Tag Archives: adhd

A New Approach to Tackling Your Kid’s Disorganization

disorg

It’s halfway into the school year, and for many parents of chronically disorganized kids, it’s a time of mounting frustration. Your child may have started the year strong, with a brand new planner and a great system of color-coded folders, only to slowly fall back into a pattern of missed assignments, coats left in lockers, and last-minute scrambles on long-term assignments. He may have even gotten back on the wagon a few times, clearing out his bag, and starting with a fresh system, only to stumble again. And when mid-year report cards come home with grades that show a lot less than you know your child to be capable of, things can start to feel hopeless. There is hope, though—oftentimes, it just requires a shift in how we look at organizational skills problems. Below are five tips to help you do just that.

1. Resist the blame game. Oftentimes kids who are disorganized are labeled as lazy or lacking in work ethic. But research at NYU Langone over the past decade tells us that organizational skills deficits are real deficits, in the same vein as a math or reading disorder. And just like with a math or reading disorder, kids with organizational deficits need extra support. Framing the problem as a character flaw is demotivating. Instead, frame it as a challenge you and your child can overcome together.

2. Take it one step at a time. Getting organized requires a lot of sub-skills—writing down assignments, keeping paper organized, managing homework time, and planning for long-term assignments, to name a few. Asking your child to make changes in all of these areas at once is setting her up for failure. Make a list of all the specific skills your child needs to work on. Choose one skill to start with (such as filling out her planner every day), and don’t move on to the next skill until she has it mastered.

3. Step it down. For kids who struggle with organizational skills, the best organizational tools are usually the ones that involve the least number of steps to use. If filing a paper means punching that paper with a three-hole punch, pulling out a binder, opening the rings, putting the paper in, and closing the rings, that paper isn’t as likely to get filed. A better solution might be an accordion file, which allows your child to just drop the paper right in. Work with your child to find organizational systems that use the least number of steps possible.

4. Make long-term rewards short-term rewards. Many kids who struggle with organization have a learning style that favors short-terms rewards (like getting out of class quickly) over long-term rewards (like knowing all the details of your assignment, so you get a good grade at the end of the semester). You can boost organization by providing short-term rewards for use of organizational skills. Give your child a small daily prize for things like coming home with all his books, having his planner filled out completely, and having all papers filed correctly.

5. Know when to ask for help. If your child has persistent organizational problems and your efforts to help her have failed, it may be time to consider a psychological evaluation. Several psychological issues, including ADHD, can lead to problems with organization. The good news is there are empirically validated treatments to help. At the NYU Langone Child Study Center, we offer Organizational Skills Training, a program developed and researched by our doctors, at our Manhattan, Westchester, New Jersey, and Long Island locations.

Most importantly, don’t lose hope! Just because it is more difficult for some kids to develop organizational skills, doesn’t mean that they can’t do it. Providing some extra support and maintaining a can-do attitude goes a long way towards setting your child on the path to organizational success.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Jennifer L. Rosenblatt, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center, and sees patients through the Child Study Center’s home- and school-based service in Westchester County, New York. 

Helping Your Child Make and Keep Friends

friends

Friendship is protective—having just one or two friends can make all the difference to a child’s development. Friends increase self-esteem, confidence, and independence. Having friends can also protect children and teens from bullying and victimization, and help buffer the impact of stressful life events.

But for some children and teens, making and keeping friends isn’t easy. Whether due to anxiety, ADHD, autism, or developmental disabilities, some lack the confidence and social skills needed to make a phone call, join a conversation, or play team sports. They may not pick up on verbal and nonverbal cues or empathize with others’ perspectives. And the consequences can be considerable: loneliness, depression, anxiety and isolation. This inevitably spills over into life transitions, including college, dating, and finding and keeping a job.

Fortunately, these skills can be taught. One place to start is building conversation skills including trading information with the goal of finding common interests, sharing conversations, and building awareness of nonverbal communication skills such as making eye contact and having good body boundaries. Another starting place is helping children and teens to choose appropriate friends by identifying a peer group and identifying extracurricular activities to find sources of friends who share common interests as a basis for building friendships.

The Child Study Center at NYU Langone Medical Center conducts social skills classes for children as young as three through young adults up to age 30 to help teach these skills. Our clinical faculty and staff use evidence-based interventions, the Children’s Friendship Program for elementary school children, and the PEERS® program for teenagers and young adults. The children, teens and young adults learn skills through in-class rehearsal and homework. It is a class; it is not a place to make friends, but a strategy on how to make friends in their real, outside lives.

The classes are developmentally appropriate for each age group. The youngest children learn how to play in groups. Elementary school children practice face-to-face conversations, make phone calls, and learn how to handle rejection. Older teens learn dating skills—how to ask someone out, how to behave, and what behavior is acceptable. All groups have homework, which involves practicing their new skills. This homework helps children gain confidence and solidify their new skills.

Parent participation is integral to the program’s success. In separate, concurrent classes, parents learn the language and skills being taught to their children—a requirement that not only enables them to help their children with homework, but also gives them the tools to be social coaches long after the program is over.

Each group meets weekly, for 60, 75 or 90 minutes, depending on age.
•Preschoolers attend 60-minute sessions for 15 weeks.
•Elementary school children between the ages of 5 and 8 attend 75-minute sessions for 12 weeks.
•Elementary school children between the ages of 9 and 10 attend 75-minute sessions for 14 weeks.
•Teens from 11 to 17 attend 90- minute PEERS® program classes for 14 weeks.
•Young adults with autism from 18 to 30 attend 90-minute PEERS® program classes for 16 weeks.

We perform an initial screening of all applicants and then meet with each child and parent to see if the child is appropriate for the group. Minimum requirements include approximately average cognitive and verbal functioning; a parent willing to participate; English language knowledge; and the child’s expressed interest in making and keeping friends.

Manhattan groups are conducted at One Park Avenue, 7th floor, New York, New York 10016. For more information, please call 646-754-5284 or email csc.sociallearning@nyumc.org.

For group offerings at our Long Island campus in Lake Success, please call 516-358-1808 or email Bonnie.Schwartz@nyumc.org.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Sarah Kuriakose, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry and the clinical director of the Autism Spectrum Disorder Clinical and Research Program at the Child Study Center at NYU Langone Medical Center.

Sarah Kern, LCSW, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.

Fun, Friends, and the ADHD Camper: Choosing the Right Summer Camp for Your Child

SPK
For most parents, sending kids to summer camp for the first time may stir up fond memories, anticipation of the fun awaiting their children, and perhaps a little separation anxiety.

It’s more complicated for parents of children with ADHD. Their kids can find making friends, playing team sports, and behaving appropriately—the hallmarks of a successful summer camp experience—challenging. Asking camp directors and veteran parents the right questions can help parents decide which camp is right for their child. Here are a few suggestions.

Will camp counselors and staff understand my child’s needs?
This goes straight to the heart of the matter. You want to be sure the camp’s counselors have the training and experience to work successfully with children with ADHD. What are their academic and professional qualifications, and do they receive special training to work with special needs children in a camp environment? What is the counselor-to-camper ratio?

What kind of programs do you offer?
Camp can be a wonderful opportunity for your child to develop social skills, increase self-awareness, and learn new coping techniques. At a minimum, that requires a structured environment to help kids stay focused, and team sports to encourage flexibility and cooperation. What skills–including friendship skills—does this camp emphasize, and what goals will your child work toward? What is the mix of sports, academic, and social programs that will help him/her succeed?

Who will administer my child’s medications?
The camp you have chosen is likely to have a nurse on site to administer medications, but it’s best to ask. There may also be a psychologist who can work with you and your child’s psychiatrist to fine-tune the medications if his behavior, symptoms, or moods warrant.

How do you communicate with parents?
You’ve done all the advanced research and preparation you can—but you’re still going to worry about your child. Find out how frequently the camp communicates with parents, and how you can check on your child’s progress.

Talking to other parents whose children attend the camp can also give you additional insight. Ask for a few references and pose the following questions:

Will my child have fun?
Fun is often overshadowed by the problems children with ADHD have in fun-like situations with insufficient structure and supervision. They may go too far, bully or be bullied. They may be shy and not know how to play with others. But fun is an essential component for camp. Ask other parents if the counselors are fun spirited and love the kids. Find out what their child gained from the experience. Did he/she make friends? Did he/she like the counselors?

Does the camp deliver on its promises?
Did your child receive individual attention? Were medications administered properly? Did the staff communicate with you about your child’s progress and/or problems? Did your child learn new skills that can be carried into every day life?

Will you send your child back next summer?
You can take heart from an enthusiastic “yes”.

About the Child Study Center’s Summer Program for Kids
The Summer Program for Kids is the only all-day, therapeutic summer program in the New York area for children with ADHD. Our methods are grounded in the latest research, and our clinical psychologists continually evaluate the program to help each child. We help our campers learn the skills they need to help them focus, make friends, and improve their social, school, and home behavior. For more information, click here.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Karen Fleiss, PsyD is an assistant professor in the Departments of Child and Adolescent Psychiatry and Psychiatry at NYU Langone Medical Center. She is the clinical director of the Child Study Center’s Long Island Campus, and director of the Summer Program for Kids.

Alternative Treatments for ADHD: Do They Work?

Mother and daughter visiting doctor
If your child is one of the 6.4 million American kids diagnosed with attention deficit hyperactivity disorder (ADHD), he or she is probably being treated with medication or behavior modification therapy—or both. Studied extensively, these first-line ADHD treatments have been found to reduce the symptoms or negative effects of ADHD on a child’s daily functioning.

You may have also heard about alternative treatments for ADHD, such as biofeedback or special diets. But what do we really know about these treatments? Do they improve symptoms and functioning? What evidence do we have? The following brief review will help answer these questions for several different treatments.

Addressing organization, time management, and planning (OTMP) skills: In school settings, teaching OTMP skills in groups has been found to be effective for middle and high school students. In clinical settings, the only program that has been tested and found effective was created at NYU Langone Medical Center’s Child Study Center. Clinical intervention improved children’s OTMP skills and academic productivity and performance, and decreased homework problems and family conflict.

Neurofeedback: Also called biofeedback, neurofeedback is a self-regulation technique in which an individual is taught to alter his or her brain’s electrical activity in an attempt to stay focused and attentive. The American Academy of Pediatrics (AAP) does not recommend neurofeedback in its recently revised clinical guidelines for diagnosis and management of ADHD. On top of concerns about its efficacy, neurofeedback is extremely expensive and time-intensive, and may not be covered by insurance.

Cogmed: A commercially available, proprietary neurocognitive training program, Cogmed is marketed as a computer-based solution for attention problems caused by poor working memory. A 2011 study concluded that Cogmed does lead to memory improvement, but does not improve function in the area of the brain associated with ADHD symptoms.

Feingold diet: Restricted in sugar and free of additives and salicylate, this diet shows no significant benefit for ADHD except for those children with related food sensitivities.

Elimination/oligoantigenic diet: An oligoantigenic diet eliminates most known sensitizing food antigens or allergens, such as cow’s milk, eggs, wheat cereals, nuts, and more. Although the AAP does not recognize dietary interventions as effective ADHD treatments, a 2012 meta-analysis of 14 studies suggests that an elimination diet can benefit some children with ADHD.

Ketogenic diet: A diet high in fat and low in carbohydrates does not help with ADHD; however, it may offer some benefit to reducing hyperactivity in epileptic patients.

Poly-unsaturated fatty acid supplements: Some children may be helped by doses of 300 to 600 mg/day of omega-3 and 30 to 60 mg/day of omega-6 fatty acid supplements. These supplements can be continued for two or three months, or longer if indicated, as a complement to medication and behavior treatment.

Other diet considerations: Sugar does not usually affect the behavior or cognitive performance of children, but a small effect on subsets of children cannot be ruled out or proven. Iron deficiency is not linked to ADHD. Any effects of food dyes or artificial food coloring on hyperactivity are inconsistent and moderate. Herbal supplements, such as ginko biloba and kava kava, have shown no positive effects on ADHD.

Exercise: A 2011 review found exercise to have positive effects on the behaviors of children with ADHD, but not necessarily on ADHD symptoms. Exercise can be used as a supplemental—but not stand-alone—treatment.

Occupational therapy techniques: There is not enough evidence to support either the wearing of a weighted vest or the use of an interactive metronome to increase on-task behavior.

If you are considering alternative ADHD treatments for your child, be sure to talk with your doctor about evidence of their efficacy, potential costs and benefits (including side effects), what concerns the treatment will address, and how to measure those concerns.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Richard Gallagher, PhD, is a clinical psychologist and neuropsychologist who directs the Selective Mutism Program and Organizational Skills Training Program at NYU Langone Medical Center’s Child Study Center. He also is an associate professor of clinical psychiatry, as well as child and adolescent psychiatry, at the NYU School of Medicine. With a PhD from Temple University, Dr. Gallagher focuses on selective mutism, disruptive behavior disorders, attention deficit disorders in children and adults, organizational skills, and parenting.

5 Ways to Help Your Child Behave Better

Angry mother scolding a disobedient child
Children with attention deficit hyperactivity disorder (ADHD) may fidget at the dinner table, may seem to ignore directions to clean their rooms, or can be inattentive at homework time. Even kids without ADHD may act this way sometimes. Whether your child has ADHD or not, it can sometimes be challenging to get your kids to sit still, pay attention, and behave appropriately. A few simple strategies can go a long way towards helping create an environment that promotes better behavior at home.

Catch your child being good. Anytime children display behavior you want to see more frequently, “catching them” at it by emphasizing and praising it will make them more likely to repeat it. But don’t wait for exceptional behavior—a praiseworthy behavior can be as simple as sitting quietly or playing nicely with a sibling. Be specific in your praise. For instance, “Great job finishing your math homework!” is better than “Great job!” and “Thanks for sharing that toy with your brother” is better than “Thanks.”

Establish a routine and stick to it. Creating a structured routine at home and applying it consistently is a powerful driver of better behavior. Parents sometimes think that after a day at school keeping it together and following routines, children are better off with free rein at home before turning to homework or other duties. However, it is often harder for kids—especially those with ADHD—to shift back and forth between structured and unstructured time.

A sample after-school routine might look like this: Snacks from 3:30 to 4pm, homework from 4 to 5pm, an hour of playtime, 30 minutes of TV time, dinner from 6:30 to 7:30pm, and then getting ready for bed from 7:30 to 8pm. Use visual reminders to reinforce the schedule, such as a calendar that can be checked off or marked with stickers. And be consistent! When you make an exception, such as allowing more than the allotted 30 minutes of TV time for a child who has pushed hard for it, he or she may push as hard or harder in the future because it worked on a previous occasion.

Change the environment. This can be especially helpful in setting up kids for success during homework time. Creating a specific, uncluttered homework space free of the distractions of TV, siblings, and the family dog can be surprisingly effective. Sometimes something as simple as sitting in a chair that faces a wall instead of out where the action is can help a child stay on task.

Give a “heads up” for transitions. None of us like to be in the middle of something we enjoy and told to stop immediately. Help children mentally prepare for an impending shift in schedule by giving them advance warning. This will help them understand, for example, that “OK, in five more minutes I have to stop playing on the iPad and go put my pajamas on.” Keep a timer or digital clock on hand to help kids track the time themselves, and praise them for making a successful transition.

Give clear, positive commands. Set clear expectations by being specific when giving instructions. For example, you might say, “Put your Legos away,” instead of the more ambiguous, “Let’s clean up now.” Stating instructions as commands rather than questions is more effective, too, so, “Please hand me that pencil,” instead of, “Can you hand me that pencil?” will be more effective. Try giving positive, rather than negative, instructions. For instance, “Please use an indoor voice” is better than, “Stop shouting!”. This will focus attention on the behaviors you like and want to see more often, rather than on what your child is doing “wrong.”

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Kaitlin P. Gallo, PhD, and Briannon O’Connor, PhD, are clinical instructors in the Department of Child and Adolescent Psychiatry at the New York University School of Medicine. Dr. Gallo, who specializes in the assessment and treatment of disruptive behavior and anxiety disorders, is a postdoctoral fellow at the Center for Mental Health Implementation and Dissemination Science (IDEAS), as well as in the Institute for Attention Deficit Hyperactivity and Behavior Disorders at NYU’s Child Study Center. Dr. O’Connor, also a postdoctoral fellow at the IDEAS Center, focuses on improving the quality of care for children and adolescents with various mental health disorders, including ADHD and depression.