Written by Heidi Bernhardt R.N.
Click here to download the blog in PDF format.
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.
Written by Heidi Bernhardt R.N.
Click here to download the blog in PDF format.
All students returning to school this fall will be forced to navigate a new reality, but students struggling with ADHD and other neurodevelopmental disabilities will be exceptionally challenged. The skills that ADHD impairs such as the regulation of attention, activity, impulse, behaviour and emotion, as well as executive function are the very skills that will be challenged in this new environment.
Schools will be expecting children with self regulation and impulsivity issues, as well as impaired skills in remembering routines, planning, organization, and social interaction to follow complex instructions on what they should and should not do. Those in higher grades will also be expected to understand and follow new and varied schedules and conquer online learning with what looks like few additional resources. This new and confusing environment along with the added load on these students’ impaired skills will cause them increased stress resulting in more behavioural and academic issues.
Anticipating this, parents are concerned. In some provinces they are being asked to make a decision about their child’s return to school with limited information. Parents want to know if their child will be provided additional support to ensure their safety. They wonder if their child will be offered additional understanding for their impairments, or be reprimanded, consequenced and ultimately excluded from their classrooms when their impairments prove too great? Of course, they hope for the latter, but some parents who have already experienced their school’s lack of understanding of ADHD impairments along with insufficient supports are rightly concerned. Their concern is so great that some parents are choosing to keep their children home. Some without the resources to do so, or others knowing that their child requires the routine and social interaction only school can provide, are opting to send their children and adolescents into the unknown.
What can parents do to help mitigate this unknown?
What you can do to assist your child transitioning into this challenging environment?
Once you have obtained the information about the environment and situation your child will be entering, take steps to prepare them as much as possible.
Prepare the school
Meet with the school to:
The decisions made during any meeting should be followed up with a written summary. If this does not come from the school follow up with an e-mail to the principal listing the things that were agreed to in the meeting and when you expect them to be implemented. In this e-mail propose a date for a follow-up meeting to review how the strategies are working and if they need to be revised.
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
What's in a Label? - Today's Parent Magazine
I strongly disagree with the recent article in Today’s parent magazine “What’s in a Label?” http://www.todaysparent.com/family/parenting/kids-health-labelling-behaviour/, which states that labeling a child with a disorder, be it ADHD, ODD, anxiety or OCD, imprisons a child and gives them the feeling of a life sentence. Liza Finlay, a psychotherapist, goes on to say that these labels allow a child to sidestep any effort to improve. My experiences are far different. From a personal family perspective as well as the perspective of someone who has spoken to thousands of families over the past twenty years, it is the lack of early diagnosis and therefore lack of treatment and access of resources that have imprisoned many children into a life of dealing with the consequences of these disorders. Left untreated, ADHD can lead to additional mental health disorders, increased rates of high school dropout, less years of education, self-medication leading to substance abuse, involvement with the justice system, as well as increased socioeconomic costs.
A psychologist who believes that the earlier mentioned disorders are nothing but behaviours, and that children can simply choose to adopt different behaviours, is an affront to decades of medical research. Does therapy combined with other treatments for these conditions prove helpful? Sometimes, but that does not mean that ADHD is simply a set of behaviours that can be unlearned.
The notion that "once a child is diagnosed with ADHD, parents stop expecting them to behave" is not only ludicrous, it is insulting. Once a diagnosis happens, parents are able to put the child’s behaviour into perspective. They are then able to focus on appropriate parenting strategies to assist that child with their behaviours and access other appropriate treatments.
I certainly agree that additionally focusing on a child’s strengths and working to increase their capacities is essential, but the best way to do this is within the understanding of a child’s overall profile. The lack of understanding of a child with ADHD can lead to all of the above mentioned consequences as well as increased childhood and family stress, family breakup, and, in extreme cases, abuse and children leaving home.
Do we need increased tolerance for those who do not fit into society’s definition of normal? Do we need to expand society’s definition of normal? The answer to both of these questions, of course, is yes. But we need to make sure that while we work on this goal, we don’t neglect the children who are labeling themselves as stupid, lazy and bad because no one has let them know why they might be finding it more difficult to succeed than their peers.
Heidi Bernhardt
President
www.caddac.ca
*** You can comment on the original article or click here to leave a letter for the editor. ***
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.
I just finished listening to a great presentation by Dr. David Goodman about this topic. If you are interested in this topic I would highly recommend you access this presentation sponsored by the National Resource Centre on AD/HD at https://www.youtube.com/watch?v=L7lYicr3s5A.
In his opening Dr. Goodman reviews the actual accuracy of newspaper articles on ADHD research.
He goes on to explain how journalists construct articles with victims, villains and heroes in order to catch a reader’s interest. He suggests that readers try and identify these roles in the storey and also question whether the author is trying to express extreme attitudes to sensationalize the story to increase interest. He points out that many journalists, especially national journalists, have agendas, or have been given agendas by their publishers, so ask yourself “What is the agenda of this article?” as you are reading it. He closes by stating, “The credibility of the information is dependent on the intent of the provider.”
Two parts of the presentation confirmed my fears that these type of articles increase fear and shame in parents and impact patient diagnoses and treatment. Furthermore, he indicated that the public is easily seduced by articles that sound scientific, but are actually lacking in up-to-date or comprehensive research on a topic, and may sensationalize new unproven research in order to interest more readers.
In the presentation and Q&A period Dr. Goodman offers concrete suggestions on:
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.
