Day: March 24, 2016

By Krista Forand, M.Ed.

Technology is all around us! We live in a world full of technology that is constantly changing and improving the way we live (although that may be arguable, particularly if you’ve ever experienced a computer crash or have had to navigate a complicated automated phone system!). We don’t really think about how we may use technology on a daily basis to solve our problems, but we all do it. For example, I often set alarms on my phone to remind me to do certain things, especially things that are more out of the ordinary and not part of my routine (e.g., taking chicken out of the freezer to defrost).

On a larger scale, we can use technology to gain access to information, demonstrate our own knowledge and abilities and take part in society. When we use technology in this particular way it is often referred to as “assistive technology”. Obvious examples of assistive technology include wheel chair ramps and hearing aids. These things allow people with disabilities to have greater access to society despite the challenges they face that are related to their disabilities. Assistive technology for ADHD might be less obvious to people, but there are many technology supports that can be quite useful for children and adults with ADHD. Below are some different assistive technologies that can be useful for children with ADHD. Consider what challenges your child faces and whether a particular assistive technology is worth trying.

My child with ADHD has a lot of trouble with understanding and remembering what she is reading. What can she do to improve her reading?  

One of the reasons why many children and adults with ADHD have difficulty with reading is because they do not engage in active reading strategies. Research has shown that “good readers” monitor their reading by asking questions like “does this make sense?” and they are active with the text (e.g., highlighting, writing notes in the margins, looking up new vocabulary). In addition to trying these strategies, it may also be helpful to use assistive technology. Many children with ADHD benefit from text-to-speech programs that take text and turn it into audio. It is recommended that children visually read along with the audio as this may help with their own reading speed and development of new vocabulary. There are several tablet applications (e.g., Natural Read) and computer software applications (e.g., read&write by texthelp) available that convert text to audio. Audiobooks are also another option. Audiobooks are widely available through public libraries, online and through special subscriptions (e.g., Audible.com).

My child has great ideas, but can’t get them on to paper. How can he improve is ability to express himself through writing?

Writing is often a very difficult task for children with ADHD because it involves coordinating different skills all at once. There is a motor component, the organization of ideas, remembering to use proper spelling, punctuation and grammar, and making sure that ideas are complete and clearly expressed for the reader. This can be a very daunting task for anyone with ADHD. Assistive technologies that may be helpful for writing include software and tablet applications that visually organize the writing process and create organized outlines of topics and ideas (e.g., Kidspiration and Inspiration). If your child is better at expressing himself verbally, consider using a speech-to-text program (e.g., Dragon Naturally Speaking). Speech-to-text allows the child to speak his ideas into the computer, which then turns it into text. Afterward, he can edit and re-organize sentences as needed. For children who are impatient with the writing process and tend to rush, speech-to-text may help to make the entire experience a lot less stressful. For children who have specific difficulty with messy writing, consider programs that teach them how to type (e.g., Mavis Beacon Teaches Typing for Kids).

My teenager with ADHD has trouble remembering to do things, being on time and getting things done on time. What can he do to improve in these areas?

One important thing to remember is that the ability to plan, organize and manage time is still developing in teenagers and the part of the brain that is involved with these executive functions (the prefrontal cortex) is not fully developed until approximately age 25. Teenagers with ADHD are typically behind their non-ADHD peers when it comes to these abilities and so it is important for parents to understand that they will require extra support from adults even into young adulthood. That being said, most teenagers are quite tech savvy and can access a number of assistive technologies for planning, organizing and time management. Help them to start using timers to monitor their time, electronic calendars with built in reminder alerts and applications that organize task lists and other activities. Some tablet and phone applications include 30/30, Evernote, DropTime, Time Timer, Todoist and Pomodoro Timer.

With all that being said, here are a few things to keep in mind when looking for assistive technology for your child with ADHD:

• Keep it simple and make it work for you. If it takes more time to figure out how to use something and maintain it, it may not be the right choice. On the other hand, many of the software programs do require time to learn and train, so be patient and help your child learn how to use them. The companies who create these products often have video demonstrations, which can be a great way to learn, rather than reading about the product or trying to figure it out on your own.
• Start small and do one thing at a time. Avoid buying or accessing too many technologies all at once. You will likely feel overwhelmed and not have the energy to give everything a fair try. First determine what area you and your child believe is the most important to address with technology. Then pick one thing and try it before moving on to something else.
• Keep costs down. Always check first to see if there are free or low cost ways of accessing technologies. Use audiobooks from the public library and ask your child’s school if they have certain software programs available for home use. Sometimes schools have software licenses that allow families to use the programs at home. Many software companies also offer free trials of their products. Take advantage of free trials and don’t commit to a product until you’re sure that it is a good fit for your child. Also, explore the accessibility features on electronic devices. iPhones and iPads have a text-to-speech function called “voiceover” that will read documents and web pages out loud. Go to settings, general, accessibility to access. (You can even try to listen to this blog right now!)

For more information about apps, software, and hardware visit the www.adhdfamilies.ca and click on the Assistive Technology tab.

Krista Forand, M.Ed.

Krista has worked in various roles with the CanLearn Society (formerly Calgary Learning Centre) since 2009. She is currently working with the clinical team as a registered provisional psychologist, providing assessments and group interventions for individuals with learning and attention difficulties. In 2014, Krista obtained her graduate degree from the University of Calgary where she cultivated her interest in learning disabilities and attention disorders. She believes in the therapeutic effect of psychoeducational assessment and how this process can empower individuals and families to take control of their lives, by understanding their unique way of being in the world.

By Krista Forand, M.Ed. 

If you look online, there is a lot of information about ADHD and diet. It can be hard for parents to make sense of all of this information, as much of it is conflicting. For parents who are considering dietary approaches to treating their child’s ADHD, it can be overwhelming, costly and time consuming to sift through all of this information and put their trust into a particular dietary approach.

One major piece of advice that I share is to watch out for dietary approaches that make sweeping general claims (e.g., “this will cure ADHD!) and that cost a lot of money. Also, if you are concerned about your child’s diet/nutrition or possible allergies speak with your family doctor about this and seek assistance from a registered dietician. Making drastic changes to your child’s diet or using mega doses of vitamins can actually cause serious health problems (e.g., mega doses of certain vitamins can cause liver problems). Lastly, don’t be fooled by product labels that say “natural” and assume that these products cannot be harmful, particularly in large doses. For example, ginger is considered a “natural” aid for stomach upset and inflammation, but it interacts with other things (e.g., ibuprofen, blood thinners), making it dangerous if taken in combination.

If you are considering dietary treatments for your child with ADHD, consider the research that has been conducted in this area and the limitations of this research. The first meta-analysis (i.e., a study of studies) that was conducted in this area was in 1983 and it focused on the Feingold diet (i.e., a diet that eliminates certain colorings and preservatives). They found a very small effect size that was not significant, meaning that this diet did not significantly help to improve ADHD symptoms (specifically hyperactivity).

In 2012, another meta-analysis was conducted that looked at both diet and food colors. These researchers found that about 8% of children with ADHD may have symptoms related to synthetic food colors. They also concluded that about 30% of children in the studies were responsive to the diets. However, they noted that the research in this area is very outdated and they recommended a renewed investigation into the influence that diet may have on ADHD symptoms.

A recent review (2014) noted several limitations of the ADHD-diet research. Out of all the dietary approaches that they reviewed (e.g., sugar and artificial sweeteners, elimination diets, amino acids, vitamins, essential fatty acids and minerals) they concluded that most of them do not have enough evidence to recommend their use in clinical practice. They did find some positive effects for fish oil supplementation and the Few Foods Diets, but noted that both of these approaches need more evidence before they can be recommended. It is also important to understand that the Few Foods Diet is a short-term restriction of foods for determining if a person has specific food sensitivities and was not recommended by these authors as a long-term treatment for ADHD. Restrictive diets can have negative consequences particularly for growing children who need a variety of foods for nutritional balance. Few Foods Diets typically take at least a year, while the longest treatment time in the studies that were reviewed was only 9 weeks.

Other issues with the ADHD-diet research include many studies that were not blinded, meaning parents knew that their child was on the special diet, which can contribute to false positive effects due to the parents’ expectation that it will work. Another criticism is that some of the studies involved parents who had a bias towards dietary approaches to treating ADHD and they weren’t blind. This is recipe for false positive effects and is not considered good research.

Another issue to consider is the effort that it takes parents to implement certain diets. The more restrictive “rules” you have about what can and cannot be eaten, the more that parents need to look for specific foods or products, find ways to cook differently and hope that their child will eat what is “allowed” according to the diet. Many families will struggle to maintain consistency with such “high needs diets”.

At this point, it is a good idea for everyone to keep a balanced perspective about the research that has been done in this area so far. Since the 1983 meta-analysis, which showed no benefits, there has been some inkling of benefit for some diets and perhaps fish oils. However, it is clear right now, that we need more research that is of higher quality. In the meantime, it is recommended that parents understand where diet may play a role in their child’s overall health, rather than seeking a dietary approach to cure their ADHD. Diet is just one of many areas of our lives (e.g., sleep, exercise, social support, education etc.) that can affect how we feel and function in everyday life. Parents may want to consider making very small changes (e.g., increasing vegetables) in these areas to help their child before seeking out more intense diet approaches that may or may not work.

Krista Forand, M.Ed.

Krista has worked in various roles with the CanLearn Society (formerly Calgary Learning Centre) since 2009. She is currently working with the clinical team as a registered psychologist, providing assessments and group interventions for individuals with learning and attention difficulties. In 2014, Krista obtained her graduate degree from the University of Calgary where she cultivated her interest in learning disabilities and attention disorders. She believes in the therapeutic effect of psychoeducational assessment and how this process can empower individuals and families to take control of their lives, by understanding their unique way of being in the world.

References:

Kavale, K.A., & Forness, S.R. (1983). Hyperactivity and diet treatment: A meta-analysis of the Feingold hypothesis. Journal of Learning Disabilities, 16, 324-330.

Nigg, J.T., Lewis, K. Edlinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 86-97. DOI: 10.1016/j.jaac.2011.10.015

Heilskov Rytter, M.J., Beltoft Borup Andersen, L., Houman, T, Bilenberg, N., Hvolby, A., & Molgaard, C. (2014). Diet in the treatment of ADHD in children-A systematic review of the literature. Nordic Journal of Psychiatry, 69(1), 1-18. DOI: 10.3109/08039488.2014.921933

By Krista Forand, M.Ed.

Lately, I have had some requests to write a blog about issues related to sharing your child’s ADHD diagnosis with others. With the help from some of my colleagues, here are some things to keep in mind when considering telling others about your child’s ADHD diagnosis.

Weigh the pros and cons and consider why it may be important to tell a particular person. Ask yourself what the benefits would be of having this person know and what may be some of the risks. It may be important for your child’s school to know so that they can put supports and accommodations in place that will allow your child to be more successful in the classroom. It may not be necessary to inform others who do not interact with your child on a regular basis. Consider what role that person plays in your child’s life and whether them knowing would be beneficial to your child.

Describe your child’s challenges rather than simply say that he/she has ADHD. You can’t guarantee that when you use the term “ADHD” that the other person has the same understanding as you. ADHD is one of the most misunderstood diagnoses out there and unfortunately, many people do not take it seriously unless they have had a personal experience with it. It’s best to describe the challenges that your child experiences. For example, a parent may say, “ADHD makes it hard for him to sit still and control his impulses”, or “she may look like she’s listening, but she could miss a lot of what you are saying”. It is also recommended to then describe what kinds of things help your child. This gives the person some specific things that they can do to increase positive interactions with your child. For example, a parent may say, “he does best when he is given a ten minute and five minute warning before changing activities” or “after you tell her something, ask her to repeat it to check and see if she understood you”. Both of these strategies make sharing the diagnosis less about the “ADHD” label and more about the kinds of things your child struggles with and the kinds of things others can do to help him/her.

Educate yourself and your child about ADHD. This will be very important, as you will likely run into people who have strong opinions about the causes of ADHD, whether ADHD exists in the first place or whether medication is an appropriate treatment for children. You may even receive not-so-pleasant comments about your parenting skills, as this is often an easy place for people to start when they are criticizing something they know very little about. If you and your child are ready to have these conversations they will be less difficult. That’s why knowing about ADHD is so important. Also, consider having a few resources (e.g., favourite books, podcasts etc.) in your back pocket to offer those who seem genuinely interested in learning more about ADHD. Knowledge is power! At the end of the day, you will also need to consider how far you want to go with conversations with certain people. A family member who interacts with your child regularly may be a person that you spend more time talking with as compared to someone who is not as involved with your child. Sometimes debating with people is not worth it and you can use your energy for more positive things. Don’t feel like you have to engage in every conversation that someone starts with you, particularly if you or your child are feeling threatened or disrespected.

Involve your child in the process and help him/her to advocate for himself/herself. If you are sharing your child’s ADHD diagnosis with others, it is a good idea to involve your child in the process so he/she can learn how to advocate for himself/herself. This is why education about ADHD is so important. Have conversations with your child about his/her strengths and challenges. Speak with your child about the importance of taking his/her ADHD seriously and not using it as an excuse, but rather an explanation for why he/she may have difficulty with certain tasks and in certain situations. When considering telling others about your child’s ADHD diagnosis ask your child what he/she thinks about it and involve him/her in the process. Don’t share information about your child with another person in front of him/her, as if your child were not present. Include your child in the conversation and support him/her in explaining to the other person what it is like to have ADHD.

These are a few things to keep in mind when sharing your child’s ADHD diagnosis with other people. As you gain more experience sharing with others, you may find different ways of communicating that work better than others. Experiment, involve your child in the process and know when to leave the conversation alone if someone continues to disagree with you.

I would like to thank the following professionals for contributing their ideas to this blog post: Dr. Michael Zwiers, Sue Williams Brawn, Tina Parsons, Dr. Meadow Schroeder. I greatly appreciate the opportunity to work with such knowledgeable and thoughtful people.

Krista Forand, M.Ed.

Krista has worked in various roles with the CanLearn Society (formerly Calgary Learning Centre) since 2009. She is currently working with the clinical team as a registered psychologist, providing assessments and group interventions for individuals with learning and attention difficulties. In 2014, Krista obtained her graduate degree from the University of Calgary where she cultivated her interest in learning disabilities and attention disorders. She believes in the therapeutic effect of psychoeducational assessment and how this process can empower individuals and families to take control of their lives, by understanding their unique way of being in the world.

By Krista Forand, M.Ed.

Many parents (those who have children with ADHD and those who do not) look for strategies to get their child to complete chores, finish homework or complete some other undesirable boring task that the child does not particularly enjoy. As a psychologist, I have come to understand, based on the vast knowledge that we have about human behavior, that we all do better in life when we are reinforced or rewarded for engaging in behaviors that are positive and productive to ourselves and to those around us (e.g., getting a paycheck at the end of the month for doing our job). We don’t do so well when we are punished for negative behaviors (e.g., getting yelled at for forgetting to pick up milk at the store) or when we have something we enjoy taken away because we didn’t do what we were supposed to (e.g., when a child gets her video games taken away because she didn’t clean up her room).

Many parents that I speak with do a lot of that last example – take away things when their child doesn’t listen or complete a particular task. There are some problems with this approach and it is important for parents to understand how this approach may be affecting their child and their relationship with their child. First, when children have things that they enjoy taken away from them they experience more negative interactions with the people who are taking those things away (e.g., their parents, teachers etc.). These interactions can end up being not-so-pleasant for everyone involved and resentment can build up on both sides. Children who constantly have things taken away from them may give up and feel hopeless and they may feel like the adults in their lives don’t really want them to be successful because they tend not to experience much success. Second, taking things away doesn’t provide any incentive for children to engage in positive behaviors, which also communicates to them that they really don’t have much control over their behavior or the outcomes of their behaviors.

There is a different way of looking at this. Rather than taking video games or favourite toys away, use them as rewards for engaging in positive behaviors. This slight variation is based on what is called the Premack Principle, and it can make a world of difference. Basically, this principle says that people will engage in a less desirable behavior (e.g., completing homework) if they know that when they do they will be able to engage in a more desirable behavior (e.g., playing video games). The Premack Principle also says to find the rewards that will work best look at what the person normally does in their free time. These are called “high-probability behaviors” because they happen frequently. Typical high-probability behaviors for kids are things like playing with particular toys, video games, computers or television. As a parent, consider what activities your child would engage in if he/she was given an entire day to do them. These activities are now your best way to reward your child for engaging in “low-probability behaviors” (i.e., those behaviors that your child barely ever engages in when they have free time, like homework).

The Premack approach also assumes that favourite activities, such as video games and television are not things that children have automatic rights to, but rather they are privileges that are granted when other activities have been completed (e.g., chores, homework). A typical way to present this approach to a child would be to say, “Once you finish your homework, you may play 30 minutes of Minecraft”. With this approach, the choice is in the child’s hands and the adult is less likely to be seen as “the one who takes things away”. Of course, with children who have ADHD this approach will likely also need to be combined with other strategies that will help the child to be successful, such as helping the child to break the homework down into manageable chunks, creating a plan for getting it done and allowing him to take short breaks if attention span is particularly problematic. Always ensure before implementing these kinds of behavioral management strategies that the child is capable of completing the task that you want completed. Again, children with ADHD will require more support and structure in order to be successful, but as they experience more success, their self-confidence will grow and they will feel less hopeless about all of those things that they find more difficult.

So if you’re considering trying out the Premack Principle, keep the following things in mind:

1. Create a list of “high-probability” behaviors that will become the rewards list. What activities does your child engage in when he/she is given free time and free choice?

2. Involve your child in the creation of the rewards list. That way, this plan isn’t just coming from you, but it is a collaboration between you and your child.

3. Next, make a list of those “low-probability” behaviors that you, as a parent, want to see happening more often (e.g., homework, cleaning up, feeding pets, taking out the garbage).

4. Work with your child to create a plan about what low-probability behaviors must occur before they can engage in a high probability behavior. An example might be “once you empty the dishwasher, you may spend 10 minutes on the computer”.

5. Keep in mind that as your child grows up, you may need to re-evaluate the rewards that you use. Some activities will no longer be “high-probability” because your child has grown out of them. Update the rewards list and try out new ones when you notice that the plan isn’t as useful as it used to be.

6. Support your child in completing the less-desirable tasks and always keep in mind that children with ADHD will need extra support in order to be successful.

7. Seek professional help if you believe that there may be other things going on that are making it hard for your child to engage in this behavior plan (e.g., anxiety, depression, communication difficulties).

Krista Forand, M.Ed.

Krista has worked in various roles with the CanLearn Society (formerly Calgary Learning Centre) since 2009. She is currently working with the clinical team as a registered psychologist, providing assessments and group interventions for individuals with learning and attention difficulties. In 2014, Krista obtained her graduate degree from the University of Calgary where she cultivated her interest in learning disabilities and attention disorders. She believes in the therapeutic effect of psychoeducational assessment and how this process can empower individuals and families to take control of their lives, by understanding their unique way of being in the world.

By Krista Forand, M.Ed.

Many parents want to know how to help their child who has ADHD. Whether you choose to use medication or instead look to alternative therapies, it is important to know what the research says about all available treatments, whether medication or alternatives, before making the decision to use one with your child. Omega-3 polyunsaturated fatty acids (say that three times fast!) are widely advertised by producers and retailers as an effective way to enhance brain functioning or improve cognitive deficits in individuals with disorders such as ADHD. But what does the recent research say about Omega 3s and their effect on cognitive functioning?

A recent meta-analysis (Cooper et al., 2015) looked at several studies that measured Omega 3s on different cognitive outcomes (e.g., attention, memory). A meta-analysis is a study of studies. It’s the putting together of a whole bunch of studies’ results and determining if overall, based on all of those studies, there was something significant or effective about a particular treatment. The studies that these researchers put together included people from the general population (i.e., people who didn’t have ADHD), people who had ADHD or a lot of ADHD symptoms and people who had ADHD and a reading problem. After searching through the research and using strict criteria for which studies would be included and which studies would not, the researchers ended up including 24 studies in their analysis. These studies were randomized, double blind, placebo control trials. What are those you ask? Well, randomized means that the participants in the study were randomly placed in either the treatment group (i.e., they took Omega 3s) or the control group (i.e., they took a sugar pill, or in this case, an “oil” pill that wasn’t supposed to do anything). Randomizing ensures that both groups weren’t significantly different in any way to start with, making it easier to detect an effect by the Omega 3s, if there was one to detect. Double blind means that the researchers who were collecting data didn’t know who was in the treatment group or the control group and the participants didn’t know whether they were receiving the treatment or not. This is important because research on placebos has taught us that placebos have positive effects on people and researchers have unknowingly or unintentionally affected results by knowing who was taking the treatment and who wasn’t taking it. So enough explanations and onto the results!

This meta-analysis found that Omega 3 supplementation had no significant effect on cognitive abilities in all of the samples (general population vs. ADHD vs. ADHD and a reading problem). They did however, find a small improvement in short-term memory in studies who supplemented the general population and ADHD and reading problem groups, but the effect was only significant for those participants who had pre-existing deficiencies in Omega 3s. Based on these findings, the claims that are being made by retailers are inconsistent with current research findings. Parents are encouraged to make informed decisions about treatment choices for their child with ADHD. At this point, it appears that Omega 3s do not significantly improve cognitive functioning. More research is needed, particularly related to those individuals who have an Omega-3 deficiency.

Krista Forand

Krista has worked in various roles with the CanLearn Society (formerly Calgary Learning Centre) since 2009. She is currently working with the clinical team as a registered psychologist, providing assessments and group interventions for individuals with learning and attention difficulties. In 2014, Krista obtained her graduate degree from the University of Calgary where she cultivated her interest in learning disabilities and attention disorders. She believes in the therapeutic effect of psychoeducational assessment and how this process can empower individuals and families to take control of their lives, by understanding their unique way of being in the world.

Reference

Cooper, R.E., Tye, C., Kuntsi, J. Vassos, E., & Asherson, P. (2015). Omega-3 polyunsaturated fatty acid supplementation and cognition: A systematic review and meta-analysis. Journal of Psychopharmacology, 29(7), 753-763. doi: 10.1177/0269881115587958