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Tuesday, December 31, 2013

Why Substituting "Behavioral" Health Care for "Mental" Health Care is Wrong

From The Boston Globe

By Claudia M. Gold, M.D.
December 22, 2013

A colleague of mine recently pointed out a study by the Center for Health Care Strategies (CHCS) about mental health care for children. Among their findings was this:

  • Almost 50 percent of children enrolled in Medicaid who are prescribed psychotropic medications receive no identifiable behavioral health treatment.

This is a disturbing, though not surprising, statistic given that these medications are commonly prescribed by primary care clinicians. Children living in poverty often experience greater environmental stress and may have greater mental health care needs, and the study points to medicaid as a possible source for improved, and presumably preventive, care.

Children with significant behavioral health needs typically require an array of services to support their physical, intellectual, and emotional well-being. These children, however, are often served through fragmented systems, leading to inefficient care, costly utilization, and poor health outcomes.

As a significant source of funding for children’s behavioral health care, Medicaid programs can advance fundamental improvements in care coordination and delivery for these vulnerable children.

This would certainly be a goal to work towards.

However, in reading about this study I was distracted by, and am struggling with as I write, the repeated reference to "behavioral health care" rather than "mental health care." This change in language is now common in our culture. It is significant and worrisome for two reasons.

First, it serves to perpetuate the stigma of mental illness. Implied in this word substitution is the idea that mental illness is something that should not be talked about.

Recently I came up against this stigma when giving a talk that included a discussion of the connection between "colic" and perinatal emotional complications such as anxiety and depression. An audience member, a mother of several grown children, spoke of resentment, that was still very much alive over 20 years later, that her friends and colleagues had been concerned about her mental well being when caring for her first, very challenging child.

Severe sleep deprivation, feelings of isolation and low self esteem are an almost inevitable consequence of having a very fussy baby. The stigma associated with identifying this constellations of concerns as a "mental health problem" is part of the reason for inadequate identification and treatment of postpartum depression and anxiety.

Research has shown that when untreated, these problems can in turn lead to mental health problems in the developing child. If we could, as the saying goes "call a spade a spade," without having it be associated with blame and shame, there might be more hope for helping for these mothers, and for preventing the development of mental health problems in their children.

The second, and more worrisome issue related to the substitution of "behavioral" for "mental" is the idea that treatment involves controlling behavior, rather than understanding the meaning of behavior. The ability to attribute motivations and intentions to behavior is a uniquely human quality.

Extensive research, that I describe in my book Keeping Your Child in Mind, has shown that children develop a healthy sense of self, the capacity for emotional regulation, flexible thinking, social engagement, and overall mental health, when the people who care for them think about and understand the meaning of their behavior. In contrast, there may be significant disturbances when there is an absence of such curiosity about a child.

This brings us full circle to the problem identified by the above study. By treating these children with psychiatric drugs with no other form of treatment, there is no room for curiosity or understanding. Children living in poverty, especially those in foster care, may have experienced significant early trauma and loss. The consequences of treating the behavior alone, in these and other circumstances can be significant.

For example, a recent long-term follow up study of children diagnosed with "ADHD" treated with "behavior management" and medication showed that there was a five times higher risk of suicide, and 3% of adults at follow up were in prison.

The CHCS study calls for "expanding access to appropriate and effective behavioral health care." For it to be appropriate and effective, we need to call it mental health care. It needs first and foremost to allow for time and space for listening, for understanding the meaning of behavior.

Monday, December 30, 2013

GI Distress and Autism: Q&A with Pediatric Gastroenterologist Tim Buie

From Autism Speaks

November 7, 2013

In response to this week’s high-profile report linking gastrointestinal distress and behavioral issues in autism, we invited the highly respected pediatric gastroenterologist Timothy Buie to answer parent questions.

Dr. Buie specializes in autism care and research at Massachusetts General Hospital’s Lurie Center for Autism, a member of the Autism Speaks Autism Treatment Network.

Pediatric gastroenterologist Tim Buie sees
a patient at Boston's Lurie Center for Autism.

Autism Speaks: On behalf of our families, Dr. Buie, thanks so much for joining us. For openers, do you think it’s still common for our parents to have their GI concerns dismissed by pediatricians and other community doctors?

Dr. Buie: I had thought we were past that point. Unfortunately, I keep seeing new patients, many of them from respected pediatric practices, with parents saying they were told “baloney” or that autism-related gastrointestinal problems were “just part of the autism lore.” There’s still a subgroup of physicians who can’t quite figure out how to put autism’s associated medical conditions into their evaluation process. Too many of them simply don’t have enough exposure to let them believe these connections.

The good news is that there are also a lot of doctors and therapists who’ve become very good at recognizing these kids. They’ve seen the wonderful difference that addressing gastrointestinal issues can make in a child’s behavior.

Autism Speaks: Are you hopeful that this week’s report in the Journal of Autism and Developmental Disorders will improve awareness in the medical community?

Dr. Buie: I hope so. JADD is a journal read by people interested in autism, many of whom already have experience helping patients who have autism. It’s not widely read by general pediatricians and other primary doctors. That’s where Autism Speaks and other media sources come in. It’s so crucial that you and others are highlighting these papers. Every time more evidence comes out and gets talked about on websites and in newspapers, it helps cement and spread understanding of how common gastrointestinal disorders are among those with autism and how these problems can contribute to some of the behaviors we commonly associate with autism.

Autism Speaks: In your opinion, how big a role does GI distress play in exacerbating harmful autism-related behaviors?

Dr. Buie: I think it plays a really big role in contributing to particular behaviors. This week’s paper talks about a variety of these behaviors. However, I think it’s very important to divide them into two categories:

First, there are self-injury and outburst behaviors that are, no doubt, related to pain. I’m talking about self-injury and aggression or other violent behaviors. These are associated with autism, but they’re not core symptoms of autism. As physicians we should be considering gastrointestinal problems whenever a child presents with these behaviors. Classic examples include self-biting and mouthing behaviors. But they can also include bolting, which can result from the agitation that pain can cause.

In the second category, are core features of autism that can be exacerbated – or perhaps even caused – by gastrointestinal problems. These include repetitive behaviors. They’re the “I’m inside my body and checking out from the rest of the world” behaviors. This report, like earlier papers, indicates that these core features of autism are more prominent in children with GI issues. When you fix the GI problems, many of these kids become more present. Some begin focusing more in the classroom. You might even see progress in other core behaviors of autism.

I’m not saying it’s all about GI issues for all kids with autism. Gastrointestinal problems are just one aspect. Similarly, migraines, dental issues and other illnesses can likewise set off problem behaviors.

Autism Speaks: Do you believe that better treatment of GI distress will significantly reduce the need for behavior-modifying medications in children and adults with autism?

Dr. Buie: I think it might. At the same time, I think it’s so important for caregivers to work together. Certainly there are times when kids are coming for a medical workup with behaviors that endanger themselves or others. They may need behavior-modifying medications first to ensure their safety. We don’t want a child banging his head on the floor and detaching his retina.

So there may be situations where one might try medication first to get extreme behavioral problems under control. The important thing to remember is that you don’t stop there. These medications have serious side effects. So just because a medication solves a behavioral problem or, say, helps a child sleep, your job’s not finished. The full medical workup can uncover issues such as gastrointestinal problems that, when addressed, allow you to take that child off the behavior-modifying medicine. This isn’t true of all individuals. But it’s true of enough of them that we should always evaluate for underlying medical issues that may be causing the behavior.

Autism Speaks: When should parents or physicians suspect GI distress in children or adults with autism – particularly in those with limited communication abilities?

Dr. Buie: It’s important to look for behaviors that we think are strongly associated with acid reflux and other gastrointestinal problems. Disordered sleep – especially if it is a change in sleep pattern – is one of those behaviors. It correlates strongly with acid reflux.

We likewise think mouthing behaviors and pica behaviors can be hallmarks of GI distress. So is repeatedly tapping the stomach and chest. These children are doing their best to point to body parts that hurt. I had one young man tapping his chest so much that he had developed a callous. When I looked in his throat he had erosive acid reflux.

Other tell-tale behaviors include lying over furniture or therapy balls.

Autism Speaks: How would you like to see pediatricians and other physicians apply the growing body of research linking GI distress and behavior in individuals with autism?

Dr. Buie: Above all, this research is telling us that we need to listen to parents. When kids with autism get evaluated by GI specialists, those evaluations usually back up parent’s descriptions of their children’s symptoms.

Autism Speaks: How can parents and others use this information to advocate for their loved ones with autism?

Dr. Buie: I think it’s particularly helpful when parents can describe what they see versus presenting the doctor with their theories of what’s causing the problem. For instance, I think it’s more helpful to describe a child’s pain or behavior than ask the doctor to find out if yeast is the problem. Often, the latter can be impossible to prove. But we can address the former.

Another thing I suspect is that general pediatricians and family practice doctors can get overwhelmed by the totality of a child’s autism. It can be hard for the doctor to stay focused while a child is running around the room and the parents are describing the inadequacies of his education program.

To get more traction, I encourage parents to help that doctor focus. Go in with one focused issue such as your child’s gastrointestinal problem. Let the doctor know that this is what you want to address in today’s visit.

Autism Speaks: Are you satisfied with the amount of time and money being spent on the study of autism and GI-related issues today?

Dr. Buie: I think that autism is a condition that has many research needs. So part of the difficulty in our field is that the need to support research is greater than the funding available. I want to see research funding go to investigate autism’s genetic causes as well as its associated medical conditions. I want to see money going toward resources for families and to increase awareness. There’s an awful lot of need.

That said, I’m not convinced that we’re doing enough when it comes to looking at autism’s associated and underlying medical conditions. I respect that people are trying. I respect that this is an important part of the work being done by the Autism Speaks Autism Treatment Network and by other research projects funded by Autism Speaks.

Yet we’re also entering a new frontier where we’re investigating how aspects of the gastrointestinal system are intertwined with the immune system in ways that can affect brain activity. Some of this very exciting work involves how changes in the microbiome – the intestine’s bacterial “flora” – can direct impact brain function.

We’re entering a time when we can seriously investigate how gastrointestinal issues may not just exacerbate problem behaviors but may be part of the cause of autism’s core symptoms in some individuals. It’s an exciting time to be doing research that could soon deliver benefits to families.

Sunday, December 29, 2013

Scratch a Happy Adult, Find a Socially Connected Childhood

From Greater Good
The Science of a Meaningful Life

By Lauren Klein
December 12, 2013

New study: a happy life is much more about making friends than it is about making the grade.

When I was a little girl, I was asked to complete this sentence: “When I grow up, I want to be ________.” I might have said “crossing guard” (I really did want that) or I might have said “artist” (I still secretly do want that).

But neither of those made the cut. In fact, I didn’t mention any profession at all.

I said that when I grow up, I want to be happy.

Research suggests that the roots of lifelong happiness often do indeed stretch back into childhood. But what’s the right path to help kids like me realize our dreams of a happy adulthood? Is it all about excelling in school? Or does building strong relationships raise our happiness quotient?

A recent study, published in the Journal of Happiness Studies, tackled these questions by tracking kids’ happiness as they matured into adults. According to the results, a happy life is much more about making friends than it is about making the grade.

In the study, the authors (all Aussies) followed 804 New Zealanders from childhood through adulthood, taking a total of 15 assessments of the kids over the years, the last at age 38. They were looking for something very specific: the relative importance of social and academic pathways to well-being in adulthood.

To measure social connectedness, they looked at the strength of participants’ feelings of attachment to others, asking questions like, “To what extent do you communicate, trust in, or feel alienated from parents and peers?” They also asked about participation in organized sports, activities, and youth groups.

The researchers also gauged academic achievement from a variety of data points. In childhood, these included language expression and comprehension; in adolescence, it was reading ability, exam performance, and high school completion.

Fast forward to adulthood, which was measured at age 32.

They found, generally, that those kids who did well in school and those who had a rich network of connections were happier as adults than those who suffered academically and felt alienated from friends.

What’s more, from the time kids were 15 or 18, being more outgoing, kind, independent, good at sports, and having lots of hobbies—in other words, being more socially connected—was more significant than academic success in predicting later happiness.

“The pathway between adolescent social connection and well-being over a decade later,” the authors write, “illustrates the enduring significance of positive social relationships.”

Compare the social connectedness pathway to academic achievement, and the authors find that the “direct effect of adolescent achievement on well-being was smaller.”

That’s not to suggest that academic achievement is unimportant to later happiness—it just does not predict happiness as strongly as social connections and relationships. That said, evidence suggests academic success can foster social connectedness; when that’s the case, the path from academic achievement is more than twice as strong a predictor of adult happiness.

Happiness, as the authors define it, isn’t just about feeling good or having positive emotions. It’s also an ability to deal with difficulties in life, to feel involved in your community, to recognize your own strengths, and to perceive the life you’re living as one that’s meaningful.

That social connectedness is a more direct pathway to adult well-being than academic achievement points to the “importance of parallel investments in the social development of children and adolescents during the school years,” according to the authors.

In other words, families and schools need to nurture kids’ social skills, not just their academic ones. “If social and academic pathways are separate,” write the authors, “positive social development across childhood and adolescence requires investments beyond development of the academic curriculum.”


Along these lines, they go on to propose the development of a “social curriculum” with programs and activities that “enhance social inclusion and connection.” For ideas and techniques to make that happen, please see Greater Good’s education channel!

Saturday, December 28, 2013

How to Help Kids Overcome Fear of Failure

From Greater Good
The Science of a Meaningful Life

By Vicki Zakrzewski
December 5, 2013

According to the research on failure, students may need more than just grit to succeed.

A couple of weeks ago, a New York Times op-ed asked the question, “Are kids too coddled?” In other words, shouldn’t we let them fail once in awhile so they develop some backbone? Or don’t they just need more grit?

The answer is not that simple, because human beings are not that simple.

According to U.C. Berkeley professor Martin Covington, the fear of failure is directly linked to your self-worth, or the belief that you are valuable as a person. As a result, Covington found that students will put themselves through unbelievable psychological machinations in order to avoid failure and maintain the sense that they are worthy—which, as all of us who have ever dealt with the fear of failure know, can have long-term consequences.

Fortunately, the research also provides tips for educators to help students deal with feelings of failure—and help them to fulfill their true potential.

The Games We Play to Avoid Failure

Covington’s years of research found that one way people protect their self-worth is by believing they are competent and making others believe it as well.

Hence, the ability to achieve—and the quality of performance that reveals that ability—is critical to maintaining self-worth. This is particularly true in competitive situations such as school and, later, the workplace. In a nutshell, failing to perform means that one is not able and, therefore, not worthy.

If a person doesn’t believe he or she has the ability to succeed—or if repeated failures diminish that belief—then that person will begin, consciously or not, to engage in practices or make excuses in order to preserve his or her self-worth both in his or her own eyes and in the eyes of others.

The more intense the effort behind the failure, the more important the excuses or defense mechanisms become.

Covington found that, when it comes to dealing with failure, students generally fall into four categories:

1. Success-Oriented Students: These are the kids who love learning for the sake of learning and see failure as a way to improve their ability rather than a slight on their value as a human being. Research has also found that these students tend to have parents who praise success and rarely, if ever, reprimand failure.

2. Over-strivers: These students are what Covington calls the “closet-achievers.” They avoid failure by succeeding—but only with herculean effort motivated solely by the fear that even one failure will confirm their greatest fear: that they’re not perfect.

Because the fear of failure is so overpowering and because they doubt their abilities, Overstrivers will, on occasion, tell everyone that they have very little time to prepare for an upcoming test—and then spend the entire night studying.

When they pass the test with flying colors, this “shows” everyone that they are brilliant because their “ability” trumped the need to extend any effort.

3. Failure-avoiding: These students don’t expect to succeed—they just want to avoid failing. They believe that if they extend a lot of effort but still fail, then this implies low ability and hence, low worth. But if they don’t try and still fail, this will not reflect negatively on their ability and their worth remains intact.

In order to avoid failure that might be due to lack of ability, they do things such as make excuses (the dog ate my homework), procrastinate, don’t participate, and choose near-impossible tasks. However, this can put them into a tricky position when they encounter a teacher who rewards effort and punishes for what appears to be lack of effort or worse.

Ultimately, there’s no way out for these students—either they try and fail or they’re punished.

4. Failure-accepting: These are the hardest students to motivate because they’ve internalized failure—they believe their repeated failures are due to lack of ability and have given up on trying to succeed and thus maintain their self-worth. Any success they might experience they ascribe to circumstances outside their control such as the teacher giving them the easiest task in a group project.

Two more points: Both failure-avoiding and failure-accepting students tend to focus on non-academic areas where they can succeed, such as sports or art or even risky behavior. And students who, in general, are motivated by fear of failure tend to have parents who rarely praise success, and instead punish failure. This leads these students to believe that their parents’ love is conditioned upon their academic success.

Understanding how the complexity of the fear of failure can lead some students to succeed in school and others to give up makes it evident that telling students to “buck-up and deal” when the going gets tough won’t work for many or most of them.

Overcoming the Fear of Failure

So, what can teachers do to help their students become success- rather than failure-oriented? There are no easy answers and not all the research-based suggestions below will work with each kind of failure-orientation. The key is for teachers to know their students well and recognize when they are starting to engage in failure-based behavior.

1. Emphasize effort over ability. Thanks to Carol Dweck’s research on mindsets, many teachers have started to give more importance to students’ efforts rather than their “innate” ability. This is particularly important for teachers of upper elementary students through university as research has shown that as children get older, they tend to value ability over effort.

One way to encourage effort is to provide specific feedback to students that recognizes and praises effort. Studies have shown that students who receive this kind of feedback are not only more motivated to succeed, but also believe that they can succeed. However, be careful not to tell students to try harder if they failed, particularly if a lot of effort was expended to succeed. Otherwise, they may begin to doubt their abilities and eventually become failure-avoidant or accepting.

2. Encourage students to practice self-compassion when they fail. Covington suggests that at the heart of the fear of failure is a push-pull between self-acceptance and being able to see ourselves as we really are. This is where self-compassion can help.

Kristin Neff writes in her book Self-Compassion that in order for self-compassion to be effective, we have to first realize that, “Our true value lies in the core experience of being a conscious being who feels and perceives.” In other words, rather than making our self-worth contingent on categories such as academic success, appearance, or popularity, we must value ourselves solely for the fact that we are human beings and accept that failure is part of the human experience.

When we do that, it is easier for us to extend compassion to ourselves when we fail. Rather than beating ourselves up for not being perfect in something like academics—as the Over-striver might do—we practice self-talk that is kind and compassionate. This makes it easier to look realistically at what caused the failure and then consider what can be done to improve next time.

Research has found that people who practice self-compassion recover more quickly from failure and are more likely to try new things—mainly because they know they won’t face a negative barrage of self-talk if they fail.

3. Build positive relationships with students. This is particularly important for students who are failure-avoidant or accepting. Research has shown that students are motivated to try their best when teachers to whom they feel attached value academic tasks. Studies have also shown the opposite to be true—that students are less motivated when faced with teachers whom they feel don’t care about them.

One final suggestion that Covington makes is to talk with students about how the fear of failure might be impacting their lives. When he did this with undergraduates, he found that they were grateful for the information as it helped them take control of their attitude and behavior toward schoolwork.

Deepening our understanding of the fear of failure not only can make us more compassionate and understanding of our students—but of ourselves as well.

Common Core Reading Survey Shows Slow Start To Teaching Shift

From The Huffington Post

By Joy Resmovits

October 23, 2013

Common Core Reading Survey Shows Slow Start To Teaching Shift

 On a sunny summer afternoon, teachers fill a bright red auditorium in the basement of the Soho headquarters of Scholastic Inc., the educational publishing giant. In front of them, a coach uses a big screen to show them books.

Because of new learning standards called the Common Core, New York City educators attending the presentation will soon have to revamp how they teach reading. The coach, who wears glasses and a colorful floral blazer over dark capris and no-nonsense sandals, is trying to teach them how to do that.

When teaching from a book like Yes Day! -- about a boy whose parents give him one day that all his requests are answered with "yes" -- the coach suggests that teachers following the Common Core ask students to notice patterns, or to create their own Yes Day! books.

Stephane Mbenga goes over fractions with long-term substitute teacher
Naomi Wamble in May in a fourth grade math class at Piney Branch
Elementary School in Takoma Park, MD. Montgomery County fourth and
fifth grade math teachers are training to teach students in a new
style of learning math to prepare for Common Core.

Common Core standards, which aim to standardize curricula from state to state, require that each school day include more informational text, and that students react to readings by reaching conclusions based on evidence, instead of reflecting on what the material means for their personal lives. This mandate leaves some teachers puzzled.

"Students always rely on personal connections first," one teacher asked, her hand raised. "What are your thoughts on making it more meaningful?"

The coach thought for a few seconds. "We're going to have to be the ones to say this. We have best practices that are research-based," she said, eliciting a chorus of mmm-hmms and nods. "We're not going to abandon them because it's not specifically stated in a Common Core standard." She suggested layering that personal background on top of deep dives into texts, which she said she wouldn't have done before the Common Core.

"It's good to hear you say that," the questioning teacher said, comforted.

The Common Core, adopted by 46 states, is supposed to help American students gain skills that translate into success after graduation. That means classroom debate on ideas based on evidence derived from reading. But with school budgets strapped and funds for teacher training squeezed, it's hard to know whether teachers are actually changing their reading instruction.

On Wednesday, the right-leaning Thomas B. Fordham Institute, a Washington-based think tank, released a report that tries to answer that question. Based on an extensive survey of a small but nationally representative sample of teachers last year, the group suggests that teachers mostly have not yet overhauled reading instruction in a way that will herald change.

"In summary, these results reveal that many teachers have not yet confronted the new text complexity demands of the Common Core," the report concludes.

For decades, American students -- particularly the oldest -- have struggled with reading improvements. Despite public battles over phonics, the federal government's Reading First programming and No Child Left Behind, which mandated standardized testing,, bending the flat results on reading tests has proven nearly impossible. On the long-term National Assessment for Educational Progress, the performance of 17-year-olds is little better than it was in 1971.

In the introduction to the report, Fordham's Chester Finn, a former Reagan administration official, and Kathleen Porter-Magee, theorize that readers stagnated because states set their own standards, and the complexity of reading texts declined. Over time, teachers began focusing on reading strategies, rather than deep analysis.

"In trying to improve reading comprehension, schools made a tragic mistake: they took time away from knowledge-building courses such as science and history to clear the decks for more time on reading skills and strategies," they write. "And the impact, particularly on our most disadvantaged students whose content and vocabulary gap is so great, has been devastating."

Porter-Magee and Finn said they see the Common Core as a potential remedy. It theoretically requires teachers to introduce more non-fiction, and reading and writing based on evidence instead of personal narratives. Teachers are supposed to assign readings based not on a student's actual reading abilities, but rather on the reading level of that student's school year.

According to the survey, 64 percent of elementary teachers are still assigning books based on individual abilities, as are two out of five math teachers. When picking novels, 51 percent of elementary school teachers reported doing so based on students' reading levels regardless of grade, as did 40 percent of middle school teachers and 28 percent of high school teachers.

"It's one thing to say these are shifts that the Common Core promotes, and it's another thing to say they're making their way into the classroom," Porter-Magee said in an interview.

The survey found that 73 percent of elementary teachers and 56 percent of middle school teachers emphasize reading skills over text-centered lessons. High school teachers are split in half on this issue. The survey found the most popular texts were Because of Winn-Dixie, Bridge to Terabithia, Anne Frank: The Diary of a Young Girl, To Kill A Mockingbird, and Martin Luther King's "I Dreamed a Dream Speech." The survey deemed the texts "slightly easier works."

To conduct the survey, Fordham had the FDR Group survey 1,154 reading or English language arts teachers -- 300 in elementary, 370 in middle school and 484 in high school -- in February and March 2012. The results have a margin of error of plus or minus 3 percentage points, and are intended as a baseline. The next administration, in 2015, the authors write, will be a better indicator of Common Core progress, because implementation is now in its early phases.

Friday, December 27, 2013

Top Ten 2013 Advances in Autism Research

From Autism Speaks

December 18, 2013

Highlights from an unprecedented year in advancing diagnosis, prevention and treatment of autism and its associated medical conditions.

This year brought signs of a gratifying maturation in autism research. Beyond an unmistakable increase in the number of autism studies making headlines was a shift toward research that delivered concrete advances in the prevention, diagnosis and personalized treatment of autism and its associated medical conditions. This progress also reflected the growing appreciation that, for some individuals, autism is a whole-body disorder.

"This year has offered us plenty of exciting and relevant science stories to discuss, making it incredibly difficult to narrow down to a top ten," says Autism Speaks Chief Science Officer Rob Ring. "When it comes to scientific discovery in autism research, it just keeps getting better and better."

Here then, are Autism Speaks' Top Ten Advances in Autism Research 2013:

In July, the first results from Autism Speaks "10K Autism Genome Program" demonstrated the usefulness of whole genome sequencing for providing unprecedented guidance for the diagnosis and personalized treatment for autism and its associated medical conditions.

Researchers used high-tech eye tracking to discover a subtle but consistent decline in eye contact that begins around 2 months of age in babies who go on to develop autism. If confirmed, the finding would be the earliest biomarker of autism. It may also represent an opportunity for very early intervention that could improve the course of brain development, learning and social engagement.

Strong Evidence that Prenatal Folic Acid Can Reduce Autism Risk

In February, the Journal of the American Medical Association published the results of a large study showing that autism rates are lower among the children of women who take folic acid supplements in the weeks before and after conception. The findings suggest a safe and practical step women can take to reduce autism risk. However, the benefit may turn out to be restricted to women with propensities to low folic acid levels.

Gene Study of Neurodevelopmental Disorders Finds Overlap between Autism and Major Mental-Health Conditions; Potential for Common Treatments

In February, the results of the largest-ever genetic study of neurodevelopmental disorders and psychiatric illnesses revealed strong commonalities between autism and ADHD, bipolar disorder, depression and schizophrenia. The shared genes included two that balance calcium levels in brain cells, suggesting a common direction for the development of new treatments.

New Tools Enable Investigators to Track Activity of Autism-linked Genes

In November, the results of a large study on a diverse group of children with autism confirmed that they experience high rates of gastrointestinal symptoms. The study went further to associate GI distress with more-severe autism symptoms including social withdrawal and irritability. The findings lend strong support to Autism Speaks Autism Treatment Network guidelines urging doctors to look for and treat GI symptoms in children with autism.

"Optimal Outcomes" Rare but Real in Autism

In January, a landmark study confirmed that a small subset of children with autism entirely overcome their disabilities. Researchers documented that these children had significant autism symptoms when diagnosed and suggested that intensive early intervention and biological differences may have been crucial to their optimal outcomes.

Beyond Autism Genes: Epigenetic Differences in Identical Twins

By studying identical twins who differ in autism diagnosis or symptom severity, researchers found tell-tale clues showing how environmental influences may contribute to – or protect against – autism.

Autism, Long Genes and DNA Detanglers

In August, investigators reported a set of discoveries that linked autism to disruptions in very long genes and the enzymes that untangle them. The researchers have launched a search for chemicals that prevent these important enzymes (topoisomerases) from doing their job. Their discovery may also help explain why autism risk is higher among the children of older parents.

Large Study Supports GI Link to Problem Behaviors in Kids with Autism

In November, the results of a large study on a diverse group of children with autism confirmed that they experience high rates of gastrointestinal symptoms. The study went further to associate GI distress with more-severe autism symptoms including social withdrawal and irritability. The findings lend strong support to Autism Speaks Autism Treatment Network guidelines urging doctors to look for and treat GI symptoms in children with autism.

'Good' Bacteria Ease Autism-like Behaviors in Mouse Model

Researchers using a well-known mouse model of autism found that a probiotic known to relieve gut inflammation also improved social behavior while reducing repetitive behaviors and signs of anxiety. The study added support to the idea that intestinal inflammation can worsen or even cause autism symptoms in people. It opened the door to clinical trials that will administer the probiotic to children with autism and GI symptoms.

Thursday, December 26, 2013

Concussion Tests' Marketing Outpaces Scientific Evidence, New Review Says

From ScienceDaily.com

December 20, 2013

Computerized neurocognitive testing for concussions is widely used in amateur and professional sports, but little research over the past decade proves its effectiveness, says a paper published this month in the journal Neuropsychology Review.

Jacob Resch, director of the Brain Injury Laboratory at The University of Texas at Arlington, is lead author on the review, which updates a 2005 look at the available research on computerized neurocognitive testing. In 2005, researchers said not enough evidence existed to support clinical use of the then relatively new assessments.

The more recent work acknowledges that computerized tests, such as those marketed under the name ImPACT, HeadMinder, CogState, and ANAM, have become extremely commonplace across the sports world. But, the authors still urge caution with their use and point out a need for more peer-reviewed studies.

"Limited data has been published since 2005 to assist clinicians in determining the clinical value of this form of testing," Resch said. "While these products are an important component of concussion management, their development, marketing and sales seem to have outpaced the evidence. So, some caution is needed."

Co-authors are Michael McCrea, an author of the 2005 study and director of brain injury research at the Medical College of Wisconsin, and C. Munro Cullum, professor and head of the neuropsychology program at U.T. Southwestern Medical Center.

"Given the attention that concussion in sport has gained in recent years, it is surprising there has not been more research into the some of the newer computer-based methods used to evaluate post-concussion symptoms," Cullum said.

"Since there is no single brain-test or biomarker for concussion at this point, the diagnosis of concussion remains a challenge in many cases, as it relies upon reported and observed symptoms."

Resch, McCrea and Cullum found 29 peer-reviewed articles since 2005 have addressed the characteristics of commercially available computerized neurocognitive tests. After a detailed analysis, they concluded that evidence on reliability and validity of the tests wasn't consistent.

For example, in a May, 2013 study published by the Journal of Athletic Training, Resch and other researchers found that the ImPACT test misclassified healthy study participants as impaired as much as 46 percent of the time for some evaluation factors. ImPACT stands for Immediate Post Concussion Assessment and Cognitive Testing, and is by far the most used computerized neurocognitive test for concussion management.

An Institute of Medicine report early this year said that the number of people 19 and under treated in U.S. emergency rooms for concussions and other non-fatal, sports and recreation-related traumatic brain injuries increased from 150,000 in 2001 to 250,000 in 2009. With the recent settlement of a landmark lawsuit filed by former NFL players, concussions remain in the headlines and on the minds of athletes, parents, coaches and others in the sports world.

Recently, nearly 40 percent of athletic trainers reported using a computerized neurocognitive tests as part of their response to a sports-related concussion, according to the new paper. The convenient computerized tests are typically used, just as pen and paper versions were in the past, to establish a baseline to use as a point of comparison after an athlete is injured.

But, because concussion symptoms can vary widely across individuals and may be subtle, clear documentation of mild brain injury can be difficult.

The findings of the new survey should serve as a caution to those utilizing and interpreting computerized cognitive test results, the researchers said.

"Neurocognitive testing is an important component of the concussion assessment, but should not be used as a stand alone method to diagnose injury or determine an athlete's level of recovery and fitness to return to play," said McCrea.

"A multi-dimensional approach is supported by the evidence as best practice."

Until more research is done, the new paper from Resch, McCrea and Cullum recommends healthcare professionals who use the tests take some precautions, including:
  • Making an informed decision when choosing a test and investigating its limitations.
  • Making sure the test is part of a multi-faceted concussion management approach.
  • Incorporating a clinical neuropsychologist into the sports-related concussion management team to assist in interpretation of test results.
  • Ensure proper training of those administering the test.
  • Conducting quality control reviews of baseline testing.

Journal Reference

Jacob E. Resch, Michael A. McCrea, C. Munro Cullum. Computerized Neurocognitive Testing in the Management of Sport-Related Concussion: An Update. Neuropsychology Review, 2013; 23 (4): 335 DOI:10.1007/s11065-013-9242-5

Dads: How Important Are They?

From ScienceDaily.com

December 4, 2013

"New findings from the Research Institute of the McGill University Health Centre (RI-MUHC) show that the absence of a father during critical growth periods leads to impaired social and behavioral abilities in adults."

Even with today's technology, it still takes both a male and a female to make a baby. But is it important for both parents to raise that child?

Many studies have outlined the value of a mother, but few have clearly defined the importance of a father, until now. New findings from the Research Institute of the McGill University Health Centre (RI-MUHC) show that the absence of a father during critical growth periods, leads to impaired social and behavioral abilities in adults.


Two parents vs. one, without regard to gender?

Note that the authors themselves acknowledge that their study "suggest(s) that both parents are important in children's mental health development."

A defect in their design is that absent any reported gender-specific data as to the role of the father specifically, they failed to examine differences between offspring in two-parent and single-parent family units This is clearly a significant weakness in their mouse model. They rightly recommend additional research.


This research, which was conducted using mice, was published today in the journal Cerebral Cortex. It is the first study to link father absenteeism with social attributes and to correlate these with physical changes in the brain.

"Although we used mice, the findings are extremely relevant to humans," says senior author Dr. Gabriella Gobbi, a researcher of the Mental Illness and Addiction Axis at the RI-MUHC and an associate professor at the Faculty of Medicine at McGill University. "We used California mice which, like in some human populations, are monogamous and raise their offspring together."

"Because we can control their environment, we can equalize factors that differ between them," adds first author, Francis Bambico, a former student of Dr. Gobbi at McGill and now a post-doc at the Centre for Addiction and Mental Health (CAMH) in Toronto. "Mice studies in the laboratory may therefore be clearer to interpret than human ones, where it is impossible to control all the influences during development."

Dr. Gobbi and her colleagues compared the social behavior and brain anatomy of mice that had been raised with both parents to those that had been raised only by their mothers. Mice raised without a father had abnormal social interactions and were more aggressive than counterparts raised with both parents. These effects were stronger for female offspring than for their brothers. Females raised without fathers also had a greater sensitivity to the stimulant drug, amphetamine.

"The behavioral deficits we observed are consistent with human studies of children raised without a father," says Dr. Gobbi, who is also a psychiatrist at the MUHC. "These children have been shown to have an increased risk for deviant behavior and in particular, girls have been shown to be at risk for substance abuse. This suggests that these mice are a good model for understanding how these effects arise in humans."

In pups deprived of fathers, Dr. Gobbi's team also identified defects in the mouse prefrontal cortex, a part of the brain that helps control social and cognitive activity, which is linked to the behavioral deficits.

"This is the first time research findings have shown that paternal deprivation during development affects the neurobiology of the offspring," says Dr. Gobbi. These results should incite researchers to look more deeply into the role of fathers during critical stages of growth and suggest that both parents are important in children's mental health development.

Journal Reference

Francis R. Bambico, Baptiste Lacoste, Patrick R. Hattan, and Gabriella Gobbi. Father Absence in the Monogamous California Mouse Impairs Social Behavior and Modifies Dopamine and Glutamate Synapses in the Medial Prefrontal Cortex. Cereb. Cortex, 2013 DOI: 10.1093/cercor/bht310

Wednesday, December 25, 2013

Merry Christmas!

Selective Mutism: How A 6-Year-Old Was Finally 'Cured' of Her Anxiety Disorder

From The Huffington Post

By Catherine Pearson

December 17, 2013

For weeks after she started preschool, Alvin Asencio, 27, and his wife Krystal, 28, thought their daughter, Kailee, was just battling typical shyness and nerves. Though the 3-year-old was relatively chatty with them, she would not speak to her teachers or classmates.

"[My wife] told me, 'Al, there's something wrong," Alvin said. "I was kind of in denial, not in an egotistical kind of way; more of, 'She's fine, she's so smart. It's just a phase or something.'"

Kailee struggled to speak in front of anyone but her parents
due to an anxiety disorder called selective mutism.

But weeks turned into months, months turned into more than a year, and Kailee remained painfully quiet in school, as well as with friends or family she did not know. In class, she would sit by herself drawing detailed pictures -- of faces she saw around her, or how she was feeling that day.

Kailee expressed interest in going to her classmates' birthday parties, but she refused to play with the other guests when she arrived. She loved the playground, but would keep largely to herself. At her family's home in Brooklyn, N.Y., she would talk with her parents, but only if no one else was watching.

Relatively early on, Kailee's parents had her evaluated, and the results suggested she had a speech impairment. "I knew she didn't," Krystal said. "But because she wouldn't talk in front of the evaluator, or the speech therapist, they assumed that."

"It became really frustrating for us at that point," Alvin said. "It's not that she was a genius, but she was very well-spoken ... She was going to get all these special services at school, [and we knew] she didn't need them. Those services could've gone to another kid that really did."

But despite expressing frustration to experts, there seemed to be no other options for the family. The couple was willing to try anything, so they dutifully took Kailee to speech therapy, and hoped for the best.

Eventually, one cherished therapist, whom Kailee saw for more than a year and was the only expert able to get her to even whisper, mentioned The Child Mind Institute, a mental health practice in New York City. It was enough to start the parents on a search. They called, made an appointment, and in one session, got more answers than they'd had in years, Alvin and Krystal said: Their daughter, who will turn 7 next month, had selective mutism.

Selective mutism is an anxiety disorder, characterized by a child's inability to speak in certain settings and to certain people. Children or adolescents with selective mutism (estimates suggest it may be most common in those 5 and under) understand language and are able to speak, the Selective Mutism Group explains, but "demonstrate a persistent inability" to do so.

Like so many disorders, there is no one clear test for selective mutism, or "SM" as it's sometimes called, and parents like Alvin and Krystal often spend years hunting for answers and help for their children.

"By the time kids are seeking help for this, they have gone literally years without talking to a peer or teacher," said Steven Kurtz, a clinical researcher and child psychologist with The Child Mind Institute, who added that doctors often hypothesize that the children are simply being willful, or that they have autism.

Kurtz estimates that the issue affects about 1 in 140 young children in the U.S., primarily those ages 4 to 7. Because it's relatively rare, he said, many clinicians have not seen or treated a child with SM. "Until I had one, I had never seen or heard of it in my training. Most of the people I train in [treatment] have never seen a kid with SM before," Kurtz said.

The Child Mind Institute prides itself on being one of the few places in this country that specializes in the diagnosis and treatment of selective mutism, including options for families who are not in the New York City area. "Brave Buddies" is a cornerstone of its treatment program -- an intensive behavioral intervention designed to help children speak in school and in other social situations. Last August, Kailee attended a week-long, 30-hour program in a simulated classroom, where she was led through social interactions of increasing difficulty.

"We've counted the number of times that school-age children [with SM] will avoid opportunities to talk -- it's about two times a minute, which yields about 133,000 times per school year. Imagine you practiced playing your scales wrong 133,000 times per year ... you get very good at doing it wrong," Kurtz explained.

"What we do is take these six hours a day, five days in a row, and we do what's called 'over-learning.' We practice over and over and over again all the things that these kids have been avoiding." Every child participates in saying what the weather is, for example. Every child does show-and-tell. Every child does an expert presentation. Parents are also trained, daily, in reinforcement methods and games that facilitate "brave talking."

For their part, Krystal and Alvin believe that just one week with the Brave Buddies program effectively "cured" their daughter. (Kailee also takes a very low dose of an anti-anxiety medication.) Every day she was doing something she had never done for years," Alvin said. "She would tell me, 'I ordered an ice cream today! ... I asked for sprinkles, and syrup, and whipped cream' ... She was just a different person."

Kurtz agreed that Kailee has been "cured" through the short treatment, though he cautioned that her outcome is unusual. "The typical kid has had some treatment with us before that week, and after that week, and may or may not be combining it with medication," he said.

But while Alvin and Krystal are aware that there is always a chance their daughter's issues will return, they're very hopeful about her future. They said they're thrilled by how happy she now seems, having been freed of what was an enormous burden. "She's super chatty, talkative ... she's really confident," Alvin said."She ran for library monitor. She had to do a presentation and a campaign."

"And she won," Krystal said. "She won!"

Tuesday, December 24, 2013

Learning Disabilities and Asperger’s Syndrome

From NCLD.org
The National Center for Learning Disabilities

By Sheldon Horowitz, Ed.D.
December 22, 2013

Since children with LD and Asperger’s Syndrome (AS) sometimes share characteristics, it is tempting to say that they meet the diagnostic criteria for either classification. But this is not the case—learning disabilities and Asperger’s Syndrome are separate and distinct disorders, and different types of assessments and strategies for intervention need to be selected to address the distinct and sometimes overlapping features of each.

The article, Nonverbal Learning Disabilities: A Primer, calls attention to some of these overlapping features.

Children with NVLD are described as showing signs of:
  • Physical awkwardness (e.g., not knowing what to do with their hands during casual conversation; showing anxiety-induced behaviors in public that often resulted in embarrassment);
  • Social intrusiveness (e.g., standing too close to someone or following someone around during casual conversation; not knowing when or how to join a conversation or having a hard time engaging in the “give and take” of informal chatter); and,
  • Social isolation (e.g., not being sure of how to join a group or initiate social interaction).

It will become apparent as you read on that there is a great deal of overlap between Asperger’s Syndrome (AS) and Nonverbal Learning Disabilities (NVLD), which sometimes complicates the differential diagnosis process (a term used by clinicians that simply means “figuring out what’s really going on and deciding how best to name it for the purposes of prescribing treatment”).

Further complicating the diagnostic process is the likelihood that educators and clinicians view children’s behaviors through different lenses, some looking primarily at language and cognitive (thinking) skills, and others attending first to social and behavioral concerns. Most professionals seem to agree that these two groups differ in severity, with Asperger’s Syndrome generally showing more severe impairment than NVLD.

That said, the degree of severity in both disorders can range from mild to severe. Children with AS have been described as having “a dash of autism,” and some say that AS is the same as “high functioning autism,” while others are more prone to making a connection to NVLD.

It should also be said that teasing apart AS and NVLD is complicated by the fact that there is no single battery of tests or uniform profile for either of these disorders. NVLD is often difficult to recognize, and children with NVLD are sometimes unfortunately mislabeled as being lazy or unmotivated.

Some of the characteristics of NVLD, such as problems with organization, motor planning, problem solving, and social adaptation, are also present in children with AS. And while both children with AS and NVLD demonstrate areas of significant weakness, they may also have specific areas of incredible talent (this being particularly true for children with AS).

Some Basics on Asperger’s Syndrome

Asperger’s Syndrome is a developmental disorder that affects a child’s ability to socialize and communicate effectively with others. Children with Asperger’s Syndrome exhibit social awkwardness and problems with communication and social skills. AS is one of a number of conditions that fall along the autistic spectrum, with AS at the milder end, and severe autism at the other.

It has been estimated that two out of every 10,000 children has Asperger’s, and boys are three to four times as likely as girls to have the disorder.

Perhaps the most striking feature of this disorder is an all-absorbing (at times obsessive) interest in specific topics. Children with AS typically gather enormous amounts of information about their favorite subjects and seize every opportunity to learn more and talk about them, incessantly if given an audience.

The conversation they generate about these topics may at times seem like a random collection of facts or statistics, with no point or conclusion, and their uncanny expertise is often shared in extraordinary detail, in advanced grammar and with rich vocabulary.

Sometimes called “little professors,” they communicate with a serious and formal demeanor, and their speech patterns often lack rhythm so their conversations have odd inflections and sometimes are either too soft or too loud for the setting.

Children with AS have trouble reading social cues and recognizing other people’s feelings. They tend to be very literal and have trouble understanding nonverbal cues. They may also exhibit strange movements or mannerisms, or have problems with motor skills (e.g., learning to ride a bike, swinging a bat, or catching a ball). Together these qualities can make it extremely difficult for them to make friends.

Other symptoms of Asperger’s Syndrome may include:
  • Obsessive or repetitive routines and rituals;Clumsy or uncoordinated movements;
  • Pronounced sensitivity to sensory information, such as light, sound, texture and taste;
  • Noticeably high levels of restlessness or over-activity in early childhood, which might lead to anxiety or depression in young adulthood; and,

More About Asperger’s Syndrome

By definition, children with AS are of average to above-average intelligence, and some (not all) demonstrate truly extraordinary pockets of skill and knowledge. While they are often able to “fit in” to their peer group because of their intelligence, they struggle because of their social naivete and are often viewed as being eccentric or odd and are therefore frequently considered an easy target for teasing and bullying.

Also noted about children with AS are tendencies to turn away from a person while speaking to them (gaze avoidance) rather than face a person and to not know how to initiate or sustain conversation in a relaxed and socially-inviting and reciprocal (“taking turns”) manner.

If one was to compare AS to autism and more severe disorders on the autistic spectrum, one would find that in AS:
  • The onset of symptoms is usually later (autism is almost always apparent before age two, while the signs of AS can be subtle and in some cases remain undiagnosed throughout the elementary school grades);
  • Overall outcomes for children with AS are generally more positive, meaning that they often benefit from special education and behavioral therapies in ways that make it possible for them to marry and care for children, sustain independent social relationships and engage in competitive employment;
  • Social and communication deficits are less severe;
  • Verbal abilities are usually more highly developed than performance abilities (in autism, the case is usually the reverse);
  • A family history of AS, or similar types of disorder, and;
  • Fewer co-occurring neurological disorders are also present.

A Life-long Challenge

As is the case with LD, Asperger’s Syndrome is not something that is outgrown or that disappears over time. But like LD, many of the challenges faced by individuals with AS can be lessened and even overcome given specific types of therapy. Carefully designed programs of remediation and support that focus on teaching social and pragmatic skills have been shown to be effective, and anxiety and features of Obsessive Compulsive Disorder can often be treated with a combination of medical intervention and therapeutic support.

Additional Resources
  • The National Institute of Neurological Disorders and Stroke (NINDS) is a government-funded program that supports research and publishes resources on Asperger’s Syndrome and other neurological disorders. See this fact sheet on AS for a history of the disorder, an overview of diagnostic criteria, and a listing of organizations that focus on providing information and support on AS.
  • The National Institute of Child Health and Human Development (NICHD) is another government agency that was initially established to investigate the broad aspects of human development as a means of understanding developmental disabilities. The NICHD conducts and supports research on all stages of human development, from preconception to adulthood, to better understand the health of children, adults, families and communities.
  • MAAP offers services for Autism and Asperger’s Syndrome.  A wide range of valuable information on Asperger’s Syndrome, Autism and Pervasive Developmental Disorder can be found on their web site.
  • The Autism Society of America (ASA) is a formative resource for the autism community in supporting education, advocacy, services, research and support. They offer information about autism spectrum disorders (including Asperger’s Syndrome) for educators and families, and maintain a network of chapters, members and supporters who can seek help and share their journey via the web site.
  • Genius May Be an Abnormality: Educating Students with Asperger’s Syndrome, or High Functioning Autism is an article written by Dr. Temple Grandin, a faculty member at Colorado State University and a well-known and highly accomplished person who is living with an autistic spectrum disorder.


Sheldon H. Horowitz, Ed.D. is the Director of LD Resources amd Essential Information at the National Center for Learning Disabilities.

Monday, December 23, 2013

The Aspire Internship Program

The Aspire Internship Program helps young adults with Asperger’s Syndrome and related Autism Spectrum Disorders learn the skills needed, and required, to be successful at work.

Through strategic employer partnerships across the metro Boston area, we offer a 9-week (unpaid) and 17-week (paid) internship and, education and skill-building in areas of: social competency, self-awareness and stress-management.

Program Highlights
  • Our highly trained and experienced staff offer on‐site training to management teams and departments on how to help interns thrive and succeed in the workplace.
  • We provide a professional job and performance coach at each site to support an intern’s transition into the work environment. Additionally, our coaches provide any needed on‐going support to supervisors and other staff.
  • We provide weekly seminars for all interns. This is designed to help reinforce optimal work performance.
A Typical 17-Week Internship Schedule
  • 2-day seminar prior to start of internship
  • 3-day work week, up to 24 hours/week
  • 2-hour weekly group seminar at our Wellesley, Charlestown or Lexington offices

What our interns are saying about the program:

Liberty Mutual intern – Accounting Representative: "My personal goal is to have a positive work experience for myself while contributing to the company and the people I work with, and successfully sharing my skills to benefit the team. I thank Aspire so much for giving me this opportunity."

Mass. General Hospital Physician’s Organization intern - IT Special Projects: "This internship program has helped me learn how to work in a professional environment and practice my skills in a meaningful way. This is a great option for people looking to join the world of work and earn a living."

To learn more about our program, go to:
Contact: Marci Shaffer
                     Manager of Career Development
                     Young Adult Internship Program
                     Email: mshaffer2@partners.org
                     Main Aspire office: (617) 726-0060

Identifying ADHD and LD Problem Situations

From NCLD.org
The National Center for Learning Disabilities

By Erik von Hahn, M.D.
December 20, 2013

As a developmental-behavioral pediatrician, I see children with a wide range of disabilities. When I first meet with a family, I always ask the parents what they hope to gain from their visit with me.

One of the most common questions parents ask is, “What does my child have?”

This question is understandable, because treatments and services are based on a child’s diagnosis. The disorder is usually the focus of the health care and educational systems.

While it is my job to provide a diagnosis, I always tell parents that the diagnosis isn’t necessarily the most important question to answer. I believe the more important question is: “What situations does my child struggle with?”

Another way to state this is to ask: What is my child unable to do successfully, and how can I help him improve his performance?

One reason why I focus on a child’s problem situations, rather than on a diagnosis, is that a diagnosis alone can be confusing. Most children don’t clearly display classic symptoms of only one disorder; they tend to have symptoms or behaviors that occur with more than one disorder. The symptom overlap between learning disabilities (LD) and Attention-Deficit/Hyperactivity Disorder (ADHD) is a good example.

Both conditions cause children to struggle in similar problem situations. Another reason why I focus on problem situations is because I find it to be therapeutically much more useful. The management or treatment of LD and ADHD are very similar.

Symptoms and Problem Situations Common to ADHD and LD

ADHD and LD are two common conditions that affect children’s learning and behavior at home and school. ADHD shows up as hyperactive behavior, distractibility, forgetfulness and poor organizational skills. LD plays out as slow (or lack of) progress in basic academic skills (reading, writing and math). However, many students with ADHD also have learning problems. Similarly, students with LD can be hyperactive, forgetful, easily distracted and disorganized. How can you distinguish between the two?

There is no clear-cut way to distinguish between them. Even if a child doesn’t have both conditions, the overlapping symptoms make it confusing, because:
  • A student with LD shows symptoms of ADHD because of learning fatigue, resistance to academic tasks or inability to do academic tasks.
  • A student with ADHD shows signs of LD because his inattention and poor organizational skills interfere with learning.

Identifying “Problem Situations” Can Lead to a Diagnosis

A professional who is familiar with both LD and ADHD can make an accurate diagnosis for each disorder, but most professionals are trained to diagnose only one or the other. ADHD is diagnosed by physicians, while LD is identified by educational specialists. In order to understand and fully address all of the symptoms of each disorder, a proper evaluation for both is required.

However, even when a comprehensive evaluation is completed, many parents remain unsure about what they are supposed to do. The answer lies in identifying the child’s problem situations, and then addressing each of those in turn. In fact, parents can start to identify problem situations even before a professional makes a formal diagnosis.

How to Identify Problem Situations

Think about all of the demands placed on your child: the daily routine, learning and performing at school and social interactions. Then consider how often you have to remind or correct your child in each of these areas—and how often you come into conflict as a result. When you think about these factors, you’ll be able to identify your child’s problem situations, such as:

1.) Getting ready for school. Can your child get dressed, brush teeth and hair, and get out of the house on time for school?

2.) Organizing the backpack. Can your child remember all of the items that he or she needs for school, and make sure they are in the backpack?

3.) Making sure necessary belongings and school materials are taken to and from school. Does your child remember to bring everything home from school that is needed for homework? Does he or she take books, projects, and homework back to school?

4.) Tasks and chores around the house. Can your child do a quick clean-up routine and pick up the bedroom?

5.) Homework. Does your child resist doing homework or do it in a sloppy manner? Or does your child seem incapable of doing homework at all?

6.) Learning in the classroom. Does the teacher think your child is able to learn successfully? How does your child's performance compare with that of his or her peers?

7.) Socializing and making friends. Is your child invited to birthday parties and play dates? Does your child have the capacity to take turns and follow rules in a game? Can he or she let friends decide what they'll play together instead of always insisting on having his or her way?

Seeing the Doctor if You Think Your Child May Have LD or ADHD

Gathering the information above and taking it to your child's doctor will help him or her make diagnostic and referral decisions that much sooner. Learn about strategies parents find helpful in managing children’s problem situations—regardless of the diagnosis.


Erik von Hahn, M.D. is a Developmental-Behavioral Pediatrician. He works at the Floating Hospital for Children of Tufts Medical Center, and is assistant professor of pediatrics at the Tufts University School of Medicine. He sees children with diverse disabilities in a clinic setting, and consults with school districts. He has a special interest in promoting collaboration between hospital clinics and schools.