Written by Heidi Bernhardt R.N.
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What exactly is this new “quadmester” system?
Instead of two semesters there will be four semesters in this 2020/2021 school year in Ontario. Two subjects will be taken per semester with each semester lasting approximately ten weeks. Students may choose in school learning or remote learning before each quadmester. If students choose in- class learning versus complete remote learning, they will be in school for approximately 2.5 hours per day, two days out of five one week and three out of five the next week. After their in-class sessions they will be expected to complete their day learning online. The days of the week that they are not in school will be spent in online learning.
How might these changes impact our students with ADHD?
There may be a slight benefit for students with ADHD in this quadmester system because they will only need to focus on two courses at a time, rather than four. This means less juggling of multiple assignments, which is a challenge for many students with ADHD and executive functioning impairments. A more concentrated learning schedule will require a faster moving curriculum which depending on the student may be a benefit or drawback. Some students will find it difficult to keep pace requiring additional time to process and integrate new concepts. Others with ADHD who find classes too slow and boring may actually do better when classes move at a quicker pace. However, this faster pace will mean that if a student misses a day or two due to illness, they will most likely become overwhelmed fearing that they will never be able to catch up.
For most students with ADHD the expectation that they sit and listen to lecture style teaching for extended periods of time with minimal breaks will cause a problem. In addition, many of our students need to move frequently which will undoubtedly be even more restricted than usual. This will further reduce their attentional capabilities and may lead to more shifting of position, tapping, squirming etc., causing them to be unintentionally more disruptive. Also, the new schedule of moving from in-class learning to online learning at the end of the day and through the week will be difficult for students with ADHD. Consistency of routine is a necessity for those with ADHD.
Tips for students with ADHD and their parents on navigating this new quadmester system.
A post published by Mark Bertin M.D recently caught my eye for several reasons – one being the fact that Dr. Bertin will be one of our featured 2015 conference speakers, and another being his well-balanced multimodal approach to addressing ADHD, and his realization that the high levels of stress this disorder causes often drives the way families deal with ADHD.
Dr. Bertin begins with a genius analogy describing the fundamentals; the need for a strong foundation consisting of three pillars that has been proven to have significant impact on ADHD symptoms; school accommodations that recognize executive functioning impairments and; family supports and medical interventions.
Next steps would involve looking for ways to better things such as sleep, nutrition, exercise, communication, time management, safe driving and the excess time spent with electronic technology and media. Dr. Bertin concludes his analogy by talking the focus of his upcoming book, the use of mindfulness as a tool to help in “holding it all together”. If you have a child with ADHD who is struggling, or you are having difficulty functioning as a family with ADHD, this article may assist you in assessing where to start and how to build upon the successful management of ADHD as a family. Unfortunately while reading this article what came to my mind is the fact that in many parts of Canada it still remains difficult to access two of the supports that Dr. Bertin identifies as crucial: school accommodations and family support.
To view the Dr. Bertin’s entire post: https://www.psychologytoday.com/blog/child-development-central/201501/the-house-we-build-adhd
Recent studies out of the Karolinska Institute in Stockholm, Sweden found that people with ADHD have an increased risk of suicide. In addition, they also found an increased risk of suicide in the parents and siblings of people with ADHD.
http://www.livescience.com/46532-suicide-risk-adhd.html
This study is the first large scale study to show that ADHD and suicidal behaviour could share genetic risk factors. Researchers felt that the findings suggest that genetics may link ADHD and suicidal behaviour.
The study looked at national data for 52,000 patients with ADHD, about a third of whom also had another psychiatric disorder, as well as about 260,000 people without ADHD. The researchers found that, of the study participants without ADHD, 1.3 percent attempted suicide and 0.02 percent completed suicide. People with ADHD had a risk of 9.4 percent attempted suicide and 0.2 percent committed suicide. Parents and siblings of people with ADHD also had an increased risk of suicide, according to the study. The researchers found that 6.6 percent of the parents of people with ADHD attempted suicide, and 0.7 percent completed suicide. Among the siblings, 3.4 percent attempted suicide.
Even when researchers excluded data of people with multiple psychiatric disorders numbers remained well above the norm for people without ADHD.
An additional study found that medication to treat ADHD did not increase suicide attempts or completed suicides and may actually be protective.
In this study 38,000 people in Sweden diagnosed with ADHD between 1960 and 1996.
Experts in the field stated that this was a very well designed study because it was very large and because it tracked suicidal behaviours when individuals were either on or off the medications.
http://www.nlm.nih.gov/medlineplus/news/fullstory_146919.html
I recently came across an article that nicely summed up things parents should consider when deciding on ADHD medication treatment: linked here.
The article listed five things to parents should consider when making the decision, the first being a thorough medical evaluation by a trusted expert in the field of ADHD. For a description of what is involved in a thorough ADHD assessment access Diagnosing ADHD on the CADDAC Website. For further reading, access Assessment and Diagnosis for Children and Adolescents.
Once you are assured that your child has ADHD, your next step would be to ask yourself what is your desired outcome. How will it benefit your child? I would add that your expectations of medication treatment should be realistic. The symptoms that you would like to target should actually be something that medication will assist.
You will then need to consider all side effects; not just those of medication treatment, but also symptoms of untreated ADHD. Also consider that the decision to try medication as a treatment is not a permanent decision. Most ADHD medication may be started and stopped quickly or used only when required.
Finally, remember that this is not a decision that must be made quickly or under pressure. Other treatments, such as school accommodations and parenting strategies, should be tried initially. Medication treatment can always be added at a later date if necessary.
On the other hand, it may become evident very quickly that many things have been tried unsuccessfully in the past and the child is in significant distress. In this case, a medication trial may be initiated immediately. Also you should be aware that it may actually take some time to find the right medication and the right dose.
Medical professionals make a treatment decision by assessing benefit /risk ratio and so should you. What are the potential benefits to your child and what are the potential risks? While assessing these, make sure that you are relying on proper medical research that has been peer-reviewed and duplicated on a large scale, not anecdotal stories on the Internet.
An interesting article called "The Smart Pill Oversell" was just published in the latest issue of the online publication Nature International Weekly Journal of Science. Unlike much of what has come out in lately in the media, this article is more balanced; offering a variety of opinions and some interesting points of discussion.
The majority of current studies indicate that medication treatment alone does not improve long term academic performance. ADHD and how it impacts learning is very complex, so why would we expect that medication alone would solve these complex impairments, especially those of executive functioning? This is why multimodal treatment for ADHD: including learning strategies, behaviour strategies, therapy, coaching, and so forth is recommended.
Unfortunately, many forms of treatment are often difficult to access due to the lack of availability, cost, and the continuous demand by schools that students with ADHD prove their learning is actually impaired. This requirement still exists in in many school boards and some universities; although current testing does not accurately assess executive functioning impairment in those with ADHD. At the same time, medication has proven beneficial for many children, and parents should not be made to feel guilty for or fearful of choosing to add this treatment to a child’s regime. They should, however, be fully informed, as some researchers in the article point out, medication is not magic, and will not automatically make their child academically successful.
Recently, many of the researchers involved in the original MTA study and the follow-up of the study are evaluating why long term gains for those in the study were not what they originally expected. This article presents a variety of different viewpoints, including the fact that after three years, these children went back to accessing community treatment, which was most often of a lower quality of care than they received in the study. Peter Jensen’s statement that only one in four children in the U.S. is getting adequate treatment for ADHD is very concerning, because I would assume it is no different here in Canada. Further research is really the only option that would provide us with a definitive answer. Unfortunately, these long term studies are very expensive; and often unethical because they necessitate a control group of children that you inadequately treated for a long period of time.
The article also points out that, while we know that medications for ADHD are misused by those without ADHD as study aids or cognitive enhancers, there is no evidence that these medications actually enhance cognition. Interestingly though, a paper that is cited here states that students who do not have ADHD, report feeling a boost motivation after taking the medication and perhaps that is why they feel their learning has been enhanced. This theory is yet unproven. We should be improving our efforts to educate young adult students that ADHD mediations do not really make them smarter or improve their academic abilities.
In closing, I would recommend this article for anyone interested in the current discussions on ADHD medication.
Heidi Bernhardt
ADHD is neither a mental health crisis nor a cultural one, as Maclean’s Magazine asks in the title of their article this week. It is a mental health condition that needs to be taken seriously as a medical issue, and not used to sell newspapers and books. I was actually interviewed for this article and, as I was assured, by the author, were Canadian medical ADHD experts, this however was not evidence anywhere in this article. One would expect the authors and publishers of the books highlighted in this article to do their utmost to sensationalize the title of their books and create catchy, if inaccurate sound bites, to sell their books, but how easily journalists, such as Kate Lanau fall into line with the marketing ploy is rather shocking. Journalists who use these exact tactics themselves to increase sales totally disregard the harm they do when they sensationalize a medical condition without balancing it with decades of scientific research. How many children and adults who may have received help will go undiagnosed because this misinformation is being promoted? The most unfortunate thing is that some real issues that do need looked at here in Canada, such as the misuse of medication by some post-secondary students, and the lack of training for physicians and educators in ADHD, won’t be discussed because everyone will be focused on the pure sensationalism of this article.
Since the chances that they will publish it are slim, here is my letter to the editor of MacLean’s Magazine.
“It is irresponsible to publish an article regarding a medical condition, in a Canadian publication, using US medical, information statistics and issues with very vague Canadian references, but not include Canadian expert interviews covering the Canadian situation. We are seeing far too much of this type of journalism lately in regards to ADHD.”
This is another perfect example of how the media jumps on anything about ADHD that is controversial.
http://nypost.com/2014/01/04/adhd-does-not-exist/
Harper Collins the publisher is doing a superb job of selling the book even before it is released and the media falling right in line with their marketing plan. Again the hugely frustrating thing is that almost every article and blog about this book does not allow for a rebuttal from the other 99.9 percent of medical experts to comment on some of the sensational statements that are obviously meant as a selling tool for the book. Unfortunately the author and publisher, as well as the journalists who buy into these tactics, totally disregard the harm they do by using sensationalism without balancing it with decades of scientific research. How many children and adults who may have received help will go undiagnosed because this misinformation is being promoted?
As Dr. Kenny Handelman stated in his blog post in January: http://www.drkenny.com/adhd-does-not-exist. I was also reluctant to comment on this fearing I would drive more attention to this book, but taking the high road in the past has not helped to decrease misunderstanding and stigma around ADHD in the past. ADHD professionals understand, as should parents and adults, that making a diagnosis of ADHD means ruling out any other potential reasons for symptoms of distractibility and hyperactivity, as much as it does confirming that the symptoms are due to ADHD. This is a very basic part of the assessment process. But, of course this is fact is not included in these articles.
If you come across any articles promoting this book and its messages, I encourage you to send your comment so people can “Get Real” about ADHD.
Shire Canada ADHD Scholarship Program
Deadline for Applications is April 15, 2014
Shire Canada will award up to FIVE scholarships to residents of:
who have been accepted to or are enrolled in a program at a Canadian accredited two- or four-year college, university, trade school, technical school, or vocational school located in the afore-mentioned provinces for the academic school year 2014-2015.
The recipients must be diagnosed with ADHD and under the care of a licensed health care professional for their ADHD, but do not have to be receiving medication treatment in order to be eligible.
Each scholarship recipient will receive an award of $1,500 and one year’s worth of ADHD coaching services from the EDGE Foundation. Winners will be notified on May 25, 2014.
To apply, please visit their website at: http://www.shireadhdscholarship/com/CA-EN/default.aspx and either apply online or print and apply via form, which must be sent in.
We know ADHD can be frustrating & seem mysterious. Here's some answers to common questions from adolescents. That's why CADDAC put together this page on our website full of helpful information for anyone curious or unsure about the topic.
Follow this link to CADDAC's website.
