ADD/Waiting for the brain to mature

[ChristaN]

My dd has an ADD/inattentive type dx as well as an anxiety disorder, NOS dx.  My mother is strongly in favor of us having her repeat a grade for a few reasons and I am really torn as to what to do to help her.  Any input would be appreciated.

Background:

Dd's grades and achievement test scores are erratic.  She seems to have difficulty with attention to detail as well as sustaining the attention needed to follow problems all the way through w/out forgetting where she was going at the start and just writing down the "answer" as some piece of the puzzle.  For instance, if a math problem requires her to find the area of a parallelogram and then the area of a circle and then subtract the area of the circle from the area of the parallelogram, when I ask her how to solve it, she knows the steps.  She also knows how to find the area of both figures.  But, then she'll start the problem and lose her way declaring the area of the parallelogram to be the answer.  When I remind her that she still has to do the second figure and then subtract, she'll say "oh, yeah," continue on and then get lost again stating that she is done as soon as she has the area of the circle.

She is, by far, the youngest in her grade due to a bd that doesn't quite make the cut-off for the grade she is in.  She started elsewhere where the K cut-off was later.

She is also, by far, the smallest child in her grade due to genetics ;).

Her older sibling is almost exactly 2 yrs older but is already 3 grades ahead of her due to a grade skip.  Holding dd10 back would entail having her be 4 grades below her sister.

She is very bright, but has a poor short term memory and doesn't really fit in either placement we've tried: accelerated classes (where she is now) or the std classroom.  She, technically, isn't a poor student, but she is a very frustrated student.

Has anyone with a child with ADD seen substantial growth in terms of sustained attention in the 10-11 year old age range?  We're worried about sending her on to middle school in the fall with the same deficits.  I don't know that holding her back would change anything, though, other than giving her brain more time to mature.

Thoughts?

[karne]

The growth I have seen is in the 11-12 years, and continuing on from there.  My experience is that the maturation was actually fairly dramatic, and ADD symptoms have gone "underground".  I actually feel that this subtlety is more difficult, but that's just my experience.

Grade retention, at this age, is tricky, and most of what I have read advises against it because the long term outcomes don't suggest that benefits outweigh the negatives.  That being said, you know your dd best.  Has your dd been tested for a learning disability?  A child can be gifted/advanced, and have an LD.  Erratic school performance might suggest further testing.  I don't know if you've had a full eval to look at overall functioning/processing?  Has she had academic intervention to address areas of concern?

[KCMichigan]

I cant say I have a child w/ ADD, but *I* was very much like your DD.

I had suspected ADD (inattentive)  in MS and HS. I was gifted (per IQ), but struggled in accelerated classes--but frustrated w/ standard classes since they went so much slower.

Elementary I did not have much trouble really- but once you added the social dynamic and the '7 classes with 7  teachers with 7 different teaching styles' it got more complex. I was a dreamer/spacey, etc.

I had some rough years 7/8/9/10 grade due to a mismatch between ability to multi-task/attend and cognitive abilities. I KNEW I should be able to do things, but struggled with focusing long enough to complete the task/and or follow all the steps in written format. But I understood the concepts quickly and was able to handle abstract thoughts. I feel for your DD, it is difficult as a teen to comprehend things easily, but unable to seem to be able to complete simple tasks or to make so-called- careless errors due to lack of attention- even though I was highly motivated to do well in school and enjoyed it. The combination of puberty and attention difficulties were a challenge to be successful. I did graduate with High Honors from HS after developing some coping mechanisms, maturing, and a lot of family support. I went on to succeed in College (also with High Honors).

I can say it got 'more ' difficult in HS than Middle School. I even took Dr. prescribed medication for it that helped, but ultimately used caffeine (soda) to regulate myself. I had trouble focusing and attending from grades 7- 11th or so. I assume I had some brain maturation during that time since not only did my ability to recognize when I was losing attention improve, but I developed skills to help stay on track, and the insight to know what did and did not work for my learning style. I also was 'young' for grade and slightly socially immature. Retention was never considered since I passed all my classes and was a good student.

I would also look into a learning disability and/or vision difficulties. Ruling those out can help narrow your focus on 'what' areas she needs to improve in (study skills, work completion, etc).

That is just my personal observation, it may be different for others. I am now a successful adult. =]

I would discuss it with her. See what she thinks- she may be relieved to be able to 'redo' some classwork or she may feel even less 'capable' of doing the work. It all depends on her outlook and personality. Also- talk to the school teachers and counselors. They may recommend retention, but may not if she is academically doing well enough. You could even seek outside help (Kaplans, tutors, Dr, medication, Cognitive Therapy, etc).

They may be able to arrange a 504 or adjusted coursework for her. Some proactive measures that will help her be more successful (extra time, less classes, extra study hall, support from teachers, etc). 

[ChristaN]

To answer a few questions:

Yes, we've had two private evals.  Her IQ is in the 99.9th percentile with very high (99th+) verbal and perceptual skills and average working memory and processing speed.  Her individual achievement scores all came out in the 98th-99th percentile range so we were told she didn't have a LD.  Her group achievement scores (MAPS in particular) are another story.  They go up and down by 40+ percentiles every time she takes the tests.

Her school is not likely to be in favor of grade retention.  Like the pp, she is a straight A student who finds the work too simple when placed in the regular classes but who struggles with her attention to detail and inability to follow through on all of the steps in the accelerated classes and whose grades suffer as a result.  She is currently being subject accelerated in math and is in the GT reading class.  She did have an A- in this reading class on her last report card and gets some very good grades and some very mediocre grades in both classes.  They are just draining for her not b/c the material is too hard but b/c she can't seem to consistently do the work to the same std and pay attention to the directions.

Her school is not wanting to do a 504 and I'm not pushing for it b/c I don't know what they could do differently that would help her be more successful.  We tried one test with extra time which made no diffference.  Her reading/math teacher said we could try having her test in a separate room but she's never implemented that in class.

The psych who dx her with ADD and anxiety wasn't too sold on meds b/c of dd's size (she weighs 56 lbs at 10) and b/c she felt that they were less likely to help for inattentive type ADD than ADHD.  Generally, the feel I'm getting from her school is that she is bright, but not super bright and that any time she does really outstandingly well on some test it is due to good guessing.  I've been told "good guessing" by one of her past teachers in re to IQ as well as by the school counselor in relation to her higher MAPS scores.  ( I do realize that guessing well on IQ is unlikely.)

eta: dd tends to do worse than the first time around when given a chance to redo something.  Her anxiety gets the best of her and she freezes.  The alternative I'm thinking is putting her in less accelerated classes in 6th grade next year. 

[KCMichigan]

Originally Posted by ChristaN 

To answer a few questions:

Her school is not wanting to do a 504 and I'm not pushing for it b/c I don't know what they could do differently that would help her be more successful.  We tried one test with extra time which made no diffference.  Her reading/math teacher said we could try having her test in a separate room but she's never implemented that in class.

The psych who dx her with ADD and anxiety wasn't too sold on meds b/c of dd's size (she weighs 56 lbs at 10) and b/c she felt that they were less likely to help for inattentive type ADD than ADHD.  Generally, the feel I'm getting from her school is that she is bright, but not super bright and that any time she does really outstandingly well on some test it is due to good guessing.  I've been told "good guessing" by one of her past teachers in re to IQ as well as by the school counselor in relation to her higher MAPS scores.  ( I do realize that guessing well on IQ is unlikely.)

eta: dd tends to do worse than the first time around when given a chance to redo something.  Her anxiety gets the best of her and she freezes.  The alternative I'm thinking is putting her in less accelerated classes in 6th grade next year. 

I would keep trying extra time and/or a separate space to take tests/tasks that require concentration. It may help--- and should be tried more than once. Anxiety should be reduced when time constraints are less- as should a place that has no distractions.

It is common for ADD/ADHD to do better on one on one testing situations (IQ testing, academic testing, etc) than group testing situations due to distractibility, peer pressure, environmental influences, time of day, length of testing, set timing of testing, etc. It is not unusual at all. I see it a lot in students I work with (Many have ADHD, ADD, and other minor Spec. Needs).

'Good Guessing' is actually a testing skill that is practiced in the upper grades (HS). Students are taught to 'guess' an answer based on what they do and do not know even if they are not positive on it. (eliminate certain answers).  They talk a lot about it on SAT/ACT prep--- that even if you do not know the answer, you can be more likely to get it if you narrow the options down. So if your DD is good at guessing- it is a good skill to have! That said, IQ can not be 'guessed' and the testing methods used for IQ evaluation are very different than the way to test academic achievement.

Personally, I am neutral on meds. I am a teacher and have seen them be a wonderful solution to some kids and have no effect on others. Some people do well with and some do well without. But physical size is no reason. There are 4/5/6 yr olds that take ADHD/ADD meds and they are smaller than your DD. It is more of a personal choice between a person and their Dr. I have had just as much luck with caffeine and felt comfortable doing so in moderation. My Dr actually put me on a Mt Dew 'diet' in HS! I was allowed to have Mt.Dew 1/2 hr before a test or other important event. It did help- FWIW and I continue to do so today (only now I use soda or coffee).

I would again, push the 504 angle. Really, next year in 6th grade the teachers may not be as accommodating. If you want some modifications, you will need them in writing in order to get compliance for the multi-teacher world of MS/HS. It is is within the realm of possibility to have written in a 504 a 'redo' portion for assignments if she finds that she is more successful the second time around.

Other things that I have used with both my students and myself:

Heavy physical activity before the need to concentrate (schedule gym right before math class)

chewing gum to help focus

making sure that blood sugar is stable (concentration is shorter if a person is hungry- several simple high protein snacks throughout the day can help)

weighted pencil or lap pad

set routine or schedule for doing work/homework

use learning style to help (I am a list maker, some people/kids do better with verbal reminders, calendar/planner,etc)

enough sleep

low visual distractions (dont let a student surf web/watch TV and try to type a paper or write homework)

[joensally]

Christa, I think holding her back would only exacerbate the problem.  I understand it as an approach to try and accomodate the attentional challenges, but I think the problems far outweigh that potential, marginal gain. 

DD's now HSing grade 6.  She probably meets criteria for ADD, although I think it's situational.  I think she's a kid who's a bit introspective, spacy, creative etc, and being in classes which did not engage or stimulate her only fostered this and inhibited her ability to develop attentional strengths and self-regulatory skills.  She was able to read books in her lap and answer any question thrown at her, but has no organizational skills whatsoever.  She also has anxiety issues, which I think are exacerbated by the tremendous disconnect between her and the school environment.

My .02 are that your DD's school is a bit out to lunch given her individual test scores. 

Have you asked on Davidson?

Also, I would recommend contacting the Eides and asking them.  I'm sure they could point you in the direction of solid info on attentional maturation.

[journeymom]

Drive-by posting, pardon the intrusion!

Able to read books and answer any questions thrown at her but has no organizational skills whatsoever.

That's my 11 year old son. He's going into 7th grade and middle school next year and while he qualifies for the High Achiever program I will be putting him in the next program down from there, which is still 'accelerated'.

[Emmeline II]

I agree that holding her back is not going to address her problems.

I would ask for a 504 meeting (in writing).

And, considering the degree of difficulty she is having in school, I would revisit the medication issue. Usually, the concern with ADHD medication is that it can suppress the appetite, resulting in weight loss--but this is not a given. My ds is taking Vyvanse (formerly Concerta) for ADHD, his appetite is the same, he has held steady in weight and gained in height--he has a cousin a year older and the degree of difference in their sizes has remained the same. As for the "medication is not as effective for inattentive types", I've heard that but haven't found any support for it yet. I suspect it is either that the improvement isn't as dramatic as it is with a primarily combined-type child (like mine), or maybe non-drug support (therapy and the like) isn't necessarily pursued in the same way as it is for combined-types. Medication has helped my ds a great deal with his inattentiveness which was equal to his hyperactiveness.

• The ABC's of ADD and ADHD: Impact on School Performance
• Executive Function...What is this anyway?
• Your Child's Educational Rights

goaskmom.com--Inattentive Type ADHD

Helping Your Child Prepare for a Standardized Test

What are the treatments for Inattentive ADHD?

[karne]

We have actually had a positive experience with meds and inattentive type ADD.  What was especially helpful was using meds in conjunction with a solid plan of support around executive functioning and organizational skills.  I really don't think my dd would be doing as well in MS without having used this type of intervention.  

[ChristaN]

Originally Posted by Emmeline II 

Usually, the concern with ADHD medication is that it can suppress the appetite, resulting in weight loss--but this is not a given 

Yes, that was the concern expressed to us.  Dd doesn't have the greatest appetite and is in the 5th percentile for height and weight.  Of course, I am the family giant at 5'4" and 115 lbs and dh is only 5'6", so the genes for big size probably aren't there.  The other concern we were given was that meds can increase anxiety and dd already has pretty significant anxiety.
 

[Guinevere]

Originally Posted by karne 

We have actually had a positive experience with meds and inattentive type ADD.  What was especially helpful was using meds in conjunction with a solid plan of support around executive functioning and organizational skills.  I really don't think my dd would be doing as well in MS without having used this type of intervention.  

DS, who has inattentive type ADD, is 12 and started on meds for the first time over the summer. Your description of your DD, minus the anxiety issues, sounds very similar to my DS. We'd known about his issues for a long time, but interestingly, it wasn't until he was 10 that they really started to impact his academics negatively; my personal guess is that 5th grade was the magic year that his academic work became complex enough that he could no longer adequately compensate for his inattention issues with just his intelligence.

Before going to meds, we tried many, many other strategies, including various kinds of intense organizational and executive function support/strategies, as well as nutritional supplements and even caffeine. Nothing we tried worked well *enough* to allow him to be successful, though. His school performance last year was extremely erratic, particularly on graded, timed tests where, just like your DD, he struggled with checking his work and completing the necessary steps/following directions. Also like your DD, retaking tests usually resulted in lower scores, particularly in math, which is his strongest subject.

Meds have made a HUGE difference in his life, though, and almost exclusively for the better. We did go through 4 different meds at several different dosages to find the right one (which I have since been told is extremely common when dealing with adolescent neurochemistry), but since finding the "sweet spot," so to speak, my DS has been so happy! His grades have improved tremendously, his ability to focus is now phenomenal, and his test scores have gone through the roof. He hasn't had anything lower than an A all year so far. Honestly, he is now able to be the best version of himself in the classroom, and his frustration with school is completely gone. Like karne noted, however, we also still employ a number of organizational strategies to support him, since meds obviously don't solve those issues, just allow him to focus on tasks far better.

I wanted to address the concerns about weight loss, since we worried about lack of appetite, too, b/c DS is already skinny for his age (average height.) And he did lose some weight initially after going on meds. But he has since stabilized and gained back a few pounds after we started working harder to ameliorate the appetite suppressant effects: he eats very calorie-dense snacks/meals now and we usually take med breaks for at least one day on the weekends and during school holidays to allow him to eat normally. We make sure to weigh him monthly to see where things stand, but his growth has not been stunted: he's grown 2 inches taller since the fall.

The books I have read regarding brain development and executive function suggest that maturation in that area doesn't take place in any significant way until the later teens, so I don't know that I would count on your DD suddenly making substantial gains in that area in the next few years.

Lastly, I would also encourage you to explore 504 accommodations to assist your DD's focus in the classroom. Simply giving a child longer on a test may not make a difference, but there are a number of other strategies that can/would be helpful, many of which are listed for you already above. For example, my DS also finds it easier to focus when he listens to music while taking tests/doing homework, but after trial and error, we've discovered it must be a repetitive melody that functions basically as "white noise" for him; otherwise, if it's a catchy tune, he'll end up singing along and it only serves to distract him further. So you'll need to experiment to find what works best for your child, but some of these strategies can make a profound difference and are certainly worth investigating.

Kind regards,

Guin

[RiverTam]

I don't know what you should do with this kid, because every kid is different. But I know what my mom did with my brother and how that worked.

My youngest brother has IQ scores like that, and has a late birthday (October). He started kindergarten when he was 4, almost 5. HE was a constant behavior problem. It may have been ADHD, but it was more likely that he was just too young for his class. He was the youngest in the class and young for his on top of it. Finally, he refused to do any work in 4th grade. He simply refused to turn it in. My mother finally told him that if he didn't work, she would let the school hold him back. He didn't work and she held him back.

The next year was much better and his school performance improved significantly. He was just too young to meet the behavioral demands of the class, even though he was easily smart enough to meet the academic demands.

[ChristaN]

Originally Posted by joensally 

Have you asked on Davidson?

Also, I would recommend contacting the Eides and asking them.  I'm sure they could point you in the direction of solid info on attentional maturation.

I am having a conversation with others on the Davidson boards about ADD treatments :).  We're currently trying O-3/DHA supplements & nightly yoga or other exercise.  It's only been a few days, so I don't know if either of these will make a difference.  Someone also suggested the book, Transforming the Difficult Child by Howard Glasser.  I'm going to pick that up to see what it suggests.