Written Expression Problems in Students with ADHD

Reuters had an article about some new research that confirms what many of us already knew – that written expression is a huge problem for students with ADHD:

Kids with attention-deficit hyperactivity disorder are more likely to have writing problems such as poor spelling and grammar than their peers, suggests a new study. And the difference may be especially conspicuous in girls with ADHD.

Reading and math problems often raise red flags for teachers and parents, but “written-language disorder is kind of overlooked,” said study author Dr. Slavica Katusic, from the Mayo Clinic in Rochester, Minnesota.

[...]

Writing problems were much more common in both boys and girls with ADHD. Close to two-thirds of boys with ADHD had trouble with writing, compared to one in six boys without ADHD.

For girls, 57 percent with ADHD had a writing problem, compared to less than 10 percent without ADHD. And girls with ADHD were almost ten times more likely to have a combination of writing and reading disorders compared to girls without the condition.

Memory and planning problems in kids with ADHD may affect the writing process, the authors explain, and ADHD has been linked to learning disorders in the past.

Annette Majnemer, who has studied handwriting in kids with ADHD at McGill University in Montreal, Canada, said that many with the disorder seem to have difficulty with that component of writing.

“It might be partially the fact that they’re inattentive and distractable and hyperactive,” she told Reuters Health. It’s also possible that motor skills and coordination problems are partly to blame, said Majnemer, who was not involved in the new research.

[...]

“Clinicians and the teachers have to emphasize that the testing has to be done for everything, every kind of learning disability,” Katusic said. “It has to be identified early and the treatment has to start early.”

Read more on Reuters.

As the article suggests, there are a number of factors that contribute to difficulties in written expression and a comprehensive assessment that includes handwriting, memory, and executive functions is crucial. Once the various challenges are identified, appropriate accommodations and remediation can be designed. The good news is that we do have accommodations and techniques that can help – but only if the school recognizes and assesses the problem.

If your child is extremely frustrated every time they have to write more than one sentence or have to elaborate on their thoughts – if their written work gives you a headache because it seems out of order and poorly organized or prioritized — if they act as if you are killing them because you ask them to edit their work or insert necessary capitalization, punctuation, and correct their spelling – contact the school to request an assessment.

School re-opens soon – is your child ready?

I know that in some parts of the country, the school year has already started, but if you are in New York like I am, there are still a few more weeks.  I thought this might be a good time to remind parents of some back-to-school tips I had previously shared:

• Back to School Tip #1: Is the teacher ready for your child?
• Back to School Tip #2: Re-establish wake-up time and routines
• Back to School Tip #3: Structure and routine boost homework compliance
• Back to School Tip #4: Can they manage their clothes? Their lunch?
• Back to School Tip #5: Lost at School – Literally?
• Back to School Tip #6: Medication

Scholarships for ADHD and LD Students

Brittany Shoot of ADDitude Magazine writes:

College acceptance letters have started to trickle in, but now how to finance university tuition? These scholarships, specifically awarded to ADD/ADHD and LD students, have approaching deadlines.

See her article for information on available scholarships and where to apply. The deadline to apply for one of them closes next week, so get busy!

Teens Need Health Care Privacy

One of the things I always inquire about during an evaluation is whether the child or teen saw the referring psychiatrist or neurologist privately or if their parents were present.   Privacy is so crucial to adolescents, and in general, my sessions with children or teens do not have the parent(s) present, except for the last few minutes of a session or if we are developing a home intervention plan.

A new study that came out last month confirms the importance of health care privacy to teens and serves as a useful opportunity to encourage parents to have their child meet privately with the treating professional as the child may withhold important information or concerns if parents are present.

Read more

Breathing therapy reduces panic and anxiety

ANI has a small article on Sify about some new research demonstrating the effectiveness of breathing therapy in reducing symptoms of panic and anxiety attacks.  The premise behind the approach is that normalizing breathing can reduce symptoms.

I’m delighted to see this research as normalizing breathing is an approach I’ve been incorporating in my clinical work for decades since I came to the conclusion that one thing all effective therapies for stress-related conditions seemed to have in common was that they altered breathing patterns towards more relaxed/normalized breathing.

Here’s the abstract from the new research study:

Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity.
Meuret, Alicia E.; Rosenfield, David; Seidel, Anke; Bhaskara, Lavanya; Hofmann, Stefan G.
Journal of Consulting and Clinical Psychology, Vol 78(5), Oct 2010, 691-704.

Abstract

Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this study was to analyze pathways of change in theoretically distinct interventions using longitudinal, moderated mediation analyses.

Method:  Forty-one patients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of training aimed at altering either respiration (capnometry-assisted respiratory training) or panic-related cognitions (cognitive training). Changes in respiration (PCO₂, respiration rate), symptom appraisal, and a modality-nonspecific mediator (perceived control) were considered as possible mediators.

Results: The reductions in panic symptom severity and panic-related cognitions and the improvements in perceived control were significant and comparable in both treatment groups. Capnometry-assisted respiratory training, but not cognitive training, led to corrections from initially hypocapnic to normocapnic levels. Moderated mediation and temporal analyses suggested that in capnometry-assisted respiratory training, PCO₂ unidirectionally mediated and preceded changes in symptom appraisal and perceived control and was unidirectionally associated with changes in panic symptom severity. In cognitive training, reductions in symptom appraisal were bidirectionally associated with perceived control and panic symptom severity. In addition, perceived control was bidirectionally related to panic symptom severity in both treatment conditions.

Conclusion: The findings suggest that reductions in panic symptom severity can be achieved through different pathways, consistent with the underlying models.

To translate the above into a more reader-friendly mode: both cognitive therapy and breathing therapy are of possible benefit, and they have comparable results in terms of effectiveness. Only the breathing therapy, though, actually reversed some of the hyperventilation seen in panic and anxiety attacks.

Do you need capnometry or sophisticated technology to learn to regulate your breathing, though? In my opinion and experience: no. Learning and rehearsing diaphragmatic breathing can produce the type of benefit reported above. The “trick,” if there is one, is to treat this as any other skill: it requires practice to develop. Practice the technique daily so that you learn to go into a deeply relaxed state quickly. If a normal breathing rate for adults is 12-18 breaths per minute, I encourage people to try to slow down their breathing rate to about 6 breaths per minute, with more time spent exhaling slowly than inhaling (exhale twice as long as you inhale). Even if you can’t get to 6 breaths per minute, learning to breathe out sloooooowly and evenly is a skill that you can access when you start to feel stressed or anxious.

If you would like to practice a breathing-based relaxation technique, you can find some simple instructions on my main web site in the article called, “Relax!“

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