Back to school with ADHD

[David Baxter PhD]

Back to School With ADHD
August 3, 2004
By Martin Downs

New teachers, new subjects, new routines -- going back to school after the summer break can be taxing on any child, but it's often especially so for kids with ADHD. Parents who are mindful of this can do something to make the transition as smooth as possible.

First, give teachers the information they need to help your child have a good school year. They probably have had kids with ADHD in class before, but don't assume they know what it takes for your child to succeed.

"What may work really well for one ADHD kid may not work well for another, so it's important that parents do more than just say, 'my kid has ADHD,'" says Stephen Brock, PhD, a spokesman for the National Association of School Psychologists and an associate professor of psychology at California State University, Sacramento.

It's also best not to wait until the first day of school to address your child's needs. If you've already drawn up a 504 plan, or if your child has an Individual Education Plan (IEP), that simplifies things somewhat. Otherwise, write a letter to the teacher, and either mail it or deliver it personally before classes begin. Start the process for getting these plans in place for your child. Each is designed to create a program of instructional services to assist students with special needs who are in a regular education setting.

In the letter, detail your child's unique circumstances, including:

• Characteristics of the ADHD
• How he or she is being treated -- behavior plans and medications
• Whether the child will need to leave the classroom to take medications
• Who participates in the treatment (pediatrician, mental health professional)
• Specific strategies that have worked in the past
• What has not worked, and what causes problems
• Whether assignments or test situations need modifications[/list:u]
  It helps to let the child write a letter, too, says Stephen Kurtz, PhD, clinical coordinator of the Institute for Attention Deficit Hyperactivity and Behavior Disorders at the New York University Child Study Center. "Kids find it a very empowering experience," he says. "It helps them feel like individuals, not cases that need to be dealt with.
  
  "It also accomplishes the goal of destigmatizing the condition," Kurtz says.
  
  Elementary students typically have one teacher throughout the day, but those in junior high or high school have several, which can complicate the matter. "The parent of the middle or high school-aged student with ADHD should be in contact with the school counselor and/or school psychologist," Brock says. That person will then take your concerns to all the educators your child will be seeing daily.
  
  Expect teachers to be happy to hear your advice. "I've never had a teacher give the impression to the family that it was an encumbrance," Kurtz says.
  
  Back to School, Back on Meds
  If your child has been off ADHD medication during the summer break, he or she can go back on it at any time. Stimulant drugs such as Ritalin don't need time to build up in the system over days or weeks; they're effective immediately. "You can go from nothing today to full dosing tomorrow," Kurtz says.
  
  It's hard to say how soon your child should go back on medication before the school bell rings. Again, every child is different, and some doctors might say there's no time like the present. Kurtz, for one, isn't sure that kids should take a vacation from their meds during the summer. He says that children with ADHD should continuously take their medications.
  
  He points to the latest findings of a long-term National Institute of Mental Health study, appearing in the April 2004 issue of Pediatrics, which shows that kids' behavior problems tend to return when they stop taking medication.
  
  The same study, however, also showed that constant use of ADHD drugs appears to slightly, but measurably, stunt children's growth.
  
  "I think that part of what's important is ensuring that the child has a good summer experience," says Steve Adelsheim, MD, an associate professor of psychiatry at the University of New Mexico Health Sciences Center and co-chair of the schools committee of the American Academy of Child and Adolescent Psychiatry.
  
  If both the parents and the child feel that everything is going well "it's not clear that the medication necessarily has to be part of the equation," he says. "If those things are not happening without medication, then I think it's a different discussion."
  
  At Home and After School
  Some simple changes at home can help make the transition from carefree summer days to knuckling down at school less jarring.
  
  If you have allowed your child to stay up and sleep in late, that needs to change when the school bus starts coming at 7 a.m. Kurtz recommends gradually phasing in a new bedtime about two weeks before school starts. "One of the things that ADHD kids are vulnerable to is a poor sleep routine," he says.
  
  You could also reacquaint your child with studying by assigning some daily reading, or by reviewing some of last year's lessons.
  
  "It's the same advice we give to parents of nonimpaired kids, only these kids really need it even more," Kurtz says.
  
  All kids, regardless of ADHD, are encouraged to participate in organized after-school activities, and your child may need the structure even more. But when choosing an activity, consider how ADHD might figure in.
  
  In baseball, for example, "you're sitting out there in right field; you're sitting there [during the entire] game, and all of a sudden one ball comes your way. And if you're not paying attention, it's going to be a bad scene," Brock says. "You don't want to set an ADHD kid up for failure, or put him or her in situations that require them to do things that are hard for them, like pay attention for long periods of time.
  
  "Team sports may not be, for at least some ADHD kids, the best option," he says. "Rather, parents may want to look towards more individual sports, such as swimming, dance, and karate."
  
  Kurtz says parents should not assume that because a child has ADHD, he or she needs to participate in a high-intensity physical activity in order to "blow off steam" after school. "It's kind of a commonly accepted notion that these kids have a lot of energy to burn, but it's really not supported scientifically," he says. "Within a given situation, they're fidgety because they have a hard time persisting at either boring or repetitive tasks. But after that task is over they have no more or less need to run around than the next kid."
  
  Remember that you may need to educate the coach or other supervising adult about your child's ADHD. "In the same way that we encourage a parent to prepare a teacher, we encourage a really active dialog with whoever they're going to be with in after-school and community situations," Kurtz says.
  
  But Adelsheim says parents shouldn't make an issue of it unless they think doing so is warranted. "You might have a child with ADHD whose behavior is totally under control, and no one even knows they have ADHD," he says. In that case, "you may not need to go through any of this."
  
  Adelsheim also cautions parents against developing tunnel vision concerning a child's ADHD. Kids with ADHD can have social problems in school just like any other kid; Kurtz points out social problems are not a primary part of the disorder. Depression, too, can manifest in ways that look like characteristics of ADHD.
  
  "A child with [ADHD] can also have other things going on that may be impacting them," Adelsheim says. "I think it's important to not just make assumptions about what's going on, or say, 'Oh, that's just their ADHD.'"