Learn Your Special Education Laws, Special Education Rights, and Share IEP Goal Ideas

Mar 06
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by Jess

Addison is in the 6th grade, her first year in middle school. She did pretty well in elementary school, but she’s getting slammed in 6th grade. A couple of her teachers have described her appearing distracted, making mistakes with details, and being disorganized with her work. Addison admits to “zoning out” a lot during classes like English, Spanish, science, and geography. So clearly she has ADHD and could use some medication to help her focus.

Except that maybe she doesn’t have ADHD at all.

There are several learning problems that create the appearance of an attention deficit. Well-meaning educators and parents often are off the mark when they attribute signs like distractibility, problems with details, and disorganization to weak attention. Issues in the following areas can cause such secondary attention deficits.

auditory processing- interpreting, at a very basic level, information entering the auditory system; problems here can be exacerbated in noisy, hectic situations like hallways, cafeterias, and transitions between lessons and classes; students with weak auditory processing may seem distracted because they misread auditory signals, or they may just shut down to escape from all the clutter they are hearing

receptive language- a step beyond auditory processing to attaching meaning to language input (listening and reading); not understanding what is heard or read naturally causes confusion that can be misconstrued as limited focus (imagine living in a country where you don’t speak much of the language)

expressive language- the flip side of receptive language, or translating one’s ideas into words, phrases, sentences, and discourse; expressive language provides mental “brakes” in terms of being able to internally talk through situations to avoid impulses (think about how frustrated toddlers get when they can’t express their needs); research has shown a link between weak expressive language and behavior problems

emotional well-being- you don’t have to have clinical depression or anxiety to know that when you are emotionally stressed it’s very hard to concentrate on anything other than what is troubling you; children and adolescents can experience emotional distress for a variety of reasons

sleep- research is clear that chronic sleep deprivation takes a big toll on daytime functioning; a student may seem to be getting enough sleep, but that sleep may be of insufficient quality to recharge the batteries, so to speak; much can be done to improve sleep relative to bedtime routine, but medical evaluation and treatment is often necessary

Why is pinpointing the root cause important? Because understanding the problem is the first step to solving it. For Addison, an ADHD diagnosis may be barking up the wrong tree. She might need language therapy if auditory processing, receptive, or expressive language are the culprits. Improving the quality and quantity of her sleep might be necessary. And putting her on stimulant medication could make emotional difficulty even worse (counseling could be in order).

To be sure, attention deficits are real and affect huge numbers of children, adolescents, and adults. But if a kid starts sneezing a lot we’d be foolish not to want to figure out if it’s due to allergies, a cold, or the flu. A thorough and thoughtful assessment, by a clinician who does not jump to conclusions, can frame the learning problem (ADHD or otherwise) so that it can be addressed with the right strategies.

Dr. Craig Pohlman is the Director of Mind Matters at Southeast Psych, a learning program that provides a range of services including assessment, therapy, and professional development. Mind Matters is on Facebook, and can be followed on Twitter @MindMatters_SEP

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10 Responses to “When an Attention Deficit Isn’t”

  1. This is a wonderful post! My daughter is currently diagnosed with Expressive Language Disorder, Receptive Language Disorder. We are also awaiting the results of Central Auditory Processing Disorder as well as ADD (non-hyperactive ADHD). Why do we have her going through all these various testings, when we already have a diagnosis of Expressive/Receptive Language Disorder? To be sure we are at the root of the problem, and make sure she is receiving the absolute best help we can possibly provide for her. I don’t want to go in “half cocked”, so to speak, and only treat part of a problem, if the problem could, quite possibly, be multiple issues/concerns. So, the only thing I would add to this article, would be, don’t completely “rule out” anything… explore all options if you think your child is struggling, but listen to the advice of your Doctor. Often times, (in my experience), however, a regular pediatrician will not “diagnose” any of these issues, or may even brush your concerns under the rug! If you feel strongly about something concerning your child, and your pediatrician doesn’t seem to be very open minded about it, don’t be afraid to ask them for a referral to a Developmental/Behavioral Pediatrician, or other Developmental Professional.

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    • I totally agree – I felt there was something wrong with my son’s lack of speech (expressive language). He was 2. The pediatrician told me to come back when he’s 3 and he will probably be speaking by then. Thankfully, I sought out a talented speech/language pathologist (SLP) who diagnosed my son with severe verbal apraxia. Years of speech therapy later, my son speaks great! But had we waited that extra year…there’s no telling.

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    • I would check out and treat/give help for everything else first before going with an ADHD or ADD diagnosis. It is impossible to rule out ADHD unless you “fix” the other issues first or try the medication, but then you have to watch your child often times get worse on the medications for ADHD. This is serious medication and can have serious side effects. It isn’t as though there is a definitive test for ADHD and if you are seeing the symptoms you will possibly get a misdiagnosis if your child has other issues that can cause those symptoms. It doesn’t matter where those symptoms come from as to how they will diagnose, but it will matter where they come from as to how to treat. I only say this because there is no harm in trying other therapies to manage the other issues, stimulant medication (any medication actually) can create problems. I have two children who take medication and it helps, but I have one who has the CAPD, Mixed receptive/expressive language disorder, and emotional issues after having been bullied at school. This year, we are even seeing sleep disturbance after his becoming extremely stressed at school due to the problems from his other issues. I’m going with all the other fixes before we jump to medications that can have some very serious side effects. Including exacerbating the issues we already know he has.

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  2. Excellent post. Thanks, Carig.

    I would also add visual processing issues and sensory processing issues to the list. These, by themselves or often in combination with each other and the others you mention, can also create the appearance of ADD/ADHD.

    Kids with processing disorders already use a tremendous amount of energy and focus simply to cope with the disorders and get through the school day. If these processing disorders and the other issues you mention above are the causes, ADD/ADHD meds may seem to help by allowing the child to focus even more, but they will not address the underlying problem; and they may also cause unwanted side effects.

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  3. Good post, useful for parents as well as clinicians to consider. I blogged something similar at psychology today: http://www.psychologytoday.com/blog/intrinsic-motivation-and-magical-unicorns/201202/do-i-wiki-meet-diagnostic-criteria-adhd

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  4. This is great information to have. It doesn’t help the problem of misdiagnosis that most educators, especially beginning at the middle school levels and up, use dull, uni-directional teaching methods that, for all intents and purposes, are merely comprehension assessments of the very information they aim meaninglessly at the students. Very little language processing instruction occurs (e.g., interactively learning to reconstruct meaning, writing with no grading or consequences, and much more). Here, again, we see that content information must occur alongside literacy instruction at ALL levels and for ALL content areas. Thanks for raising our awareness.

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  5. Nonverbal learning disability can also be misdiagnosed as ADHD.

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  6. I have a kid with 5 of those issues, ADHD, MERLD (mixed expressive-receptive language delay), APD, and anxiety. It is always fun figuring out where the behavior is stemming from.

    We played the misdiagnosis round table (mostly autism) and it is difficult to get people who are unfamiliar with anything but either ADHD or autism to see past that to what is more likely the issue. Which is so important to get to because addressing it, at least with my kid, takes different techniques.

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  7. Kids with Visual Impairments often also get diagnoses of ADHD because they appear to “zone out” and have “problems paying attention” in such a visual world where their needs aren’t being met.

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  8. Be aware, andy SPED teacher who diagnoses a child as ADHD is probably breaking the law because the last time I checked SPED is not equivalent to a doctor or psychiatrist. I know, I am a SPED teacher who is ADHD. While symptoms might be similar, it doesn’t mean the diagnosis is. However, the teacher might suggest trying to get the issue diagnosed which can help with the instruction. I don’t know why the SPED teacher hasn’t visited the child in the other classrooms to see how she is doing. Then followed up with the teachers regarding her IEP to ensure they are aware of issues and modifications along with goals. Please remind people that if the SPED teacher of record doesn’t contact you, contact them! You are the expert on your child and any teacher who doesn’t recognize that doesn’t belong in the classroom.

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