ticket prices are $75 per gal. Free parking is available. Proceeds from Girls Night Out will benefit hundreds of Philadelphia seniors who call WEL at Evangelical Manor home.

Registration: Please contact Lisa Birton at 215-354-3193 or lbirton@wel.org or visit www.wel.org

Press: Please contact Holly Mantle (215-825-9633 or hmantle@levlane.com) or Caroline Pennartz (215-825-9644 or cpennartz@levlane.com) at LevLane

Wow, the response to last week’s post, What I Would Want a Mother of a Typical Needs Child to Know” (http://www.lipstickwisdom.com/2009/09/15/what-would-i-want-a-mother-of-a-typical-needs-child-to-know/), has been tremendous. I have seemingly been able to verbalize in my post what many mothers of special needs children feel in their daily life. Frustration with a lack of understanding and consideration is a common feeling among those of us with special needs children.

What, in my opinion, are the two most often cited sources of frustration and lack of understanding? I feel they are extended family and the school system. So I have been asking myself for days – how can I help to educate those who don’t know and don’t understand?

The problem is there is no universal definition for ADHD, Autism, Asperger’s, Anxiety or any number of neurological disorders (what is with all the “A”s?). Many of the symptoms can be associated with bad behavior, or lack of motivation or any number of negative things. There disabilities are particularly challenging, in my opinion, because they are “invisible”. I find that what little awareness exists is focused on the hyperactive and impulsive symptoms of ADHD which certainly can be challenging, are very visible but are not, often, the most challenging aspects of the disability.

The questions I have been asking myself include:

How do I quickly define what it is … It must be simple and direct calling for understanding …

What form should it be in so that it can be effective yet not require too much effort on the part of the receiver of information ?

Can it be something that can be handed to the individual to cause them to stop, reflect and want to understand more?

Jenn over at www.canmombecalm.blogspot.com is asking the same question. View her thoughts here http://canmombecalm.blogspot.com/2009/09/adhd-awareness-week-what-does-it-do.html,

I am trying to model my response to my own questions by looking at CC at http://www.ifonlyihadsuperpowers.blogspot.com (http://ifonlyihadsuperpowers.blogspot.com/2009/09/therapy-thursday-what-we-do-in-speech.html) as an example. CC was challenged by her principal “to consider our students in twenty years. What values and life skills do we hope they will learn from our class? Beyond the day to day articulation drills, what impact do we aspire for in their lives?.” This could be viewed as a tough and complicated question to answer. CC very cleverly answered it in the following way, “In speech, we learn self confidence and clear communication skills!”

Is there a simple and eloquent way to quickly make others stop and think about ADHD? I would love to hear your thoughts as I continue to mull over this vexing problem. Please comment with your thoughts and forward to family and friends for their thoughts. Let’s answer this question together and help educate those around us on ADHD and its implications.

Recently a question was posed on the web which asked, as a mother of a special needs child, what would you want a mother of a typical needs child to understand? As a mother to both a special needs child and a typical needs child, I found the question very difficult to answer.

Recently there was a discussion question put out on the web which asked what I would want a mother of a typical needs child to know about mothering a special needs child. As a mother to both a typical needs child and a special needs child, this question is really difficult to answer. Our son has both learning disabilities and ADD.

I have to say that I have written and re-written my answer probably a dozen of times. Finally, I think my answer comes down to what I feel is obvious. What mothers of typical needs children, family and friends need to understand is that we, families of special needs children, need understanding and consideration of our situation. Not unlike those with physically visible handicaps, those with invisible to the eye special needs require consideration, accommodations, respect and understanding. Invisible special needs can make daily situations no less daunting than for those with physical handicaps.

What is especially tricky with learning disabilities and ADHD, especially when a child is young, is that understanding the special needs and challenges takes time and work to understand and address. It has taken us a great deal of time, awareness and education to understand our son’s needs and to respect them. By respecting his needs, I mean that the way he is taught, communicated with, motivated and disciplined is done in a way specific to him and his needs. If you have a close friend or family member with a special needs child, educate yourself on the special needs of the child so that you too can RESPECT the needs that the child has.

My mother and sister have both read books to educate themselves. It has meant such a great deal to us that they took the time to understand our situation. You can read some articles online. It does not have to take a great deal of time. A little effort can go a long way.

We are extremely proud of both our son and our daughter. We love them both and recognize that each of them have their special strengths and their weaknesses.

With a special needs child, however, their weaknesses can make every day living very difficult. The difficulties can affect academics, social situations and the mundane tasks of every day life. Even with the effort we have put in to understand our son’s strengths and weaknesses, we don’t always understand how his issues will come into play in different situations. As a result, we are always on the alert with our son and we always have our “armor” on, as a favorite blogger of mine, canmombecalm, says.

We have our armor on when it comes to school and home work. His needs have to be individually understood and addressed. Even though he is in a small classroom setting, we work with the teachers closely to understand what is most effective for him in learning. Homework is never easy and takes a great deal of vigilance, creativity and patience. It has to be a part of our daily routine all year long. We need to be as or more observant about his successes and his challenges as his teachers.

We have our armor on when it comes to social settings. Group situations can be stressful for our child. Changing from one activity to the next activity can be stressful for our child. Answering on demand questions from adults can be stressful for our child. Social situations for our son can be tougher than for the typical child but they are extremely important to him. Maybe it is because he is in a small group classroom or because his homework takes longer and has to be part of a six day a week routine. Whatever the reason, when he has an opportunity to have a play date, it is extremely important to him and if something happens which causes the play date to be canceled, it is very upsetting to him.

We have our armor on for every day living. He needs time to transition from one activity to the next such as from play time to dinner time and from dinner time to homework time. Each transition requires forethought and warning. Instructions need to be broken down into one or two discrete tasks that can be communicated easily and completed quickly. He needs reminders for most daily activities.

As a result, I may seem high-strung or over-protective to a typical needs mother but I assure you that I am neither. I am simply a mother that is being respectful of the needs of her child. Because our son’s challenges are not visible to the eye, we have to be the buffer zone for our child making sure that he gets the consideration and understanding that he needs.

Is our day-to-day life more challenging with a special needs child? Absolutely. Do we worry? Absolutely. However it has made us realize that, in life, you have to celebrate each small success. We celebrate little notes written to us, we celebrate books completed, we celebrate small instructions followed and we celebrate fun, successful play dates. Life is good and we would not want it any other way!!