Category: School & Learning

Everything You Need to Know About IEPs and 504s

 (for Children and Teens with ADHD)

Navigating the ins and outs of getting help for your child in school can be overwhelming, especially when it feels like everyone is speaking a language you’re not familiar with! This week, I’ll help demystify two very different avenues of accessing school support for your child or teen – I’ll share  everything you need to know about IEP and 504 plans for children and teens with ADHD. You’ll be able to advocate for them more effectively and they’ll be able to manage classes and homework with more ease and success.  

 

Many kids with ADHD struggle in school–not just with accessing what they know when they need to use it but also with co-occurring learning disabilities that occur about 70% of the time.  There are several paths that lead to the provision of an Individualized Education Plan (IEP) or Section 504 Service Agreement (504 SA) for your child, but they all start with one thing – concern that your child may need additional support to be successful in school, and a psychoeducational or multi-disciplinary team evaluation to determine why they are struggling.  Your child’s school might request to initiate this evaluation, you might request an evaluation, or you might provide the school with documentation of your child’s existing disability or neurodivergence…there are many different scenarios in which a student can be referred to determine eligibility. 

 

Where to begin the process

Ultimately, everyone wants to ensure that if your child does need modifications or accommodations due to neurodivergence, they receive tools and strategies to be successful at school. This process often starts with a team meeting (that you or your school team typically have to formally request) to discuss concerns that can

 lead to a psychoeducational evaluation, functional behavioral assessment or recommendation to meet with your primary care provider. If your child already has a diagnosis of ADHD and/or an evaluation that you obtained privately, then this meeting will most likely discuss the information that you already have, and any impact on school performance. Either way, you and the school team will discuss what’s going on and the team will decide whether a school based evaluation is appropriate to determine if your child is eligible under IDEA for an IEP or Section 504. If so, then they will develop a plan that outlines what, how, and where any needed supports or accommodations will be provided.  

Now that we’ve laid out how to begin, let’s talk about the basics of an IEP and 504, what each of them is (and is not), and who they are appropriate for. In order to do this, I will be using the word ‘disability’ here when referring to ADHD instead of ‘difference’ because school based services are only provided based on the determination of a disability. 

Individualized Education Plans–IEPs

An IEP – “Individualized Education Plan”  is a legal document that outlines what supports and services your child will receive as a result of being found eligible for special education under a qualifying disability category.  Federal law under IDEA guarantees a free and appropriate education to all students. IDEA is about facilitating academic achievement and progress. IEPs are just one component of what falls under the umbrella of “Special Education” for children ages 3 through 21 in schools.  They offer a road map for teachers, support staff, related service providers, parents, and other team members to follow.  

The Details of an IEP

An IEP can only be drafted after the school has conducted a psychoeducational evaluation (or you bring one that the district accepts), shared the findings with you, and all participants agree that the student is eligible for special education under a qualifying disability category. The named disability has to be found to negatively impact their educational performance so that the student needs specialized support and services to make progress educationally. While disability categories can vary from state to state, federal law under the Individuals with Disabilities Education Act (IDEA, Part B) identifies thirteen categories of disability, including: Other Health Impairment, Specific Learning Disability, Traumatic Brain Injury, Orthopedic Impairment, Hearing Impairment, Emotional Disturbance, Autism, Speech/Language Impairment, etc. 

An IEP is characterized by the modifications that are deemed necessary to make the curriculum more accessible for the student to be successful. These are changes to what is taught or expected, through specialized instruction or the provision of related services (behavior supports, PT/OT, Speech, etc.).  An IEP means that the student has been found eligible for Special Education. 

ADHD and IEPs

Under IDEA, ADHD is considered an “Other Health Impairment.” The psychoeducational evaluation by the school cannot diagnose ADHD per se but will indicate that a child has the symptoms or behaviors commonly seen in attention disorders. This means that you will have to take the report back to your primary care provider or a licensed therapist for a formal diagnosis or clinical/medical follow-up. It’s a complicated process but worth it in the end to get services at school. 

 

Section 504 Service Agreement – 504 Plans

A “504 Plan” or “Section 504 Service Agreement” is a civil rights law that refers to

Section 504 of the US Rehabilitation Act of 1973.  It is a legal document that outlines what accommodations your child needs to ensure equitable access in their schooling.  

A 504 SA can only be drafted after the school has conducted an evaluation or reviewed one that you have provided and discussed the findings with you. All participants agree that the student has a disability that limits their functioning in one or more “major life areas” and qualifies for protection as a result.  ​​These functions include such things as self-care, performing manual tasks, walking, seeing, speaking, breathing, learning, working, eating, lifting, bending, reading, concentrating, thinking, communicating, and more. 

504 Plans Level the Playing Field

A 504 is characterized by the accommodations that are necessary for the student to access the curriculum. It is designed to “level the playing field”. 504’s eliminate barriers to allow students with disabilities to access the same activities and programs as their non-disabled peers. It offers protection to persons with disabilities from discrimination based on their disability. Again, within this definition, ADHD qualifies as a disability. 

Students – at any level – who attend a school program that receives federal funding can be eligible for protection under a 504 Service Agreement. They require accommodations to access the General Education setting.  This means a student who is enrolled in preschool, elementary, secondary, postsecondary, vocational, or adult education can qualify, regardless of age. 

 

With the technical information about IEPs and 504 plans out of the way, let’s look at some common misconceptions and the real truths. 

Myths vs. Facts about IEP AND 504 Plans

MYTH:  My child was diagnosed with ADHD by her psychiatrist/family doctor/specialist, she should have an IEP. 

FACT: She should have an IEP only if progress at her grade level is negatively impacted by her ADHD symptoms. 

A common misconception that many parents have is that a diagnosis of ADHD, “dyslexia” (or a specific learning disability), ASD, Anxiety, etc., made by a medical professional, means that their child automatically needs Special Education programming and an IEP.  This is only true when there is an educational impact because the symptoms of that diagnosis make learning at grade level difficult for the student. 

If she is learning at grade level, but needs accommodations like extra time on tests, verbal directions, etc., to address symptoms of ADHD, then a 504 SA could be appropriate. 

 

MYTH: Our son’s outside executive functioning coach thinks he has ADHD and maybe dyslexia. She thinks the school should diagnose him.  

FACT:  A school cannot diagnose a student with ADHD or diagnose dyslexia. For a clinical or medical diagnosis, you should follow up with a primary care provider or licensed therapist. But, if the school were to do an evaluation and also find him eligible under IDEA, he would have educational eligibility under “Specific Learning Disability” and “Other Health Impairment”, and an IEP could be drafted. Remember that in schools, ADHD is considered an “Other Health Impairment”, and dyslexia is considered a “Specific Learning Disability”. The reality is that the same diagnoses a child receives from an outside clinical/medical professional exist in schools but may be categorized or called something different. No wonder parents get confused!

 

When considering whether an IEP or 504 SA may be appropriate for your child at school, here are 5 key takeaways:

 Key Takeaways

  1. An IEP makes mandatory adjustments and modifications, a 504 SA affords access and makes some accommodations. 
  2. Not all students with neurodivergence need special education!
  3. Clinical and medical diagnoses and educational disabilities are often two different versions of the same language.
  4. A school-based evaluation determines eligibility for special education or a 504 SA. 
  5. Going through the process of determining what types of services are best for your child can be very confusing. Get the support you need by talking with your primary care provider, licensed therapists, special education advocates or knowledgeable coaches.

Overcoming ADHD Brain Fog

Dear Dr. Saline:

I’m a 30 year-old AuDHDer who would love your input. I pride myself on my ability to focus and concentrate on what needs to be done. I’m achievement-oriented and used to be able to blaze through a to-do list. Lately though, brain fog has been hitting me hard. It’s been a period of very high stress. I find myself struggling to make sense of things people say which I would previously decode with ease. I’m hoping this is temporary but it’s embarrassing. What can I do? 

Thanks!

Crystal

Dear Crystal-

Brain fog can certainly be disorienting, confusing and even a bit scary for folks with and without ADHD or autism. Brain fog refers to a group of symptoms that impact how you function cognitively–your thinking, your recall and your concentration. It can also reflect difficulty with making decisions, mental fatigue, slower response time and uncertainty. While we don’t know what causes brain fog exactly, research shows that it’s associated with chronic fatigue syndrome, long COVID, chemotherapy, autoimmune conditions or depression. But, brain fog is not a medical condition so you can’t be diagnosed with it. It’s more like a set of symptoms that arise when something else is going on and you are not thinking as clearly as you could.

As you have shared, the symptoms of brain fog can make it difficult for people to engage in conversations, perform routine daily tasks and follow instructions. Plus, brain fog differs from person to person, particularly women. In fact, it disproportionately affects women because of hormonal changes related to menstruation and menopause. For folks with ADHD who already struggle with focus, memory and organization, stress can bring on brain fog by overwhelming weaker executive functioning skills. 

Develop coping strategies for daily stress

Of course, living with ADHD and AuDHD means living with a baseline of stress that neurotypical adults don’t have to deal with. The consistent inconsistency of being neurodivergent leads to being unclear– if you will follow through on things, if you will arrive on time, and if people will like you. You may freeze in the moment, unsure of what to say or do. Perhaps you lose your train of thought more often and get distracted more easily. Or, maybe you interrupt others or say something awkward without knowing it. This is especially tough in the middle of social situations, peer interactions or important work meetings.

Rely on coping strategies

Crystal, it seems like you’ve developed some useful coping tools to help you make sense of what others are saying to you and respond effectively. I can’t even imagine how frustrating it is for you to deal with this disorienting brain fog. And, let’s be honest, everybody spaces out sometimes. Yes, this may happen more intensely and more often for folks living with ADHD due to how their brains are wired. You are not alone in your embarrassment when this occurs. But, being upset with yourself for something that you cannot control only increases your stress and worsens the very brain fog that is troubling you in the first place.

It seems that  the question you are asking is, “How do I navigate these moments with more ease and less self-criticism?” I think your first step to lower your stress. I am a big fan of being authentic. Authenticity means being transparent and non-defensive when you miss a comment in a conversation or do something that you later regret. Self-care, exercise and self-compassion are all ways to reduce the tension in your life and hopefully the brain fog too. Try these  strategies to lower your stress.

4 techniques to manage brain fog in your life:  

1. Reduce stress by focusing on one task at a time: In today’s busy, constantly connected world, we live with too much to do and not enough time to reset. When we take a walk while talking on our phone or scroll while eating lunch, we don’t actually give ourselves the true break that we really need. We shred our time into distracted chunks instead of having space to exhale and regroup. When we multitask, we stress our brains and exhaust ourselves. Opt for single tasking as often as possible. You may not be able to eliminate all media multitasking habits but, with single tasking, you’ll feel more productive and less stressed.

2. Get enough sleep:Nothing weakens our coping abilities like a lack of sleep. Many people with ADHD struggle with sleep issues. Typically, folks wrestle with three aspects of sleep: falling asleep, staying asleep and waking up. It can be tough to turn off your mind. Perhaps you experience racing thoughts, intrusive worries or a fitful night of sleep marked by “tossing and turning” throughout the night.

Some people sleep so deeply that they struggle to get up in the morning, requiring numerous alarm clocks or physical reminders. Think about your sleep needs: how much, when and what helps you relax. Practice consistent sleep habits by going to bed and waking up at the same times and staying off screens for at least thirty minutes before you nod off.

3. Exercise regularly: I cannot emphasize enough how much exercise helps with clear thinking. The endorphins that are released during exercise enhance focus and increase your overall sense of well-being. Moving your body has been found to improve motivation, build energy and reduce confusion. The Centers for Disease Control (CDC) recommends that adults engage in at 150 minutes per week of moderate-intensity activity such as brisk walking, running, biking, etc. Of course, eating well helps your overall health too. So the next time that you are feeling brain fog descend, try to move your body and see what happens.

4. Chunk your activities and write things down: Instead of relying on hyperfocus, try breaking tasks down into 30-45 minute work blocks. You want to give your brain time to reset and rest a bit throughout the day rather than go intooverdrive and burnout. It can be tough for a lot of people who like to hunker down and plow through a set of projects. But overworking like this uses up the natural glucose fuel in the brain and then relies on cortisol. You wind up creating stress that doesn’t need to be there. Trying to remember everything also adds pressure. Give yourself a break and write things down. This also reduces stress and gives you the visual cues you need to be productive and stay focused.

Aim for reducing brain fog not eliminating it

Learning how to schedule adequate down time to integrate and process information, asking for someone to repeat what they said without self-criticism and taking care of yourself with good sleep, nutrition and exercise habits will reduce your overwhelm and your shame. Remember, brain fog is not your fault; you didn’t choose this. Instead, just explain what’s going on to someone when it is happening and move on. You’ve got this!

Surviving Back To School: A Neurodivergent Parent’s Guide

As thoughts begin to turn from planning picnics and BBQ’s to planning school lunches, our parental priorities shift from “summer fun” to “get it done.”  The back-to-school transition helps set the stage for a successful school year. It is a great opportunity to help equip kids with the tools they’ll need for a smooth start. But for parents and caregivers of neurodivergent students, this time of year can feel especially overwhelming, as it is so much more than just pencils and pens that our students need.  In fact, parents of children who have learning and thinking differences are more likely than other parents to say they feel stressed (39% vs. 28%, respectively), unprepared (19% vs. 12%), scared (17% vs. 9%), and/or lonely (10% vs. 3%) when it comes to back-to-school season. This week, I’ll share practical tips for how you can survive and thrive during this back-to-school season.

Adjust Expectations

As the parent or caregiver of a student with unique learning needs, you know that being flexible is essential. Why not give yourself that same space (and grace) to be able to NOT do it all, and remain flexible with what you’d like to accomplish? Setting too many goals at once – “I’ll arrange playdates every weekend,”  “We will eat breakfast as a family every day,” or “I’ll volunteer 5 hours in the classroom” – can feel overwhelming to both you AND your child.

Families living with ADHD can be especially sensitive to changes in routines. When new tasks are thrown into existing ones, confusion and frustration often come along for the ride. This year, consider viewing back-to-school tasks through the lens of what is truly important to your family’s needs. Instead of one long “to-do” list to slog through, focus on one or two things that are truly important for your family right now.  By limiting your goals and adjusting your expectations, you’ll minimize pressure on everybody and reduce family stress.  

Start Preparations Now with Low-Key Conversations

Now is a great time to begin easy conversations about returning to school – asking what your child is most excited about doing or seeing when they go back, what foods they look forward to in their lunchbox, who they’ll high-five first, etc. These are no-pressure conversations that signal change is afoot. Start with “Tell me what you know about….” this new grade or this new school. You’ll get a sense of their level of understanding and be better prepared to meet them where they are.

By pairing these conversations with visual cues at home such as a countdown calendar, displaying photos of familiar school staff and classmates, meeting their teacher or walking the hallways of a new school, you’ll help make going “back to school” seem less frightening and more familiar.  These conversations are just as important with college age students so set aside some time to start now! 

Set a Positive Course with Collaboration

Setting a positive course for this year depends on collaborating with your son or daughter to establish clear goals and useful strategies. Kids with ADHD spend a lot of time listening to what they could do differently from caring adults, friends,

coaches, etc. By including some of their opinions in whatever program you create, you increase their buy-in. When they feel like their ideas matter, these kids are far more likely to cooperate. So, start this school year with a calm, honest family conversation.This chat sets the tone for how you will work together to make it a success.

Take the Time to Reflect First

Before you sit down with your son or daughter, consider your responses to these questions: 

  • What do you hope for your child or teen this year?
  • What went well last year and why?
  • Can you identify any behaviors or decisions that made a positive difference? 
  • What were some of the challenges? What improved them?

When you’re ready for your conversation, ask them similar questions. Offer some of your reflections and see if you can agree on some goals for this fall. Write these down and, together, choose one to start with.  It can be fun to treat this as a “time capsule” too: make a copy and place it in an envelope to be opened at the end of the semester. Then you can review how things actually worked out–the successes and the challenges.- kept in an envelope until the end of the year (or month, semester, etc.), then reviewed together and discussed.  

Practice time management skills now

Many children who are neurodivergent struggle with time and get frustrated.This makes morning routines tricky and causes conflict.

It’s harder for them to feel time, plan for things accordingly and then actually do them. They tend to overestimate how long a task will take and how much effort it entails. Then they feel overwhelmed, procrastinate or avoid it altogether. Or, they underestimate how long a task will take and the effort involved. Then they leave things until the last minute, rush to complete them and feel very stressed in the process.

Use Backwards Design to Teach Time and Planning Skills

When planning school schedules, practice using backwards design with your child to help them plan – in reverse – for where they want to be (or want to have done) in the future.  This means working backwards  by starting with the end goal and allocating time accordingly.  Sit down in advance and review what needs to be accomplished and how long things actually take.

“You have to be at school by 7:30. It takes  twenty minutes to ride your bike, lock it up and get to homeroom so that puts you at 7:10. Before that, you want to eat breakfast (ten minutes), go to the bathroom, brush your teeth and get dressed (fifteen minutes) which puts you at 6:55 am. Then you have to wake up. Usually you hit the snooze button once or twice which lasts another fifteen minutes. So that means you have to set my alarm for 6:40 if everything goes perfectly. Maybe we should set it earlier for this week, just in case.”

Backwards design benefits kids by teaching them how to estimate time, develop the ability to sequence events and improve planning and prioritizing. 

Notice the Positive to Raise Self-esteem

Parents of neurodivergent children are 2.4 x’s more likely to experience challenges related to their mental health than their parent peers, making self care strategies an essential component of your back-to-school parenting toolkit.  Equally important, however, is to extend these practices to neurodivergent learners with ADHD. They benefit from explicit support and instruction in identifying and incorporating positive events in their day that nurture self-esteem.

Spend a few minutes at the end of the day and check in with your child, asking “What are two things that went well today? What were your favorite times of the day?” Many kids with ADHD tend towards negative mindsets marked by internal self-criticism and judgment. Shifting their thinking not only nurtures growth mindsets but also self-care. By noticing what is working, they start to feel more confident and courageous. Set aside a time to review two highs and one low of the day. Often dinner is a good place to do this. One of my clients calls this talking about “the happy and the crappy;” for another it’s “the rose and the thorn.” 

Your Self-Care Makes Family Life Stronger

Noticing the positive applies to you too. Self-care goals or guidelines for this year bc when parents are stressed kids pick it up and act out.  As adults, we tend to think acts of self care look like bubble baths, a piece of chocolate, reading a book, etc. But setting boundaries, keeping organized, and lowering the pressure of unrealistic expectations also provide much needed relief.  Before tending to your child, start this school year off on the right foot by reflecting on your capacity, your limits and treating yourself with compassion. Then you can show up and guide your child towards thriving once classes begin.

  Ready, Set…LET’S GO!

Back to school will be a breeze for you and your child with neurodivergence when it includes collaborative conversations, time for community support, opportunities to practice time management, setting realistic expectations, and room for personal growth and positive reinforcement.  Help your child or teen navigate this shift back to school by easing them into the changes ahead with the tips above, and you’ll feel ready to tackle this time of year together! 

 

Ask Dr. Saline: What Does ADHD Look in Black and Brown Girls?

African-American family in their house Dear Dr. Saline,  Yesterday, I received a phone call from the school counselor about my daughter, age 12. She’s not completing her work in class, often forgets to turn in her homework, can’t recall directions, and spaces out during lessons. When she’s frustrated with an assignment, she loses her temper quickly. She’s been losing friends too. Based on some research, I’ve noticed these behaviors at home, and I think that she is showing “classic” symptoms of ADHD. But, at our last visit with Dr. Picone, he seemed to minimize my concerns about attention issues and talked about depression instead. He wanted to give her Prozac, but I refused. I think she is being underdiagnosed or misunderstood as a young Black girl, but I don’t know exactly what to do. Can you please explain how ADHD looks in Black and Brown girls and what I can do to figure this out? Thank you, Michelle. Sign-up for my newsletter + Free Handout | Ask Dr. Saline  

From Dr. Saline 

Dear Michelle: I’m sorry to hear that you and your daughter are having such a frustrating experience. I’m glad that you waited to give her Prozac without more information. Unfortunately, many physicians, therapists and educators treat BIPOC children and teens differently than they do white kids. BIPOC boys and girls are less likely to be evaluated for ADHD even though they may show the same level of symptoms. Unfortunately, this is often due to implicit bias about Black and Brown people in the United States. We must acknowledge that structural racism affects outcomes. Practitioners have to take the time to investigate and receive training about the nature of our biases and how they could emerge in treatment. Sadly, Black and Brown people in America have been subjected to unfair treatment by health care and mental health practitioners over the years and have been coerced to be subjects in inhumane studies as well (e.g., the Tuskegee Syphilis Experiment). This makes it harder for them to trust a system to help when it’s caused so much harm in the past.

Misdiagnosing ADHD Symptoms

Young black or brown girl being chastisedSo many girls are referred for counseling for anxiety or depression without considering other factors such as attention or learning challenges. This is especially true for Black and Brown girls. They may hide what’s really happening to avoid getting in trouble, being considered stupid, or getting teased. Misdiagnosing or overlooking ADHD symptoms means that your daughter, like other kids with ADHD, is more likely to engage in risky behaviors and substance use and demonstrate serious mood disorders later in life. This is especially true for ADHD in Black and Brown girls. They often come across as older than they actually are. This complicates things for kids with ADHD, who can be up to three years less mature than their peers. Plus, many BIPOC parents think that ADHD is another unwanted label. It may be possible that their students deny their struggles in an effort to comply with this cultural belief.

Client Experience

Recently, the father of one of my clients, a ten-year-old African-American male who was just diagnosed with ADHD and dyslexia, said to me: “Dr. Sharon, I don’t want him to have another label. It’s hard enough growing up Black today. This could just be something else that holds him back.” This is a very valid concern, and I really empathize. However, research shows that kids of all ethnicity with ADHD do better with useful interventions at school combined with family therapy to develop effective strategies at home and, lastly, medication. While pills don’t teach skills and the decision to take medication is personal, it is worth noting that the combination treatment produces the best results. Many families, especially those with limited access to health care, can be misinformed about the effects and benefits of medication. Do some research on well-respected sites such as ADDitudemag.com, Chadd.org, add.org, WebMD.com, Healthline.com, or Understood.com.

“While pills don’t teach skills and the decision to take medication is a personal one, it is worth noting that the combination treatment produces the best results.” ~ Dr. Sharon Saline, Clinical Psychologist

Getting An Accurate Diagnosis

Let’s look beyond your daughter’s symptoms to what else might happen. Almost 64% of kids with ADHD have a co-occurring second diagnosis, often a learning disability, anxiety, or something else. Unfortunately, many educators and providers over-focus on the secondary diagnosis or make character judgments without investigating further, especially for BIPOC kids. Too many adults zoom in on objectionable behaviors without sufficiently considering racial, socioeconomic, and psychological stressors. That’s why getting a valid diagnosis is critical.

Two Ways to Get An Evaluation:

1) Go to the principal or guidance counselor at her school and ask how you initiate a special education evaluation, or go directly to the pupil services office for your school district and initiate the process. 2) Check with your insurance company and your doctor’s office for referrals of people who perform assessments. In my last Ask Dr. Sharon blog, I detailed what to look for in this evaluation, but it should include tests of intellectual capabilities, visual and spatial processing skills, and rating forms that target anxiety, trauma, depression, and executive functioning skills. It’s important for the evaluator to understand that life stressors may worsen executive functioning skills. Remember, schools can’t diagnose ADHD because it is a health condition, but they can say that results point in that direction.

Research

Recently, a new study from the CDC found an alarming increase in sadness and exposure to violence among teen girls. This isYoung woman writing on paper particularly alarming for neurodivergent girls, particularly those of color, who are frequently misperceived by adults as older than they are, may be unfairly targeted as being aggressive, and may already lack self-esteem or confidence. When you add into the mix that inattentive girls are often diagnosed later in life because so many adults miss the signs or ignore them, the risk of missing ADHD in BIPOC girls increases. Instead, there are multiple referrals for anxiety, depression or oppositional behaviors. Then these girls can be excluded from their peers because of missing social cues or spacing out during the conversation at lunch.

In Conclusion

If your daughter receives a diagnosis of ADHD, help her take ownership of it. As a family, seek out research, so all of you fully understand what it means to wrestle with attention issues as a person of color. Learning about how her brain works are critical to accepting her challenges and advocating for her needs. It’s very important for Black and Brown kids to be able to identify what is helpful, what is working, and what they need so they feel empowered as learners and as neurodivergent adults. This will set the stage for self-advocacy throughout their lives. With a thorough evaluation, thoughtful interventions at school and home, and possibly medication, your daughter can thrive and develop into the productive, successful, and confident adult you want her to become. Thank you for your question! Be sure to join my upcoming webinars to learn more.  

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Ask Dr. Saline: How Do I Build New Skills with Executive Functioning Difficulties?

New skill loading Dear Dr. Saline,  What is the main skill to work on with someone to help with their executive functioning difficulties? Assuming they are not on meds. Sign-up for my newsletter + Free Handout | Ask Dr. Saline  

From Dr. Saline 

Dear M: When I work with people to improve their executive functioning skills, we start with their primary areas of concern–the parts of daily life that are persistently tough for them. Since you didn’t mention your primary challenges, I recommend beginning with self-evaluation to find your main skill. Then, find a quiet time to reflect on these questions.

Questions to Consider:

  • What are the performance or productivity issues that challenge you the most?
  • How well can you manage your emotional reactivity or impulse control?
  • How easily are you distracted from the task at hand? 
  • What helps you maintain focus and stick with goals?
  • Do you find that you become overwhelmed and shut down more than you would like?

If I had a magic wand…

magic wandOnce you have considered these questions, ask yourself: If I had a magic wand and could change one thing about myself, what would it be? Then, consider all your responses and choose ONE main skill you would like to improve first.

How to start the process of change

Here are some tools you can use along the way to start the process of change: Inhibition and Emotional Control: Slow things down, pause before responding to anything, expect setbacks, and create a plan for recovering and making amends. Initiation:  Break things down into smaller components; use Apps to assist you; reduce perfectionism so you can begin and complete things without pressure; decrease avoidance by starting with something easy to get rolling. Organization: Lay out steps for completing tasks; create daily routines; make spaces for dealing with and storing materials. Prioritizing: Do a brain dump to help you distinguish between what’s urgent and important; break that list down into a smaller list of 3 tasks and then identify their components in terms of time and values. Sustained attention and Goal-directed persistence: Consider possible obstacles to maintaining focus; create a system of reminders to redirect your attention after you have drifted off; set realistic goals based on your actual capabilities and schedule breaks. Working memory: Write things down where you can find and remember them; use alarms, alerts, and notifications; take notes during important meetings, classes, or conversations; if note-taking is difficult for you, brainstorm solutions with your supervisor, professor or partner that may include recording things or let caring coworkers or friends assist you by taking notes (you may also ask for ADA accommodations).  Metacognition: Ask yourself questions that help you monitor and evaluate your productivity and emotional regulation and measure your progress toward your goals. Questions to start with: “How am I doing?” “What helped me before that I could apply to this situation?” Executive Functioning Skills by Sharon Saline

“Improving executive functioning skills takes practice, patience, and determination. While medication can be very helpful, pills don’t teach skills.” ~ Dr. Sharon Saline, Clinical Psychologist

Research

Recent research from the Florida International University Center by Dr. William Pelham found that, while medication-assisted children helped children complete more seatwork, improve their classroom behavior, and reduce rates of getting in trouble, children learned the same amount of subject material such as math, vocabulary, social studies, etc. as their peers. Another study by Dr. Pelham also emphasized the importance of behavioral therapy to learn tools and strategies to succeed at home, work, school, and social environments. Does this mean that people should stop taking medication? Absolutely not. But it underscores the importance of learning executive functioning skills for practical daily living. 

In Conclusion

Brain functionAll human beings have executive functioning skills managed by the prefrontal cortex of our brains. Executive functioning skills describe the directive capacities of the brain.  They work as a command center: connecting, prioritizing, and integrating cognitive functions moment by moment. They are responsible for self-regulation, linking memory to what we see and think about right now, self-awareness and judgment, and actions related to productivity and performance. People with ADHD have significant executive functioning challenges, with some areas of severity that can be quite impairing.  

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How do I get my child properly evaluated and diagnosed for ADHD?

Doctor with teenager Dear Dr. Saline,  My son is now a junior in high school and is having trouble with the increased workload. I suspect something may be wrong. Where do I start with the process of getting him evaluated and diagnosed for ADHD?  Sign-up for my newsletter + Free Handout | Ask Dr. Saline

From Dr. Saline

For children and teens up to age 18, receiving an accurate diagnosis of ADHD can be a complicated, confusing, and frustrating experience. Often parents receive contradictory or inadequate information about the process, and navigating the maze toward diagnosis and treatment can be perplexing. In particular, the tween and teen years are development stages when trouble with attention, organization, and distractibility come to the forefront. As kids switch classes, confront more complex academic work, cope with social dynamics and pursue extracurricular activities, their lives demand that they develop and apply more sophisticated executive functioning skills. So it’s common to see challenges, anxiety, and even depression when they struggle to keep up. Typically, there are three ways to obtain a diagnosis of ADHD; quite honestly, TikTok is not one of those paths. While social media may alert your adolescent that some of their difficulties might meet the criteria for ADHD, it is not a reliable source of a diagnosis.

Evaluator Options Include:

  • Primary care providers (nurse practitioners, pediatricians, physician assistants)
  • Mental health professionals (including psychiatrists) and
  • Using school resources

Whichever route you choose, ensure the person understands and has significant experience with ADHD.  This person will conduct a thorough individual and family history with you and your child. Then, let’s look at a few options. 

Private Professional Options

1. Primary Care Providers

Doctor, parent and little girl being checked at the officeIf your child’s issues might be related to attention, you may have already started researching ADHD. Start by talking with your primary care provider or pediatrician because they have likely known your child for years and have been advising you all along. They will probably give you some forms to fill out with rating scales (and take you to the school) to get a sense of daily functioning and trouble spots and talk with each of you about behavioral, emotional, and cognitive issues. If the forms indicate ADHD, they may refer you for counseling, coaching, or a psychoeducational evaluation (private or through the school district), discuss medication options with you or give you the name of a local psychiatrist.

2. Mental Health Professionals

Mental Health MattersWhether your child or teen is already in therapy or has just been referred, your licensed counselor, social worker, or therapist will want to assess their primary concerns and symptoms to determine a diagnosis and create a treatment plan. Like your pediatrician, this provider will usually show a thorough developmental and family history and give you forms similar to the ones the pediatrician uses before making a diagnosis. Often, they will consult with your pediatrician, your child’s classroom teachers, and other school personnel. Suppose the therapist or psychiatrist has additional concerns or thinks more data is warranted. In that case, they may also recommend  ‘testing,’ especially to rule out any learning issues or for clarification of what’s going on. Some psychiatrists offer therapy in addition to prescribing medication, and others only focus on medication management. All of these folks are capable of diagnosing ADHD.

Formal Psychoeducational Evaluations

Psychologists and neuropsychologists are trained to do formal psychoeducational evaluations (e.g., testing).  Speech and language pathologists (SLP) and special education teachers can conduct more minor, specific tests. These evaluations include assessments of cognitive functioning (including verbal, visual-motor, working memory, and processing speed), other visual, verbal, math, and written skills, grade-level competencies, and emotional issues. These evaluations can be highly informative to you and your teen because they provide a glimpse into your child’s brain works, strengths, and challenges. When you choose a private evaluation (as opposed to testing through the school), you have more control over the person who does it. But ensure the evaluator takes the necessary time to explain the results thoroughly. These reports can be dense, confusing, and overwhelming. Ask all your questions and request a follow-up meeting if you need it. 

School Resources and ADHD Evaluations

Mom and girl with woman guidance counselorMany parents first learn about their child’s challenges with concentration and focus from a classroom teacher, school counselor, or principal. While these conversations can be painful, the information educators share is essential to why your child is struggling in school. Understand that public schools in the USA can name attention, concentration, and memory issues, but they cannot legally diagnose ADHD since it is considered a health issue. However, they are mandated under IDEA (Individuals with Disabilities Education Act) to assess students for possible learning disabilities, including ADHD, and, if there are conditions that interfere with learning, to provide accommodations.

How to Start the ADHD Evaluation Process

1. Begin with a parent meeting with a guidance counselor or vice principal who knows your child. 2. Discuss your concerns and see what they advise. Often, they might suggest that teachers make some minor changes in the classroom. If those are not satisfactory or you believe your child needs more support, then you have the right to request a formal evaluation, including a team meeting. This request can be made at the school or the district office. 3. What typically follows is the beginning of a thorough evaluation that is similar to private ‘testing’ but may also include additional information about speech and language skills and occupational functioning. These are similar to private ‘testing’ because they offer rich information about your child and the additional benefit of direct contact with their educational environment. However, some school districts prefer to do their evaluations but may need to wait longer than you want. 4. You also have the right to present your report. Schools can’t diagnose ADHD because it is a health disorder. You will need to share the information with your primary care provider, psychiatrist, or mental health professional to get an official diagnosis. 5. Next, a team meeting will be convened to determine the type(s) of special needs your child may have and whether they are eligible for mandated services. If your youngster qualifies, then the team will make recommendations and create an IEP plan or design the 504 at a later time.

In Conclusion

Many kids with ADHD also have reading, writing, or math difficulties which qualify as learning disabilities. Schools can  diagnose these issues. Moreover, if they are blocking academic progress, support services will be provided. You can see how complex this process can be. Take a deep breath, and stick to what you know is true about your child. Don’t get intimidated by anyone who may dismiss your concerns. Trust your instincts, and realize that you know your kiddo better than anyone else. Collaborate on creating a plan that offers the help your student needs. Stay curious, ask questions, listen with an open mind, know your rights and advocate fiercely. If you need more support, seek it out. You’ve got this!

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Ways Parents Can Set realistic Goals For The Academic School Year

Report cardThe beginning of a new year typically marks the middle of the school year and mid-year report cards. Of course, students with ADHD want to do well in school, and most of them put a lot of effort into their work. But at the same time, they must contend with issues around focus, organization, distractibility, impulse control and time management, and their academic workload. It’s a lot to handle, and often grades may suffer as a result. To better address your child’s needs, you’ll need to figure out what your child is struggling with to find the proper support. So let’s take a step back and see how you can prepare your response to a disappointing report card and a disappointed child.

Be an ally, not a critic

It’s safe to assume your child is already disappointed and frustrated with his lackluster report card, so responding with anger, lectures, and punishments will only intensify your child’s stress. You may feel upset and concerned: this is entirely understandable. However, addressing your feelings in private before speaking with your child or teen would be best. Taking time to process what’s happened and your frustration will leave you in a much better position to talk with your kid. Your child will feel connected, comforted, and heard when you are calm, attentive, and constructive. This is when brainstorming and collaboration about how best to move forward will take place. 

Read between the lines

“Listen more, speak less” is an effective parenting strategy to help your child get through a tough time. Don’t assume you know what’s happening or rush toward a resolution. When your child is going through a challenging situation, they need to get things off their chest. Maybe even cry or get their frustration out on a punching bag or old pillow. Give your child a chance to vent. When they feel they can share what’s on their mind with you without anger or judgment, they will feel more connected and likely to open up even more. teen boy head down on homework desk holding help sign Please encourage your child to share their thoughts about what happened with their grades. Be ready to read between the lines and ask for clarifications, so you have the whole story. Avoid asking ‘why’ and stick with ‘how, when, and what.’ For example, when your child says, “I hate school,” or “My teacher hates me,” it could mean the teacher frequently reminds them to pay attention. Or the child doesn’t fully understand the teacher’s expectations and keeps falling short. Instead, ask them, “How do you know this? What things does your teacher say or do to show their hatred?” The more specific the information you gather, the easier it will be to make a collaborative plan for moving forward. So it’s up to you to first listen and ask questions to get to the bottom of the issue.

Set realistic academic goals for the remainder of the school year

goal list written on notepadTogether, explore realistic and achievable goals for the next term based on their current performance. Identify what small steps they can take to make some progress. Remind your child that even if their grades don’t go up significantly, they show growth in other ways; that’s a substantial accomplishment too. For example, if your teen makes it a habit to get homework help from their math teacher once a week, that’s excellent progress. Ask your child or teen what types of support have been helpful in the past and would be useful now. For example, is there a teacher, friend, or counselor they have a good relationship? Then, get your youngster to come up with one or two suggestions for improving their study habits and grades. And if you haven’t done so already, reach out to teachers and guidance counselors to better understand what resources are available for your child.

Make sure your child has the proper academic support in school and at home

If your child or teen does not already have mandated supports at school (in the United States, these would be 504, IEP, and behavioral plans), then request a team meeting or fill out the necessary forms to get this process started. If a support plan is in place and your child is still struggling, as evidenced by their disappointing report card, set up a meeting with the team to find out why the plan isn’t working more efficiently. Make it possible for your child or teen to participate in these meetings. We want them to feel part of a process that’s for them so they will be more willing to participate in it.  While you can’t oversee what’s happening daily at school, you can provide effective support at home. First, make sure your youngster has a quiet place to study. Next, enforce effective study habits by equipping them with tools such as checklists, alarms, reminders, and practical daily routines. Finally, collaborate on and use age-appropriate incentives. Remember to rely on natural and logical consequences rather than punishments to motivate your student. Most importantly, celebrate each win, no matter how small. Going from a C- to a C may not seem like much to cheer about for your standards, but it could be a world of improvement for your child or teen. It reflects an improvement based on a lot of effort on their part. Your child or teen with ADHD does want to do well. With your empathy and support, they will shine.

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