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ADHD

Children with Learning Disabilities

Parents are often worried when their child has learning problems in school. There
are many reasons for school failure, but a common one is a specific learning disability.
Children with learning disabilities can have intelligence in the normal range but the specific learning disability may make teachers and parents concerned about their general intelligence. Often, these children try very hard to follow instructions, concentrate, and and be good at home and in school. Yet, despite this effort, he or she is not mastering school tasks and falls behind. Learning disabilities affect at least 1 in 10 schoolchildren.

It is believed that learning disabilities are caused by a difficulty with the nervous system that affects receiving, processing, or communicating information. They may also run in families. Some children with learning disabilities are also hyperactive; unable to sit still, easily distracted, and have a short attention span.
Child and adolescent psychiatrists are aware that some of the long range consequence of learning disabilities can be lessened with early intervention. However, if not detected and treated early, they can have a “snowballing” effect. For instance, a child who does not learn addition in elementary school cannot understand algebra in high school. The child, trying very hard to learn, becomes more and more frustrated, and develops emotional problems such as low self-esteem in the face of repeated failure. Some learning disabled children misbehave in school because they would rather be seen as “bad” than as “stupid”.

Frequent signals of learning disabilities, that parents should watch for in their child included the following:

  • has difficulty understanding and following instructions.
  • has trouble remembering what someone just told him or her.
  • fails to master reading, spelling, writing, and/or math skills, and thus fails schoolwork.
  • has difficulty distinguishing right from left; difficulty identifying words or a tendency to reverse letters, words, or numbers; (for example, confusing 25 with 52, “b” with “d,” or “on” with “no”).
  • lacks coordination in walking, sports, or small activities such as holding a pencil or tying a shoelace.
  • easily loses or misplaces homework, schoolbooks, or other items.
  • difficulty understanding the concept of time; is confused by “yesterday,” “today,” “tomorrow.”

Generally, an important first step is to understand the child’s learning difficulties and consider how they will affect their communication, self help skill, willingness to accept discipline, impact on play, and capacity for independence.
Such problems deserve a comprehensive evaluation by an expert who can assess all of the different issues affecting the child. A child and adolescent psychiatrist can help coordinate the evaluation, and work with school professionals and others to have the
evaluation and educational testing done to clarify if a learning disability exists. This includes talking with the child and family, evaluating their situation, reviewing the educational testing, and consulting with the school. The child and adolescent psychiatrist
will then make recommendations on appropriate school placement, the need for special help such as special educational services or speech-language therapy and help parents assist their child in maximizing his or her learning potential. Sometimes individual or
family psychotherapy will be recommended. Medication may be prescribed for hyperactivity or distractibility. Parents need to consider the delicate balance between providing too much or too little assistance to their child to help them meet their educational goals. It is important to strengthen the child’s self-confidence, so vital for healthy development, and also help parents and other family members better understand and cope with the realities of living with a child with learning disabilities.

For additional information see Facts for Families: #6 Children Who Can’t Pay Attention, #7 Children Who Won’t Go to School, and #33 Conduct Disorder. See also: Your Child (1998 Harper Collins)/Your Adolescent (1999 Harper Collins).


Children Who Can’t Pay Attention/ADHD

Parents are distressed when they receive a note from school saying that their child “won’t listen to the teacher” or “causes trouble in class.” One possible reason for this kind of behavior is Attention-Deficit Hyperactivity Disorder (ADHD).

Even though the child with ADHD often wants to be a good student, the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems. Teachers, parents, and friends know that the child is “misbehaving” or
“different” but they may not be able to tell exactly what is wrong.

Any child may show inattention, distractibility, impulsivity, or hyperactivity at times, but the child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level. ADHD occurs in 3-5% of school age children. ADHD must begin before the age of seven and it can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition.
A child with ADHD often shows some of the following:

  • trouble paying attention
  • impatience
  • inattention to details and makes careless mistakes
  • fidgets or squirms
  • easily distracted
  • leaves seat and runs about or climbs excessively
  • loses school supplies, forgets to turn in homework
  • seems “on the go”
  • trouble finishing class work and homework
  • talks too much and has difficulty playing quietly
  • trouble listening
  • interrupts or intrudes on others
  • trouble following multiple adult commands
  • blurts out answers

There are three types of ADHD. Some people have only difficulty with attention and organization. This is also sometimes called Attention Deficit Disorder or ADD. This is ADHD inattentive subtype. Other people have only the hyperactive and impulse symptoms. This is ADHD – hyperactive subtype. The third, and most commonly identified group consists of those people who have difficulties with attention and hyperactivity, or the combined type.

A child presenting with ADHD symptoms must have a comprehensive evaluation. Parent should ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat this medical condition. A child with ADHD may have other psychiatric disorders such as conduct disorder, anxiety disorder, depressive disorder, or manic-depressive disorder. These children may also have learning disabilities.

Without proper treatment, the child may fall behind in schoolwork, and friendships may suffer. The child experiences more failure
– than success and is criticized by teachers and family who do not recognize a health problem.
Research clearly demonstrates that medication can be help improve attention, focus, goal directed behavior, and organizational skills. Medications most likely to be helpful include the stimulants (various methylphenidate and amphetamine preparations) and the non -stimulant, atomoxetine. Other medications such as guanfacine, clonidine, and some antidepressants may also be helpful.

Other treatment approaches may include cognitive-behavioral therapy, social skills training, parent education, and modifications to the child’s education program. Behavioral therapy can help a child control aggression, modulate social behavior, and be
more productive. Cognitive therapy can help a child build self esteem, reduce negative thoughts, and improve problem solving skills. Parents can learn management skills such as issuing instructions one step at a time rather than issuing multiple requests at once. Education modifications can address ADHD symptoms along with any coexisting learning disabilities.

A child who is diagnosed with ADHD and treated appropriately can have a productive and successful life.

For additional information see Facts for Families: #16 Learning Disabilities, #33 Conduct Disorders, #38 Manic-Depressive Illness
in Teens, #51 Questions to Ask about Psychiatric Medications for Children and Adolescents, and #52 Comprehensive Psychiatric Evaluation. See Also: Your Child (1998 Harper Collins)/Your Adolescent (1999 Harper Collins).

The Development of the Facts for Families series is a public service of the AACAP. If you would like to support expanded distribution of the series, please make a tax deductible contribution to the AACAP Campaign for America’s Kids. By supporting this endeavor, you will support a comprehensive and sustained advocacy effort on behalf of children and adolescents with mental illnesses.

Please make checks payable to AACAP, and send to: AACAP, Campaign for America’s Kids, P.O. Box 96106, Washington, D.C. 20090

The American Academy of Child and Adolescent Psychiatry (AACAP) represents over 6,000 child and adolescent psychiatrists who are physicians with at least five years of additional training beyond medical school in general (adult) and child and adolescent psychiatry.

Facts for Families is developed and distributed by the American Academy of Child and Adolescent Psychiatry (AACAP). Facts sheets may be reproduced for personal or educational use without written permission, but cannot be included in material presented for sale. To purchase full sets of FFF, contact the AACAP Publications Clerk at: 1.800.333.7636, ext. 131.

Nelson A. Tejada, American Academy of Child & Adolescent Psychiatry, Operations Department, Phone: 202-966-7300 ext. 131, Main Fax: 202-966-2891, Publication Fax: 202-464-9980

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