ADHD explained

When ADHD is mentioned many us of immediately think of a hyperactive boy who is out of control.  We also question whether it is just caused bad parenting and a lack of boundaries. We wonder if the child is simply being naughty or lazy.

But ADHD is far more than this narrow view and there are many misconceptions held by parents and educational professionals alike.

The first thing to say is that most people have some elements of ADHD some of the time, but for those with ADHD they are habitual difficulties that have a significant impact on everyday life.

In essence ADHD is a developmental impairment of the brain's Executive Function. This impairment is both the delay in these executive skills developing and that they do not work consistently.

One of the main areas affected is working memory, for this reason there is often overlap with other learning difficulties. Reading, Writing and Maths can all be areas of difficulty for children with ADHD.  Working memory also makes it difficult to hold more than one idea in your head and so doing a task that requires more than one process can be challenging. Also tasks were you have to
draw on prior learning and combine it with new information.

 Children with ADHD have difficulty with organisation and time management. They have trouble estimating how much time a task may take and prioritising what is important within a task. They often procrastinate and leave things until the last minute.  This affects their ability to manage homework tasks or longer projects. They may spend hours on one aspect of a project because they find it interesting but neglect or rush the main part of it because they run out of time.

They have trouble keeping focus and can be distracted by external noises and movement or internal thoughts. They also have difficult switching focus and gaining an overview of the whole situation. They very quick lose interest in a task particularly if it is tedious.  The busy classroom environment can be very challenging as it is full of distractions and most tasks require children to focus on several aspects at once.

As with all learning differences there is a spectrum of difficulties from mild to severe. Every individual is affected in a slightly different way. Hyperactivity which is often the first thing people mention when discussing ADHD is only a difficulty for some children.

An important area which is often overlooked is the emotional side of ADHD. People with ADHD have difficulty managing their emotions.  Small upsets, frustrations and worries can flood their mind making it impossible to move on or focus.

One of the puzzles of ADHD is that each person has a number of tasks or situations where they have no difficulty in focusing.  This makes many teachers and parents think that it is just a matter of willpower. But people with ADHD find that even when they want to do something or know it is important they can struggle to get started. They focus best on something of high interest or when there is fear associated with not completing a task. This is because the brain chemicals needed to make connections are not produced at a high enough level when a task is not interesting. The lack of engagement is not actually a choice as many perceive but is a genuine difficulty.

On the difficult subject of medication, stimulants like Ritalin or Concerta do help about 80% of people with ADHD.  However the way each person responds is different. For some it can make a huge difference, for others it may only help a little. While medication helps focus which can put a child in a better place to learn, it is not cure. Issues like working memory difficulties and lack of organisation do not do away. Support is still needed for the weak executive functions.

Many only associate ADHD with children. However it does not disappear in adulthood but the way it shows itself is different at different ages. Sometimes ADHD is noticed later in high school or even university when the scaffolding parents and teachers have provided gets taken away.

For more information take a look at www.BrownADHDClinic.com
Thomas Brown PhD is very knowledge and has written many books including Smart but Stuck

The complexity of writing

Writing is a complex process which does not develop naturally in the same way that spoken language does.  Writing is a craft that needs time and explicit practice to develop and hone.

We don't expect everyone to be a great painter or sculptor but we expect all children to be great writers.  Often in schools, we expect children to write well, long before they have sufficient knowledge or skills to write proficiently.

Through history people have communicated in a wide range in ways through storytelling, songs, paintings, arts and crafts, plays and dance. For a long time only few people were able to write, as it was considered to be difficult skill to master.  Now in our modern world we want everyone to write and from a very early age.  We forget how challenging writing can be and that many people are better suited to other forms of communication. Of course writing is an important skill for most jobs and to function in our daily lives we need to be able to write.  But for many the writing proficiency needed for everyday life is very different from the complex creative writing required at school. 

Too often we wrongly equate the ability to write with intelligence.  If a child is verbally capable we expect them to be able to translate this easily to writing.  We forget that writing is not a natural process but is something we need to train our brain to do. It also involves learning many different processes from letter formation to spelling,  which in English involves both mastering phonics and spelling rules and learning many irregular high frequency by sight. In addition, we have to develop our vocabulary and we need to be a able to remember an idea while we compose a sentence. Finally we have to consider the purpose of the writing and know the features of that genre.

We also think that reading and writing go hand in hand and that if someone can read something they can write the same thing.  However they do not develop at the same rate, learning to write is significantly harder. It requires us to master many different skills and use them together.  Reading is decoding where we decipher what is actually there but writing in encoding we have to draw on what is in our own head to make marks on the page. Being faced with a blank page can be very daunting,  even for adults.

Giving time for each skill to develop and become automatic is important if children are going to become good writers.  Many schools rush to get children to write independently before some of the basic skills are secure. This is one of the reasons that writing can be so daunting for dyslexic students. They typically need more time to develop their letter formation. They can have difficulty controlling the pencil and remembering starting point and the sequence for each letter.  They also need explicit teaching over several years to learn common letter patterns or to remember high frequency words. They do not just pick the spellings by seeing them in texts or writing them out 3 times. When so much energy goes into these basic skills, there is little energy left for composing the sentence or thinking about interesting vocabulary.

Another challenge for dyslexic children is having a weak working memory, this can make it hard to keep a sentence in their head while they write it down.  Typically they will forget the sentence half way through or they will miss out words.  Correct punctuation can also be a challenge if you can not keep a whole sentence in your head.

The key to helping dyslexic children is trying to reduce the number of skills being used at once and fully appreciating how hard they are working to perform basic tasks. In addition it is vital that they receive regular explicit practice of weaker skills outside of the regular writing lessons.  There are many ways to help depending on their stage of development.

If they are still struggling with letter formation then an adult could scribe their ideas or they could label picture rather than write sentences.  Regular practice of letter formation can be done separately using tactile materials like waxy doodles and playdough, finger writing in a salt tray or on sandpaper help to develop the muscle memory, rhymes can also be use to help remember the sequence for each letter.

To support spelling they should be encouraged to make phonetic approximations in line with the phonetic they have been taught. They should be given the spelling of words that are beyond their spelling level. They should also be given word lists of task specific words and high frequency words. Spelling should not be corrected during a writing task but common errors can be noted by the adult and be worked another time with multi sensory methods.

Another way to support writing is for an adult to act as their working memory.  The child verbally rehearses the sentence and then the adult reminds them of their idea a  word at time. Talk tins which record a sentence at a time and can be replayed by the child can help older students remember their ideas.

The use of assistive technology is also very helpful in allowing a child to write at their intellectual level while their other skills develop.  There are many voice to text apps and programs that allow children to turn their verbal ideas into text. Word processing can also be easier for some children where a lot of energy is taken up by the physical process of writing.  Programs like Kidspiration can help with the organisation and sequencing of ideas which can be another area of challenge for dyslexic children.

Finally we need time, understanding and patience so that writing skills can develop at the child's pace rather than the school's pace.

Visual difficulties explained Part 2 Visual efficiency

If your child is reluctant to read or tires easily when doing school work or complains of headaches. There could be a genuine reason for their difficulties.

Visual efficiency is an area of vision which many people overlook or do not realise the impact that it could make on a child (or an adult) who is trying to read or do close work. 

There three main areas tracking, teaming and focus. If there are difficulties in any of these areas, then the experience of trying to read will be both difficult and exhausting. These difficulties are not readily visible to an adult observing the child and equally it is very hard for a child to be able to explain that something is wrong. They often go undetected as very often the child assumes that all people see the way they do.

1. Tracking

Many people are unaware that reading is not a natural process for us. Although many children do learn to read rapidly and with little effort, many do not. The pathways in the brain are not naturally there to decipher the written code and develop over time through practise. It also only convention that leads us to read from left to right rather than right to left or top to bottom. We have to train our brain to track from left to right and because we have to read the beginning and end of the word to make sense of it our eyes develop a jumping movement. If this movement does not develop effectively then our eyes may skip over small words or miss suffixes like -ed, - ing, -es. We may also lose our place in a text or skip lines.

      2. Teaming

Our eyes are meant to move and work together and focus on the same spot. Each eye sees a slightly different perspective which the brain then combines to make a single image. This helps to create a 3-D image and gives depth perception. If these images are not combined correctly then the person may see double. It can also lead to blurred vision, eye strain and headaches. This makes it very difficult to accurately decode and read comfortably. Common eye teaming problems are insufficient convergence, where the eyes have a tendency to turn out or convergence excess is where the eyes turn in.

3. Focus

Our eyes have to switch focus constantly to take in the world around us and perform every day tasks. Some children have difficulty switching focus from near to far which can make functioning in a typical classroom difficult.  Very often important information is displayed on the board and children are expected to refer to this as they work closely through their classwork at their desks. Copying from the board will also be laborious. This can lead the images to be blurry and cause eye strain and fatigue.

 What are the signs should we look out for?

- holding a book or paper too close

- frequent eye rubbing or blinking during reading or homework

- avoids reading

- slow reading speed

- tilts or turns head

- slow to complete homework

- closes or covers one eye

If you are concerned about these visual difficulties you should consult a Behavioural optometrist

www.eyecanlearn.com is a useful website which shows how these visual difficulties might appear to someone trying to read.

Visual difficulties explained Part 1 Visual Perception

Visual perception is the term used to describe the way in which the brain processes visual information. There can be differences in the way that visual information is perceived, processed, organised and understood.  This is different from the idea of 20/20 vision and being long sighted or short sighted.

We assume that when we show someone information visually on an interactive white board or a page in a book or a poster that they are seeing what we are seeing.  We also assume that they will be able to readily pick out the information that they need from a visual source. For many children and adults this is not the case.

Good visual perception is important for all aspects of life. We need the ability to process visual information to make sense of the world around us. We need to be able to understand shapes, colours and distance. We use visual perception to develop our understanding of everyday concepts.  For example: to know what a cup is, we need to see many cups and remember what are the key features that make a cup, as not all cups are the same.  This understanding and visual memory will help us see that while a jug is similar to a cup it is not the same. We can mentally compare and realise that a jug has a lip for pouring that a cup does not.

Good visual perception is vital to learn to read and write. We need to distinguish letters and spaces between words. We need to remember spellings and organise words on a page.  Visual perception should be one of the first things that is checked if a child is having difficulty learning to read or write.

It is not always easy to identify children who have difficulties with visual perception.  Children usually don't realise that what they see is not what others see. It is also very hard to verbalise what we see or explain exactly what the problem is.

Some of signs to look out for are:

- difficulty remembering visually presented information
- difficulty with the order of letters and objects
- difficulty picking objects out from a busy background
- difficulty organising themselves or materials in space 
- they may not realise that an object orientated differently is actually the same
- they may not notice big or small differences
- they may appear clumsy

Visual perception is complex and is made up of a number of skills. 

• Visual memory
• visual sequential memory 
• visual closure
• visual discrimination
• visual form constancy
• visual figure ground
• visual motor intergration

Children do not usually have weaknesses in all these areas,  a weakness in just 1 or 2 of them can cause significant difficulties both at school and in every day life.

www.eyecanlearn.com is a very useful website for parents that explains both visual efficiency and visual perception clearly.

If you have any concerns use should consult a behavioral optometrist who can test these areas using standardised tests. Check these websites to find a suitably qualified professional  http://www.babo.co.uk or https://www.covd.org

Over the next couple of weeks I will explain some of these areas in more detail and some strategies that can be used to help.

Early interventions for early signs of dyslexia

The signs of dyslexia show up very early, long before a child starts school, we may choose to ignore them because we hope they will go away....
Or we may be worried that there is nothing we can do at this early stage...
Or we may think that if we acknowledge a difficulty it will only make it worse....

In order to learn to read, write and do basic maths there are underlying skills that are needed:

Good spoken vocabulary
Coordination/motor skills
Visual skills
Auditory skills
Working memory skills

The foundations of these skills start between 0 - 2 and continue to develop (or not develop) throughout the preschool years.  This is why some school systems wait to teach reading and writing in order to give these skills more time to develop.

If one skill is weak we can usually compensate with our stronger skills. The difficulty with dyslexia is it is normally of a combination of skills that are weaker.  The combination is slightly different for each person which is why identifying and supporting dyslexic children is not straightforward.

Even as a very young child we will gravitate towards activities we enjoy and very often these are those we find easy or are good at.  As a result in those early years some skills become well practiced and very strong, while often our weaker skills become even weaker.

The key is to build up our child's confidence with their areas of strength but to be brave and expose them to things that may be more challenging.  It is also important to keep things fun and game based to avoid any sense of failure.

Difficulties with language skills are usually one of the first noticeable signs of dyslexia.  Vocabulary may be slow to develop, words may be mispronounced or muddled, 'thingy' or 'that' may be used as the child has 'word finding' difficulties. Research shows that around 60% of dyslexics are late talkers.

One of best ways of developing language skills is to talk to your child about things in their environment but always using the proper words or terms for example use the word 'rose' rather than 'flower'. Use everyday conversations and events as an opportunity to explain words and introduce new vocabulary.  Reading stories from the earliest age is another enjoyable way to develop a wide range of vocabulary. As soon as a child can sit up at around 6 months it is possible to share books and stories. Many people worry that the child will not understand what is being said but in fact young children 'drink' in the language both its rhythm and sounds and when they are ready they will imitate and draw on this language. Some children do find it harder to hear and distinguish sounds correctly and they may need specialist support.  Don't hesitate in consulting a Speech and Language therapist early on if their language development is slow or laboured.

Many people underestimate the importance of developing good coordination early on.  It is not that everyone needs to be a great sports person but our physical skills are the foundation of future learning. Even basic skills like crawling are an important foundation. About 20 % of dyslexics are late walkers and some do not crawl at all and are 'bottom shufflers'.  This affects the neuro pathways in the brain and makes future learning more challenging.  If you notice coordination difficulties early on consulting an Occupational Therapist can be very helpful.  Young children will consider a session with an OT as fun and will have none of the concerns that you have about something being wrong.

In addition, we want fine motor skills to develop naturally. There are lots of fun craft and mark making activities we can try at home.

In our modern age TV, video, ipads and smart phones are so part of our everyday life and we as parents enjoy their baby sitting benefits. Our children are happily engaged and we do not really consider the skills that they are not developing as a result.  In past when we went to a restaurant a child would do colouring or a dot to dot puzzle or we might engage in a conversation with our child. Think about the number of skills a child would develop in these activities compared to the passive skills that develop when using an electronic device.

Developing good visual skills should be a high priority for every preschool child but even more so for a dyslexic child where this could be an area of deficit. Fun activities that help to develop visual skills are Spot the difference, Mazes, Jigsaws, Dominoes, finding objects in a busy picture like 'Where's Wally'

Equally we should purposely try to develop auditory skills, again this can be done in a fun play based way. Saying and learning Nursery rhymes is so important for early language and memory development.  If child can say a remember a nursery rhyme early on then later they will be able to remember the alphabet sequence, simple instructions or sentences in a story.  Nursery rhymes also introduce children to the rhythm of language as well as the concept of rhyme.  Word play is important; games like 'I spy with my little eye', I went shopping... all help develop early auditory skills

We mistakenly think we have progressed in terms of activities for children.  However it is in fact the traditional games and childhood activities tend to be the most beneficial in developing the pre skills that children need for future learning and for success at school. For example building blocks, shapes sorters and wooden puzzles develop early visual and motor skills. Games like pairs, dominoes and ludo develop visual and counting skills. Dressing up and role play develop listening and language skills.  Many of us played happily as children without even realising how many skills we were developing.  We need to try to offer this same opportunity for our children.

Dyslexia is genetic and as we become more aware of it we can predict children who are likely to have dyslexic difficulties before they start school. Parents can take positive action and work on prereading skills to lessen the challenges faced by these children as they begin to learn to read and write.  This will need a deliberate effort as parent, as typically the games and activities we do with our children tend to be those we also enjoy or find easier ourselves. If we have poor coordination and do not enjoy sports, we are less willing to kick a ball around. If we did not enjoy reading as a child, we are less likely to read stories to our children when they are very young.  We often unknowingly perpetuate our own deficits as we avoid tasks we found difficult as a child with our own children.

There are so many fun and playful activities we can do with our children that can make such a difference in the long run.  I would encourage every parent to embrace to chance to help their child develop their early skills.