According to an article in Medical News Today (http://www.medicalnewstoday.com/), the National Academy of Science reports,

Three percent of neurobehavioral disorders in children, such as autism spectrum disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), are caused by toxic exposures in the environment and another 25 percent are caused by interactions between environmental factors and genetics. But the precise environmental causes are not yet known. While genetic research has demonstrated that ASD and certain other neurodevelopmental disorders have a strong hereditary component, many believe that environmental causes may also play a role…”

Topping the list of toxins researchers suspect may contribute to autism and learning disabilities—which therefore should be studied more—are the following chemicals commonly found in many consumer products such as fish, pesticides, textiles, home furnishings, and food packaging:

1. Lead
2. Methylmercury
3. PCBs
4. Organophosphate pesticides
5. Organochlorine pesticides
6. Endocrine disruptors
7. Automotive exhaust
8. Polycyclic aromatic hydrocarbons
9. Brominated flame retardants
10. Perfluorinated compounds

The editorial calls for a research strategy that focuses on these chemicals in order to discover potentially preventable environmental risks for neurobehaviorial disorders.

To learn more see The Top 10 Toxic Chemicals Suspected Of Causing Autism And Learning Disabilities (http://www.medicalnewstoday.com/releases/244622.php)

In 4 Common-Sense Proposals for Special Education Reform, Miriam Freedman makes the case that The Individuals with Disabilities Education Act (IDEA) has righted the wrong it was intended to remedy and now is in need of a major overhaul “to address its unintended consequences.”

And what are those unintended consequences? According to Freedman, a Boston attorney and author of Fixing Special Education—12 Steps to Transform a Broken System, the list is long and varied, ranging from excessive costs and over-regulation to implementation barriers and an adversarial rather than collaborative model for solving problems. Freedman’s suggestions for improving Special Education include the following:

At the very least, schools and parents should have more flexibility to work together collaboratively in the spirit of the 1975 law. Here are four common-sense proposals:

• Focus on improving regular education for all students. The better that regular education is, the fewer students need to be identified for special education services. When developing inclusive programs, schools should base them on effective teaching practices that improve educational outcomes for both students with disabilities and regular education students. As part of this mission, align IDEA and NCLB to end confusion.

• Work to end the “medical model” in which IDEA eligibility for services requires a specialist’s diagnosis. This model is costly, problematic, and inexact. It often kicks in too late, after previously undiagnosed students have struggled and failed. The far better solution is to provide timely and appropriate education services for all students in our schools, based on their current performance, without the need for a diagnosis or label.

• End the compliance-based approach to special education. Parents and teachers alike should be liberated from endless form-filling and meetings. Compliance does not improve student results. Only time on task — in classrooms—does.

• End the adversarial approach of “private enforcement” by parents and use other dispute resolution models, such as via mediators and ombudsmen or federal and state enforcement mechanisms that encourage trust-building and collaboration between schools and parents.

Read the full article in The Atlantic and tell us what you think of Freedman’s proposals.

Levine has partnered with the pharmaceutical company Shire to launch “The Own It Project,” an effort to encourage adults with ADHD to take responsibility for their attention issues and share their stories with others.

Those wishing to participate in the project can submit their story about when they knew they needed to own their ADHD. Participants are entered into a national contest with a chance to win prizes along with the opportunity to be the next “Own It” campaign spokesperson. In addition to receiving an autographed guitar from Levine, the winner will be able to choose between two prize packages, one focusing on technology and the other built around professional appearance. Both packages include sessions with an ADHD coach.

“The Own It Project,” says Levine, “is important because it encourages adults, like me, who are owning their ADHD, to become advocates and tell their story. I hope that this effort will help people realize the importance of owning their ADHD.”

Submissions must be sent to OwnItProject.com by June 6, 2012.

Led by OHSU scientists Damien Fair, Ph.D., assistant professor of behavioral neuroscience, psychiatry, and the Advanced Imaging Research Center; and Joel Nigg, Ph.D., professor of psychiatry, behavioral neuroscience and pediatrics, the recently completed study suggests that ADHD is similar to cancer in that there are many different subtypes.

To reach their conclusions, the research team measured a number of cognitive skills (e.g. memory, inhibition, attention, comprehension, etc.) in a large sample of ADHD patients and a control group. The results, which are published in Proceedings of the National Academy of Sciences, were reported in Medical News Today (MNT).

Key Findings

In essence the researchers found a wide variation in both the ADHD and control groups; neither group consistently was found to have the same strengths and weaknesses. In addition, according to MNT, the findings showed “that ADHD patients can be subcategorized depending on their deficits and relative strengths, showing unique subgroups among all children with ADHD.” Dr. Fear explained the implications:

Traditionally, physicians and psychologists have diagnosed patients through the use of the Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM.

The problem with this approach is that it often relies on secondary observations of parents or teachers, where even if the descriptions are accurate, any given child may be behaving similarly, but for different reasons. Just as if there might be many reasons why someone might have chest pain, there might be many reasons why a child presents with ADHD. However, unlike diagnosing countless other well-understood diseases, there is no one test that can differentiate individuals when it comes to psychiatric and developmental conditions like ADHD. The data here highlights ways to recognize such individual variability and shows promise that we might be able to identify why any given child presents with ADHD, thus allowing for future examinations of more personalized treatments.

Based on this and future research, those who evaluate patients for ADHD may soon be able to replace observation with a battery of cognitive tests, which will allow them to determine strengths and weaknesses of their patients, categorize them accordingly, and tailor treatments for various subcategories.  

Writing in The New York Times, Kate Murphy notes:

Many children are given a diagnosis of ADHD researchers say, when in fact they have another problem: a sleep disorder, like sleep apnea. The confusion may account for a significant number of ADHD cases in children, and the drugs used to treat them may only be exacerbating the problem.

Citing a new study published recently in the journal Pediatrics, researchers found that children who had sleep issues due to apnea or common breathing problems such as snoring and mouth breathing were “40% to 100% more likely than normal breathers to develop behavioral problems resembling ADHD.”

A Little Deprivation Can Be Problematic

According to sleep experts, it doesn’t take much sleep loss for children to manifest behaviors associated with ADHD. Just one half hour less per night can have a detrimental effect on behavior—regardless of whether the loss is due to a sleep disorder or simply staying up too late watching TV or playing video games.

Having a correct diagnosis is fundamental to proper treatment. Children with sleep problems who are mistakenly treated with stimulant medication because they have been misdiagnosed with ADHD are at risk for even greater sleeplessness. When used improperly, ADHD medications can cause insomnia, thus exacerbating the problem.

Sleep Smarts

With so much at stake, both parents and doctors must learn more about the signs and symptoms of sleep problems and how to differentiate them from behavioral issues such as ADHD. In her article, Attention Problems May Be Sleep-Related Murphy points out that, “Of the 10,000 members of the American Academy of Sleep Medicine, only 500 have specialty training in pediatric sleep issues.” That leaves doctors to rely on parent reports of sleep concerns, which also may not be forthcoming. Adds Murphy:

Parents themselves often are uninformed about healthy sleep habits. A study conducted last year by researchers at Penn State University-Harrisburg and published in The Journal of Sleep Research showed that of 170 participating parents, fewer than 10 percent could correctly answer basic questions like the number of hours of sleep a child needs.

Sleep Recommendations

The National Sleep Foundation offers the following guidelines:

AGE                                                SLEEP NEEDS

Newborns (0-2 mos.)                    12-18 hrs.
Infants (3-11 mos.)                        14-15 hrs.
Toddlers (1-3 yrs.)                         12-14 hrs.
Preschoolers (3-5 yrs.)                  11-13 hrs.
School-Age (5-10 yrs.)                  10-11 hrs.
Teens (10-17 yrs.)                          8.5-9.5 hrs.
Adults                                              7-9 hrs.

This is one of several new policies instituted nationwide in response to a cheating scandal that was uncovered last year in Nassau County, NY. Twenty teens were arrested for taking part in a scheme where students paid others to take the SAT or ACT exam for them.

Fittingly, the new security measures were announced in Nassau County in late March. At the press conference were representatives from the ACT and the College Board, which runs the SAT in conjunction with the Educational Testing Service. Also on hand was Nassau County District Attorney Kathleen M. Rice who said:

“These reforms close a gaping hole in standardized test security that allowed students to cheat and steal admissions offers and scholarship money from kids who played by the rules. Millions of college-bound students who take the SAT and ACT each year should have renewed confidence that honest applicants will not take a back seat to cheaters, and that those who cheat will be caught.”

In other efforts to thwart cheating, registrants will be required to provide their gender and list their high school when they sign up. In addition, on-site registration (where students sign up the day of the test) will no longer be allowed.

More Cases or Greater Awareness?

Does the dramatic increase in ADHD diagnoses mean that the condition is more prevalent than it used to be? Probably not, says Dr. Craig Garfield, Assistant Professor of Pediatrics and Medical Social Sciences at Northwestern University and the lead author of the study. “The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD, which may have caused more physicians to recognize symptoms and diagnose the disorder.” The authors suggest that public awareness campaigns coupled with media coverage and advertisements for ADHD medications played a role in making both parents and physicians more aware of the problem.

Other Findings

The study also found that the number of children being treated for ADHD by child psychiatrists was growing at the expense of treatment by pediatricians. At the onset of the study about 25% of children were seen by psychiatrists; by the end of the study the number rose to 33%.

Finally, results of the study showed that stimulant medications remain the most common treatment for ADHD, although their use has declined from 96% of patients in 2000 to 87% by the end of the study period.

To learn more see Trends in Attention Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000–2010.

Related Smart Kids Links

Signs & Symptoms of ADHD

Evaluating Your Child for ADHD

Medications for ADHD

Ensuring that your child with learning disabilities has a successful camp experience may take an extra measure of planning. It begins with both you and she establishing a clear understanding of what she wants to get out of the camp experience. The best way to get at that is through an open and honest discussion about her needs, wants, wishes, and worries.

Once you’ve settled on goals for the camp experience, you then must evaluate options most available to meet those goals—and they are many, from simple day camps to summer-long, specialized camps. In Summer Camp Guidelines for Kids with LD and ADHD we provide useful information to help you navigate your choices to find the best setting for your child socially, emotionally, and behaviorally. The effort you put in up front will serve your child well.

For more age-specific guidelines for Kids with LD and ADHD, see:

Camp Guidelines for Elementary Kids

Camp Guidelines for Middle School Kids

Camp Guidelines for High School Kids

For parents of teens with ADHD—and those who share the highways and byways with them—that’s a worrisome statistic.

The mix of inexperience, inattention, and impulsiveness is a potent cocktail for those who get behind the wheel.

“It’s a bad combination,” explained Dr. Barkley, who also noted that many drivers with ADHD overestimate their driving skills. “They’re more prone to crashes because of inattention; the reason their crashes are so much worse is because they’re so often speeding.”

Preventing Problems

Experts agree that teens with ADHD can become safe drivers, but the process of getting there is likely to be slower and more challenging than it is for their peers without attention issues.

Some suggest teens with ADHD may be better off postponing driving. “If I were a parent of an ADHD or other special-needs kid, my goal would be to delay licensing,” said Dr. Bruce Simons-Morton, senior investigator at the National Institute for Child Health and Human Development.

“They mature, they accommodate to their deficits, and they’re more likely to take medication.”

Medication seems to play an important role. A number of studies have found that ADHD medications that focus attention can reduce the risk of accidents. In fact, Dr. Barkley maintains that medication should not be optional and he further encourages the use of extended-release formulations that work into the night hours when most accidents occur.

Other experts focus on maturity as an important indicator. As stated in the article, “If a teenager with ADHD is showing consistent poor judgment or has earned only limited independence, he may not be ready. Behavioral problems can be a red flag, regardless of whether they have to do with driving.” Adds pediatrician Dr. Patty Huang, “If your kid is that oppositional and defiant, she shouldn’t be driving.”

Other helpful strategies include hiring a professional driving instructor, allowing for an extended learning period, close parental monitoring after the license has been obtained, and forbidding the use of cellphones.

To learn more, read the full article Learning to Drive with ADHD.

Related Smart Kids Link

Driving Under the Influence of ADHD