It just sounds cool: Hemispheric Asymmetries

We take a lot for granted during our waking hours: our bodies’ automatic breathing, automatic walking, automatic speech production. In fact, a problem for people with ADHD is the automatic speech production — words get blurted out that they wish had some filtering before exiting their mouths.

Both automatic and volitional actions start in our brains. While we often cannot “sense” this, when there is damage to the brain, we see the actions are impacted. A common trauma to the brain is a stroke. Depending on where the injury happens in the brain, different actions — speech, walking, memory recall — get affected.

This is explained brilliantly in a book by Dr. Jill Bolte Taylor, My Stroke of Insight. The first few chapters describe what happens physically inside the brain organ, where blood vessels can rupture and create damage to the surrounding tissue. For me, the more fascinating aspect of Dr. Taylor’s descriptions are of the differences in perception from alternate halves of the brain.

The brain is shaped symmetrically, sort of like a walnut. There is a right half and a left half, or hemisphere. While it looks similar from the outside, different kinds of activities get processed in specific sites in the brain. That’s why some people who have a stroke have trouble recalling words, while others lose the use of one side of their body (the opposite side to where the stroke happened in the brain, which is interesting). Also, there is a tube that connects the two hemispheres called the corpus callosum that allows communication between the different sites to coordinate.

The term hemispheric asymmetry refers to the idea that specific actions take place in only one part of the brain. We process language on the left side of the brain; we process attention, memory, reasoning and problem solving on the right. There is an interesting article from the American Speech, Language and Hearing Institute on this topic — teaching speech therapists how to help stroke victims recover their ability to communicate. So, while it’s not polite to accuse a person with ADHD as having “brain damage,” it is useful to look at it as a phase in brain development which might need the same kind of attention and training as a person who’s suffered an injury in that part of the brain.

While a stroke is a traumatic event that can be devastating effect on a person’s ability to function, what is hopeful and useful to study about it is the way patients heal, and rebuild skills that were lost. It is really incredible to think that we can re-build networks of thoughts and actions even if the roadway we used previously has been destroyed. We can actually generate new nerve cells as we practice skills! (This post on BrainBlogger gives a good description.) Yet, I cannot help but see how kids with ADHD can also build or rebuild neural networks to help them master the skills they need for daily living.

By looking at improving outcomes for people with ADHD as a brain-based, developmental problem, we can take away the stigma of a person being lazy or unmotivated. After working with people with ADHD, I quickly so how willing and capable they were — but a lot of things simply did not occur to them. Homework just didn’t bubble up as something they had to do. Other things — usually visual — caught the attention of the right side of their brains, and they focused on a TV show or a video game or sports instead. Part of our job to help people with ADHD is to put the things they need to do in front of them.

Flowing Thoughts, or The Curse of Cursive

My concern for all kids is whether or not they are developing a “flow” in their thinking and expression of their thoughts. Personally, I think there is a pervasive shift in the way we are communicating (a lot more oral communication and visual communication, and a lot less written). Are schools stuck in the old ways? But… how are we going to communicate / transmit ideas without being fluent written communicators? I don’t see how we can have logical arguments without being able to point to specific ideas or thoughts — it’s hard to know exactly what someone said or thought without the written word to point to.

Writing to me is part of the process of developing logical thinking. Yet I see many, many kids struggle with this. It starts with learning how to print letters, and becomes noticeably difficult when cursive is introduced. (Somehow they start kids off with cursive in France… interesting!)

French cursive

When you see a child struggling to remember how to form a letter, and then how to join letters together, you see there is no more “cognitive space” to think about expressing one’s own ideas. It’s more like seeing someone learn how to roll modeling clay to make a skinny tube than to create a unique sculpture. Yes, we all need to be patient and allow the child to develop the skill… yet are the students given adequate time to learn this difficult skill?

Which, of course, brings me to baseball.

Coordinating motions through your arms

If you have ever played baseball, you may discover that there are so many individual sub-skills that you need to develop that it can be difficult to perform on the spot. If a ball is hit your way, you have to process so many things at the same time: run toward the ball, estimate when it will come nearest to you, rotate your glove in the best way to receive it, judge the speed and the height the ball will come at you based on where it bounces, etc. Just knowing which way to rotate your wrist is a major skill. Oh, yeah, then you need to catch it — or chase it.

The point, obviously, is that you need to train yourself, for hours on end, to make certain skills automatic.

When writing, you need to be able to hold a complete thought in working memory. You need to be able to hang onto it long enough to write every word of that thought down. Perhaps it’s like a phrase in music; it makes sense only when it’s complete.

Most students I work with cannot do both. They cannot think about how to connect the letter o to the letter u in cursive and write a narrative about what they think of a character in a story. They need to dictate their ideas, which are generally disorganized or simply responses to direct questions, and then they can think about what they said. It’s messy and very dissatisfying… and they never know if the teacher will accept what they’ve said or written. They are often insecure about the expression of their ideas.

Girls tend to be more interested in the appearance of their writing. Yes, we’ve all seen the hearts and flowers which dot i’s and j’s. Girls tend to be more patient in learning the formation of the letters, and spend time outside of school trying out different ways to form letters and words with their pencils and pens.

Which, of course, brings me to female teachers.

Most elementary teachers are women. (There’s a nice article here about this: http://abcnews.go.com/Health/men-teach-elementary-school/story?id=18784172.) According to MenTeach.com, only 18% of elementary teachers are men. My experience is that female teachers expect that their students spend free time practicing cursive because… it is fun. Similarly, women tend to enjoy going to stationery stores and buying nice notebooks and pens because they are pretty and pleasing and of course they want to fill them up with notes. Here is an obvious gender divide, and I see many boys fall off the cliff. They struggle with the act of writing; they do not develop a flow in their thoughts which can be transcribed through their hands; and they are penalized as being “sloppy” and “lazy” for their poor output.

While most parents have encountered this problem, what do we propose to do about it? Should we simply declare cursive and printing a lost art and get all kids onto keyboards? But… do they develop the “flow” of their thoughts any better on the keyboard? (And btw most keyboarding skills are very poor, and do not improve much when introduced too young. In my experience, 6th grade is the first time kids can actually flow with their thoughts and their keyboards simultaneously.)

My suggestions are (1) allow more time DAILY in the classroom for good ol’ practice, starting in 3rd grade. Not forcing the kids to come up with original thoughts, but just practice, boring practice, 30 minutes a day. (2) Allow extra time for kids with ADHD and executive skills deficits on all written assignments.  (3) Discuss and describe the flow of thoughts with your child. How do you transfer the ideas that you have in your head to others? Especially if you are in a profession where written words are judged and pointed to — science, law, broadcast journalism. (4) Spend more time with kids on the sequences of good writing — and help them understand how the audience processes information — not all at once, but note by note, sentence by sentence.

Finally, we need to remind ourselves that for most people, writing is hard. For good writers, writing is hard. Wrestling with conflicting ideas is hard; spending a long time with a pen and paper is wearying. Kids can learn the rewards of expressing their ideas in other ways, too, through videos and art and so on. Still, we need to be able to write! We need to buckle down and do more of it, both the skill and the art.

 

Virtual Reality Tests Reality of Executive Functions

OK, parents, you’ve decided to take the plunge and have your kid tested for ADHD. How does this happen in the doctor’s office? You’re nervous, your child is nervous, you’re all alone in the room with the doctor, and your child is perfectly still and silent. Where are the signs of ADHD? In a medical setting, how you and your child describe his or her behavior count for most of the diagnosis. The doctor will probably not witness these behaviors him- or herself, but will most likely ask some pointed questions and conclude that your child struggles with attention in a variety of settings, and may prescribe medications.

 However, there are tests, called “psycho-educational” assessments (shortened to “psycho-ed,” a rather unflattering moniker), which probe a bit deeper for some of the real-world or everyday problems associated with ADHD, particularly executive functioning deficits. They also look at some psychological issues, such as anxiety, depression, rule-breaking, etc.

Still, these psycho-ed assessments are also anecdotal, ”paper-and-pencil” tests. An examiner (usually a psychologist) asks you, your child, and/or your child’s teacher, a series of questions, and you answer them with “Always,”  “Frequently,” “Sometimes,” “Rarely,” or “Never”. These tests probe more deeply into whether the student falls within the norms of these behaviors for their age and gender, or whether there are indications of a deficit, disability, or some other dis-word.

taken from http://www.dailymail.co.uk/sciencetech/article-2356854/The-gaming-headset-transforms-video-games-virtual-reality-worlds.html

The authors of a study[1] were verifying whether a virtual reality (VR) “computer game” could predict whether or not a person has deficits in executive functions (EF). A problem with traditional paper-and-pencil assessments of attention is that they are administered in a quiet office, with few distractions, in a one-on-one setting. The examiner does not get to visit the child’s classroom, witness his or her behaviors when trying to control him-/herself in a quiet classroom, becoming easily distracted by someone or something in his/her environment, or forgetting to write down a homework assignment and having no idea what to do once he or she gets come.

I’ll quote directly from the published paper:

 In this study, performance on a VR-Stroop-like task of inhibition correlated with more traditional forms (paper–pencil and parent questionnaires) of EF assessment, but VR performance more accurately reflected everyday behavioral EF.

A “Stroop” task is a brain puzzle where you are shown a name of a color, for example, blue, but it is printed in a different color. When you see this: blue, and you are asked what color is written, you might say “red” because the color you see is red. This is supposed to test how often you can juggle conflicting information in your brain and come up with a correct answer, even when there is interference.

…the “Virtual Classroom” was originally developed as a controlled environment with varying levels of distraction in which attentional processes can be assessed in children (Rizzo et al., 2000b)… The environment also incorporates systematic and controlled presentations of typical classroom distracters, such as classroom noises and movement of virtual classmates or cars in the street.

Blair Middle School, Pasadena, CA

This idea struck me as quite brilliant. They are simulating a real environment, with distractions, while administering the test. It’s adding an extra level of distraction, which is usually present in everyday situations, so the child’s performance should be equal to or worse than a typical child’s.

…by its ability to explain outcome on well-recognized scales of behavioral EF and externalizing behavior, while a similar paper–pencil EF test (D-KEFS CWIT) failed to predict the same outcomes. These results support the idea that VR does not only look like the real world, it also includes demands that require real world functional abilities.

btw: D-KEFS, the Delis–Kaplan Executive Function System,  is an assessment that has five sub-tests that measure some facet of executive functioning: ability to reason, ability to prioritize, being flexible, juggling conflicting information in working memory, etc. The CWIT is the Color Word Interference Test, which is a version of the Stroop color name/word test.

The researchers concluded that “VR appears to be a strong predictor of everyday life executive functioning and behavior.” While they could not conclude the VR game could predict similar results on all of the paper-and-pencil tests they compared it to, it did at least produce results that confirm that executive function deficits are present in the child.

Finally, another reason to use this kind of technology when looking for indicators of “real” ADHD (and not just anxiety, or some other behavioral disturbance) and EF deficits is that kids like to do it:

VR technology seems to enhance participant enjoyment leading to increased motivation (Rizzo et al., 2004). The use of VR appears to reduce motivation problems and ceiling effects reported in paper–pencil cognitive tests (Rizzo et al., 2004; Schultheis et al., 2002).

So let’s get those goggles going in our doctors’ offices, and help people realize how real – and not virtual – this attention problem is!

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[1]  “Assessment of executive function in adolescence: A comparison of traditional and virtual reality tools” by Gabrielle Lalonde, Mylène Henry, Anne Drouin-Germain, Pierre Nolin, Miriam H. Beauchamp, who are based in Montreal or Quebec, Canada.

Published January 2013 in the Journal of Neuroscience Methods: 219 (2013) 76–82

The slings and arrows of outrageous fortune and chocolate

Stress. It happens to everyone, but it happens every day to someone with ADHD, particularly a child or adolescent. Somehow there is something that they do “wrong,” sometimes just by being thoughtless. Of course, a better description would be “thought-free” — his or her thoughts were not on what someone else was thinking, or might do, or might think. Nonetheless, it is considered rude, and the ADHD sufferer gets told that he is wrong just for being the way he is. The cause of just being born with ADHD, or just being born a prince in a dysfunctional family, cause a lot of Shakespearean suffering.

taken from http://theelearningcoach.com/learning/what-is-cognitive-load/

Most people come around to seeing that their weaknesses can be useful, or that their unvalued qualities can be strengths; the old “challenge/opportunity” dilemma. If you have ADHD, you might be able to hyper-focus on something — which could be good or bad. Good if it helps you perform in ever-changing environments, like an emergency room. Bad if you are 12 years old and stuck in a traditional classroom with a teacher lecturing you on something you are not interested in.

In an opinion piece in the LA Times by Robert M. Sapolsky, a noted neuroscientist at Stanford University, he links  stress to performance, or “cognitive load“. Learning new information, and making important decisions, are interrupted by stress.  His example is called “Rich Brain, Poor Brain.” He describes how the stress that affects poor people creates hardships that are just not as bad for people with comfortable income. A car problem: does it stop you in your tracks, as you decide what bill not to pay so that you can fix your car and get back on the road to work, or do you have a comfortable enough income that you can get the car taken care of while you continue with your regular routine? The stresses that poor people deal with interfere with their “regular routine” — worrying thoughts, i.e., stress, increase the number of things that they have to juggle.

Sapolsky describes a creative experiment done by Anandi Mani, testing people who will experience a great stress over money on their cognitive functions before and after the stressful time (harvesting a once-a-year crop). The farmers’ performance on the cognitive tests plummeted dramatically when they had not yet received their annual income. The conclusion is that worrying about money (being poor) increases the cognitive load — leaving less memory and attention to thinking and planning.

Try to think about anything else but these Lillie Belle Chocolates! http://www.lilliebellefarms.com/belle-of-the-berries-box-12/

An excellent example involves chocolate! If you need to get something done, you are using your executive functions to plan, prioritize, and pull up ideas out of your memory. This happens, most neuroscientists think, in the pre-frontal cortex area of your brain. Well, you can’t remember everything all at once, obviously, so you juggle the current ideas in your working memory.

According to Sapolosky, “Extensive research shows that ‘frontal function’ is impaired in people who increase their cognitive load with such things as distracting tasks, stress, sleep deprivation, pain or even resisting temptation (for example, if you make someone’s front cortex work hard in order for them to resist eating chocolate, they are less capable immediately afterward of performing frontal cognitive tasks.)”

If (not) resisting chocolate is something you can relate to, then you can imagine how terrible it is to have stress caused by something bad: a punishment for not remembering an assignment, poor grades in school, knowing how angry your parents are going to be at you, and hatred for yourself for being “stupid.” Let’s increase our awareness of the stress that children with ADHD are going through, and find ways to reduce that stress, to give them a fairer chance to do their school work.

1,000 most (81) commonly (423) used (149) words (250) in (6) English (524)

When writing, one way to check to see if a student’s work contains some original words is to see if they are NOT on this list: http://www.insightin.com/esl/1000.php

Truthfully, this brings up a deeper issue of personal originality. People who perceive themselves as “different from the mainstream” usually are (until they hit 35 years old). Many people find their identity in being different and unconventional. Some people with disabilities are so well-adjusted that they demand to be accepted as they are. I have been so impressed with the “Don’t Cure Autism Now” movement that came out as a response to the fundraising organization, “Cure Autism Now!” or CAN. http://winklett.com/about/jonahs-journey-a-journal-3272005-72808/dont-cure-autism-now-62806/ (This is an older blog post from 2006; I don’t know how to cite it correctly.).

Please let me clarify this — I’ve received a comment about it — I am not against research to understand autism, which is the basis of CAN’s work. (CAN is merged today with another organization, and they are called Autism Speaks.) What I admire about the “Don’t Cure Autism Now” is the sense of identity that some people with differences have. They don’t want to be “cured” — they want to be accepted as they are, and are comfortable being defined as “different” and not “neuro-typical”.

However, many people, especially adolescents, who have ADHD wish there was a cure for it. They wish there was a cure that did not mean taking medication for “it”. Having a disability means instantly not belonging to “normal”. Most kids fear this state of being. Particularly in early adolescence, they will do anything to fit in. We have witnessed dire consequences of this kind of thinking, such as taking drugs to fit in with a crowd — even a crowd a person is not really comfortable being in.

A more commonplace experience, though, is fitting in at school, which means (1) not asking questions, (2) not admitting that you don’t understand something, (3) not admitting that you have a learning difference, (4) never letting anyone know that you take medication, (5) not advocating for yourself when you have a 504 plan or IEP in place to support you, and the more than 1,000 variations on this theme of hiding your disability and suffering in silence.

An important process in dealing with ADHD — and any learning disability — is demystification. The family with a person who is different needs some help: the parents must mourn the child they thought they had, and embrace the one they do have. This wise saying has stayed with me for years, and I keep trying to spread it to as many parents as I can. Demystification means learn as much as you can about yourself as well as about a particular disability. Stop looking at it like an unpredictable monster. Start seeing what really is presenting itself. Find out… what is common about it! (I think the Don’t Cure Autism Now adherents also want to understand how their way of interpreting the world is *not* understood well by neuro-typical people. They help demystify the experience of autism by writing about it and sharing their understanding of themselves.)

Since I work with adolescents, I also see their burgeoning self-concepts develop, and they, too, need to know what a typical brain is like, what their brains are like, and how they can compensate when their atypicality interferes with success. Again, that is another, deeper conversation in itself.

But getting back to writing, which is so hard for people with ADHD to accomplish, be as original in your writing as you are in your person! Find some unusual, awkward, blurt-worthy words and use them in your sentences! Embrace that you’re not one of the 1,000 most common students, and thank the Lord/Creative Life Force for that!

ADHD Awareness Month, October, 2013

It is not exactly a “Hallmark Moment” to celebrate, having ADHD every day of your life. However, there are many ways that we can learn how ADHD affects individual people whom we know, and how we can be more patient and understanding so that we reap the benefits of their gifts.

This site, ADDitude, has many resources for any month of the year. In particular, though, there is an expert giving a free webinar, and I recommend it to anyone interested in this subject.

Dr. Brown’s book on ADHD and Executive Functions

His name is Thomas Brown, MD, and he’s written many excellent articles and books on recognizing and treating ADHD. You can listen to him via ADDitude’s website, http://www.additudemag.com/awarenesswebcasts.

October 16, 2013, 1PM EST
Exposing ADHD Myths: Science’s New Understanding of ADHD
with Thomas E. Brown, Ph.D.

In addition, this site is hosting many other intriguing talks, and has lots of articles and handouts that might help raise awareness of the issues facing people with limited attention, memory and executive function skills.

It is worthwhile to reduce the stigma, I think, especially within the school system. That doesn’t mean people with ADHD should be allowed to remain unconscious of their effects of their behavior on others, or be excused from doing their very best at any given moment. It means there needs to be a recognition of the condition, a plan in place to know what to do if that person is not able to perform at the moment, and a support system in place for making up work later on. Dr. Mel Levine referred to the first part as “demystification”.

I was stunned when meeting a 5th grader who was very ashamed of having ADHD. He thought it meant he was possibly mentally retarded. He was extremely worried that he would be pulled out of his regular class where his friends are, and put into the special education class. He wondered if it meant he had autism too.  He worried that he was unconsciously doing things that upset other people and he did not know about it! That’s a heavy psychic burden for a 10-year-old boy, especially one who is very active and talented in many, many areas. Interestingly, he had a lot of compassion for those kids who are in the special education class; he wondered if they had friends, or if they got in trouble for their “behaviors”. Somehow, though, he ingested all those negative messages about special education, and doubted his own version of reality. THAT is what I would like to help dispel. That’s where demystification comes in.

So, yes, I will be on some bandwagons, and I will be handing out some of ADDitude’s flyers. Viva demystification!

Gifted Adults Can Have ADHD Too

The Gifted Adult, by Mary-Elaine Jacobsen, Psy. D.  New York: Ballantine Books, 1999.

My motivation for reading this book was (1) personal – always nice to feel “gifted” and “special”; and (2) my consistent impression that the parents of the kids I work with are gifted, but may suffer from a case of ADHD or Strict Moral Upbringing or SBU (that’s my own acronym!) and feel their own unease coming out when they see their children struggling.

This book is incredibly pragmatic. It even includes a self-assessment that you can score.

But first of all, Ms. Jacobsen re-defines “intelligence”. Most adults grew up with the idea that IQ is a fixed number, and a fixed ability. Ms. Jacobsen widens the definition of intelligence to include several new facets – some that are a bit hard to define or quantify – but I think she does a good job.

She includes Gardner’s Multiple Intelligences (MI), critics be damned. While these are used a lot in elementary schools, they have not been seen as verifiable qualities that can be measured by most psychologists. Still, in an effort to help adults move past rigid ideas about their own intelligence, she includes questions on her survey to help them see new aspects of how they approach the world.

From there, she moves into the concepts of Intensity and Excitability, which she calls Gifted Traits (GT) (pp. 98-99). She includes descriptors for complexity and drive, too, which is necessary if you are going to get your ideas out in the world.

btw she loves acronyms, especially 2-letter acronyms.

The next section she calls Advanced Development (AD), which is quite nice in my opinion because she sees the desire to help others as a parted of the gifted personality. She loves making up “equations” such as:

AD = HV + MM + RA. These abbreviations stand for Advanced Development equals having a Humanistic Vision, a Mandated Mission, and a need to perform some Revolutionary Action.

All of these qualities of your interests, your proclivities, and your higher self are tabulated into your EvIQ, or Evolutionary IQ. She gets Evolutionary IQ from the notion of “evolve” – just as we evolve as a species, each individual evolves as we mature. We are able to have a vision and to take action once we are adults, in different ways than when we were born. Even if you like the idea of having a fixed IQ, you can see how you evolve your intellectual gifts into meaningful action through your work or your community involvement.

She really sees this definition of IQ as one that changes over time. After you’ve answered qustions on her survey, you tally up your scores in the areas of Multiple Intelligences, Gifted Traits, and Advanced Development, for a single score, which is your “current level of Evolutionary Intelligence” (p. 108).

And then what? Let’s assume that if you are reading this blog, you have a high EvIQ. J She has positive suggestions about meeting / confronting the usual criticisms you’ll receive – either from yourself or from others, such as, “Why don’t you slow down?” and, “You’re so sensitive and dramatic!”

I really like her section on Intensity (pp. 258 – 267). She has a chart that shows the differences between extremes of intense behavior, and a balanced version of the same energy:

Collapsed	Exaggerated	Balanced
Listless	Wired	Exhilarated by life
Numbers out with substances	Thrill seeker; addicted to excitement	Frequent peaks of experience
Dodges controversy; steers toward popular opinion	Intractable opinions; dominates conversations	Engaging conversationalist; comfortable with intense discussion
Substitutes mindless banter for in-depth conversation	Caustic; uses words as weapons	Articulate; stimulating
Deprecates self as laughingstock	Jokingly mocks and humiliates others	Joyous; congenial
Cold and remote	Doting and smothering	Warm and caring

She gives advice on how to reclaim your true self, your gifted self, and to seek balance to find joy and meaning in your world – but not by hiding your gifts, stifling yourself, or repressing others.

She ends the book with information about how you interact with others – relationships and finally your place in society. I expect for many people this last phase involved a sense of intuitive spirituality. Even if that sort of thing turns you off, it is important to know that those questions of the meaning of your life, and the legacy of your life, will be important as you continue along this journey. I hope everyone can find his or her gifts, see how the intention and willingness to change and improve can turn into reality, and how much our society needs you to share your gifts.

Diagnosing ADHD with Brain Imaging

In a related field, autism research, new findings show a brain-scanning measurement of “grey matter (GM) volumetric data, to assess whether individual ADHD adolescents can be accurately differentiated from healthy controls based on objective, brain structure measures…”

from Autism Speaks, http://asdresearchinitiative.wordpress.com/2013/05/24/grey-matter-adhd-autism/ 

While this study is looking for biological measurements to identify people with autism spectrum disorders AND ADHD, it explains that the screening mechanism is a good way to detect ADHD. Rather than compare brain waves (see my blog post here), it looks at actual structures of different parts of the brain.

Many doctors and psychologists say that there are usually enough (subjective) behavioral reports from parents and teachers to determine if a person suffers from ADHD. However, these objective biometric tests may be useful in deciding on medication/s, which could be enormously helpful.

 

The “Myth” of ADHD?

The Myth of the ADD Myth

Review of The ADD Myth: How to Cultivate the Unique Gifts of Intense Personalities by Martha Burge (San Francisco: Conari Press, 2012)

Ms. Burge asks some provocative questions in this book, such as, “Intensity: Gift or Disorder?” While the word intensity here has a specific meaning, as described by Dr. Kazimierz Dabrowski as a particular giftedness, I appreciate her implication of how “intense” a person with ADHD can be. People with ADHD really are intense people; they feel intensely, they think intensely, they play intensely… and they fall apart intensely.

Ms. Burge, a life coach who practices in Southern California, has written this book to discuss the positive aspects of being intense in both the general and technical senses of the word. She writes compassionately about the people she has worked with who have a “deep sensitivity, a fullness of experience, a capacity for fantasy and creativity, and an intellectual curiosity” (p. xx), and who are not merely marred by attention problems.

She states that she developed her own theory of “intensities,” and then later discovered the work of Dr. Dabrowski, whose concepts described the same behaviors she had described. (See, for example, the Supporting the Emotional Needs of the Gifted (SENG) site for more information, or my blog post.) She came up with a great acronym for these different types of giftedness: SPICE. A person might be intensively Sensual, Psychomotor (Physical), Intellectual, Creative or Emotional. Generally, people who are gifted tend to be more “intense” in one of these 5 areas, and may have strong tendencies or talents in some of the other.

I want to point out that her approach may apply only to adults, and I am not sure all her ideas or suggestions can be used with children or adolescents. I have some criticisms of this book which mainly apply to how to help students function in a typical classroom setting.

A good point that she makes is that ADHD is “too common to be a disorder” (p. 18). There are many estimates of how many people have ADHD; I’ve seen research reports with 3%, 4%, 8%, 10% and even 15%. Over time, the numbers just keep creeping up. She poses a good question: “At what point do we look at a pattern of behaviors as within the normal range?” (pp. 18-19).

However, some points she makes are simply wrong. She claims that the National Institute of Mental Health (NIMH) estimates the number of people with autism is less than 1% of the population; their website states 2% (see http://www.nimh.nih.gov/news/science-news/2013/prevalence-of-parent-reported-autism.shtml). She states on p. 20 that “there are no objective tests that prove the existence of ADHD or any other psychiatric disorder,” but there are some biometric tests now for ADHD.  She skirts the issue of the efficacy of medication; she states that meditation can help most people – without using drugs. She has a section of her book, pp. 4 – 11, entitled “Medication Goes in Search of Patients” which has misleading information. She states that CHADD, Children and Adults with ADHD, was funded and founded by a big pharma company. She implies that they were set up to support giving out medications, as if all the other very helpful advice they offer is mere placebo. Yes, the pharmaceutical companies have something to gain by funding a resource like CHADD, but much of the information requires a lot of education even to understand whether or not your child has a disorder or disability. Frankly, I can’t think of anyone who would want to identify as having ADHD — how can she say that “the disorder seemed to go in search of patients” (p. 4)?

She throws in a very scary comment, that “the very same people,” i.e., doctors, who encourage parents to buy medications, are the ones who “will also tell you that stimulants are deadly” (p. 5). Hold on now! Of course abusing any substance is deadly! But death-by-overdose affects a very small percentage of patients, usually those with a pre-existing condition, and the medication is prescribed so that it will not be abused! Of course stimulants can be deadly, but so can hormone replacement therapy, aspirins, and sugary foods that lead to diabetes. It’s just not fair to scare people into ignoring a valid treatment, medication, just to serve your own pet theories. I distrust this kind of non-objectivity.

She calls meditation “the drug to end all drugs” (p. 52). Her approach to helping her adult clients includes meditation, mindfulness, and understanding some intellectual constructs, such as “the internal map of reality” (p. 46). It has been my experience to witness people with ADHD to be able to relax and focus only after they have taken medication to regulate their brains. I agree that meditation is wonderful and that developing a sense of your “inner voice” is an essential part of growing up and healing. But I do not think it is fair to tacitly discredit the use of medication. Some people can’t get to the state of being able to meditate until after they medicate. As with most conditions, every person is somewhere on the spectrum … some people have an “intense” case of ADHD, and many of those people when undiagnosed turn to drugs and alcohol to soothe or self-medicate – leading to an unproductive life of addiction and substance abuse.

As Burge points out, many people choose not to meditate, or believe they can’t meditate, because it takes too long – and a pill is a lot more convenient. I would ask her and all the anti-medication people out there – please leave room for both. If you can succeed without medication, great. But if you are a child or a young adult who is failing in school, you may be limiting your future choices if you can’t perform tasks that require focus, concentration and completion. There are minimum requirements to get into college, and we all know that earning a college degree is one of the most predictable ways to be financially secure as an adult.

While I respect a parent’s desire not to give medication to his or her child, I hope that parent is able to provide the time and energy to support that child – including sitting with them during a daily meditation period – to teach them how to utilize the non-medication tools of meditation, visualization, deep breathing, stretching, and developing an inner voice. My experience is that most 10-year-old boys who have ADHD – it’s not a myth – do not have the self awareness yet to benefit from this kind of training. Yet, they struggle and suffer and lose their self-esteem as they watch, mystified, their grades plummet and the respect of their teachers and peers diminish. That can cause permanent damage.

I used to think that ADHD was a myth, too. “We never heard of it when I was a kid in school!” Then, I walked into an elementary school classroom, where I hadn’t been in over 35 years, and saw a young man sitting backwards on a chair, his torso hanging over the back of the chair, his shoes off, as he attempted to work on a piece of paper with a pencil. He was not a myth. His disability was real. He didn’t want to be that way; he didn’t know why he felt like he was crawling out of his skin when forced to sit properly. He just couldn’t pay attention because he was physically – and yes, to use Dabrowski’s term, sensually – out of balance.

Middle School & High School – Organizing Materials

This is not “my” system; I have been inspired by several other people who have worked out functional systems. In particular, I refer to these two authors:

That Crumpled Paper Was Due Last Week by Ana Homayoun (2010)
& Seeing My Time by MaryDee Sklar (2012)

Supplies needed:

• A 1” binder for each subject – total 5 binders – different colors
• 5 packs of 5 tabbed dividers for each subject
  For an example, see: http://www.staples.com/write+on+tab+dividers/directory_write-on+tab+dividers?
• A pack of 5 dividers – transparent, with pockets (sometimes these are with the folders) For an example, see: http://www.staples.com/Avery-Two-Tone-Double-Pocket-Insertable-Plastic-Tab-Dividers-5-Tab/product_710149?cid=PS:GooglePLAs:710149&KPID=710149
• Loose-leaf paper, with a reinforced edge, 3-hole punched
• A backpack that is big enough to fit 5 binders, plus a planner, and an electronic device, comfortably
• 3-hole punch
• Planner, provided by school, or a “friendlier” one, such as http://orderoochaos.com/shop-products#!/~/product/category=5059090&id=21117059

1. Have a separate binder for each subject. Each binder should be 1”, with 5 tabbed dividers. (Of course, if a teacher specifies a 2″ binder, get that for his or her class. If there is a subject with very little paperwork, like wood shop or health, get a ½” binder for that class.)
2. Put one clear/transparent pocket divider in the 3-rings, in the front of everything else. This is where you will stuff any papers that need to go back and forth from school to home.
3. Behind the transparent pocket divider, put one pack of 5 dividers: (1) notes, (2) homework, (3) handouts, (4) tests/quizzes and (5) blank paper. Write these labels on the top of each tabbed divider. I like the plastic kind that you can write directly on the tabs; those little white slips can fall out and that’s kind of frustrating.
4. In the very front of the first divider, put the syllabus for the class.
5. Do not use spiral binders or spiral notebooks. Use loose-leaf paper from the back of the binder. If a teacher specifies a spiral binder, he or she may want you to paste papers into it, such as science labs or history hand outs. This can get very messy, since the handout is usually the same size as the spiral binder. See if you can find a Science Lab Book, which is bound and bigger than 8 ½ x 11, or a spiral binder with the spiral on the top rather than the side. These are easier to work with over the semester. For an example, see: http://shopping.netsuite.com/s.nl/c.ACCT126734/it.A/id.195/.f

Using This System:

At school, take the binder you need for your class with you (you’ll either carry it in your backpack or get it out of your locker). Put the binder on the desk and open it up. If you have to turn in some homework, take it out of the pocket in front and hand it in. Take out one piece of paper to take notes. When taking notes is finished, put it in the “Notes” section.

If you are in a rush, just put any notes or other papers you get in the clear pocket in front.

When you get home, take out all your folders, one at a time. Go through the papers in the front clear pocket. Put any notes in the Notes section. Do any homework you need to do, and put it back in the clear plastic folder to turn in.

This binder has 5 tabs. Since it is for science, one tab is for “Labs” instead of “Homework”.

If you get back any handouts or quizzes/tests, punch them with the 3-hole punch and put in the correct place.

• Everything should be 3-hole punched.

• At the end of every semester or quarter, take everything out of the binders and file them at home.

HANDOUTS: Papers of information that the teacher hands out go here. This is not homework. Sometimes, it might make sense to put some of these under the “notes” section. You decide in that case.

QUIZZES/TESTS: Quizzes are the bases for tests; tests are the bases for final exams. Keep all quizzes and tests, even ones that don’t have a good grade. It is useful to go back and review those ones in particular! (Parents: do not stress out so much about a bad score – your child may try to “hide” those quizzes from you, and then they get lost.)

PAPER: Reinforced paper is one of the best things ever invented. The back of each binder should have twenty to thirty sheets of this paper. (Otherwise the backpack gets too heavy.)

SCHEDULE A TIME WEEKLY TO ORGANIZE EACH BINDER. Find a time that works for both of you and one of your parents. For example, Saturday afternoon at 3:00 pm. Once you get used to this, you can go through 7 binders in less than 30 minutes.

Our evolving system at home. My middle school son takes a binder that he puts ALL of his handouts in, plus whatever binders he needs for that day (his school follows a block schedule). He keeps the others at home on this desk, and we go through the main binder every night to put away the papers in their proper binder.

Some students, especially those with ADHD, need to organize their binders daily. “Having a time every night to check binders and planners, organize papers, and get assignments sorted out will probably be an essential part of their daily structure. … For many of these kids, a timer is essential. For instance, setting a timer for twenty minutes before your son starts a homework block for him to clean out his binders, recycle necessary papers, make sure all homework is in his planner, and get any necessary materials to the space where he or she will be doing homework will help him or her to be able to complete the work with less distractions.”

PLANNER: Ideally, the school planner will have the block schedules noted on each page. It should have enough room in each block / column to write down the assignments. If it is too small or crowded, find another (larger) planner at an office supply store.