ADHD Diagnosis (and “Read”shirting)

 

“The ADHD Diagnosis Problem” appeared in the December 4, 2018 issue of The Wall Street Journal based on research that was reported in The New England Journal of Medicine last week. Children whose birthdays are in August have a 32% higher rate of ADHD diagnosis than those who are born in September in states in which the cutoff date for entering school is September 1. This is another example of the differences that exist, on average, between being one of the oldest and one of the youngest in class. In New York, the cutoff date for starting school is December 1. Children who are 4 years and 9 months old may be reading, but that does not mean that it is reasonable to expect all children to be reading at that age.

 

The article does not mention that there were similar findings a few years ago for ice hockey players in Canada. Looking at their date of birth was the best way to predict who would become an elite hockey player. The oldest had an advantage in the beginning and their success bred success. Learning to play ice hockey and learning in school are both dependent on a child’s developmental age which correlates with their chronological age. Instead of being ignored, it should be expected. Parents recognize this and redshirt their children for school and for sports. It should also be recognized that numerous factors make it difficult for children to catch-up; to start to learn faster or grow faster than others in their grade.

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Similar research was reported in the Journal of Child Psychology and Psychiatry in October which studied 13 countries. The same age correlation held in all the countries other than Denmark whose parents commonly delay their children’s entrance into school by one year. While the WSJ article is focused on the age of starting school, the critical message is that we need to pay more attention to child development. Expectations should not be structured on when we want children to have certain skills, but on when most children are ready. Children differ in their rates of development. Many children develop asynchronously. It used to be routine to assess  child development. It is now assumed that all children are the same or that the school can make them the same. If these are not the assumptions, what is the rationale? Children who naturally read early have advantages, but that doesn’t mean pushing children creates the same love of reading. It is more likely to have the opposite effect.

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Our focus is visual development, but vision does not develop in isolation and all areas of development are important; language, social skills, physical abilities, self-control, and focus. We see the effects of academic acceleration in the office. Most of the children with vision-related school problems who were brought into the office in the past were in third and fourth grade. Most of them are now in first or second grade. Many are in kindergarten because they are not reading and they are having difficulty with the visual motor control needed to write. Their parents, with similar skills at the same age, would have been judged OK. May the pendulum start to swing back towards an appreciation of child development.

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Here’s to the Value of Appropriate “READ“shirting!

New JAMA research shows reading problems linked to treatable vision problems

Understanding Motor Skills in Children with Dyspraxia, ADHD, Autism and other Learning Disabilities: A Guide to Improving Coordination

Becoming a Nation of Readers

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The Man He Became

 

How FDR Defied Polio to Win the Presidency

James Tobin

Franklin D. Roosevelt, seldom seen as a polio survivor, with Ruthie Bye and Fala, 1941

There are a few stories interwoven in this book. It starts with information about polio, immunity to polio, the change in the disease as hygiene changed, and postulates how Roosevelt contracted the disease. Continue reading

New JAMA research shows reading problems linked to treatable vision problems

The VisionHelp Blog

Eye Teaming…Tracking…Focusing

When speaking with parents about their child’s eye coordination instead of speaking about problems with vergence, accommodation and oculomotor function, terms that will automatically trigger a “deer in headlights” look, I’ve learned it is far better to refer to these essential visual skills as “teaming…tracking…focusing”.

These three eye coordination abilities are essential for reading fluency. Specifically, when referring to these visual functions, Eye “Teaming” is another way of saying we have two eyes and they must work together in what is known as binocular vision. The skill of using our binocular vision is referred to as “vergence” which is commonly thought of as convergence or divergence. When an individual has trouble with convergence they may demonstrate under convergence, known as convergence insufficiency, or over convergence known as convergence excess.

The vergence system also must work synergistically with eye “Focusing” otherwise known as  accommodation. When a child…

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The Neural Basis of Reading

Cornelissen, Hansen, Kringelbach, Pugh

The following clinical pearls should not be buried in a compilation of scientific papers. This knowledge should be applied to reading instruction. It can also help understand how the process is breaking down for some children.

Continue reading

Narrative Medicine

Narrative Medicine

In the October 6, 2018, Wall Street Journal, Suzanne O’Sullivan previews her new book, Brainstorm: Detective Stories from the World of Neurology. She explains how technology can deceive us with its wonderful images into thinking that it can provide all the answers. It does not. Continue reading