Posted tagged ‘school’

ADD and head injuries

December 18, 2008

A recent study from the British Medical Journal concerning the causes of Attention Deficit Disorder (ADD) illustrates the power of using epidemiologic studies to determine the cause of a disease.

Epidemiology looks at factors in a population that might or might not be associated with illness. Researchers look at large groups of people with and without a certain disease, and try to tease out what wakes the two populations different. Does one group exercise more? Or eat more of a certain food? Does one group have more of a family history of that disease? Or maybe a certain environmental exposure? Studies like these can get quite complex, because human lives themselves are so complex.

As an example, we know that lung cancer used to be very rare—almost unheard of, in fact. It started becoming more common in men during the 1930s. Factors that may have correlated with the rise of lung cancer could have been increased living in cities, increased use of automobiles, or increased reading of newspapers. But careful observations of these and other factors found that it was cigarette smoking that contributed most heavily to lung cancer. Over the following years, as more women started to smoke, their rates of lung cancer rose to about the same level as men. No clinical trials have ever been done in people proving that smoking causes lung cancer—that is, no one has deliberately exposed people to cigarette smoke to see if they get cancer—but the overwhelming weight of epidemiology has been instrumental in demonstrating the risks.

ADD affects 5-8% of schoolchildren, and contributes to poor school performance, delinquency, and substance abuse. We know that genetics plays a part, but environmental influences also seem to be important. One observation that has been made is that many children with ADD have a history of some sort of head injury in early childhood—so is it possible that minor brain damage from these kinds of injuries is a cause of ADD? That’s what the BMJ study tried to figure out.

The study looked at 62,000 children in the United Kingdom, using a heath database that records diagnoses and medical problems. They found that in this group, children with ADD were about twice as likely as children without ADD to have had been seen at a medical facility for some kind of head injury in the past.

Does that mean that head injuries cause ADD? Maybe. But perhaps it’s the other way around. After all, we know kids with ADD are more impulsive and hyperactive—maybe they’re more likely to hurt themselves. Which comes first, the ADD or the head injury?

To answer that question, the authors looked at another health observation among the children: a history of any burn injury. A burn on some other part of the body wouldn’t cause injury the brain, but would be another way of showing that the kids with ADD are more injury-prone in general. Sure enough, in the database the children with ADD were also about twice as likely to have had a burn injury than kids without ADD. So it’s not just head injuries that are associated with ADD, it’s injuries of any kind—which fits the hypothesis that kids with ADD are reckless, and hurt themselves more. That’s why they more often have a history of a head injury. It’s not the head injury that caused the ADD, but rather the ADD that caused the head injury.

So: don’t worry about the inevitable minor head bonks. They’re a part of childhood that can’t always been avoided. But children who are especially reckless and get injured a lot might just be telling their parents what kind of person they are.

The adjustment to preschool

October 12, 2008

Here’s a question from Meredith: “My daughter (23 months) has just started a preschool class that meets 2 days/week for 4 hours a day. She cried the first day, which was expected, because I did too. She has now cried all 4 days she’s attended. I know it might take a while for her to adjust, but it is affecting her sleep patterns (nap and bedtime) quite a bit. She is also much more sensitive, whiny, and sometimes uncontrollable, which has not been her nature until now. Any suggestions for talking to her about school or should I wait a few months and try again? I thought for sure she’d be ready by now!”

Actually, I think a two-year old is going to be “less ready” than a one-year old would have been. Many two-year-olds are quite clingy, and have a rough time with transitions. That the preschool is only two days a week will actually make it harder for her—she’ll be less able to adjust to a new routine that’s so infrequent.

So: first, ask yourself why you’re putting her in school. Good reasons might be because she seems bored at home, or because she seems to enjoy group playdates. Another good reason might be that you need the time for yourself. Less-good reasons would be because you’re feeling pressure from other parents, or because you’ve read somewhere that two-year olds “should” be in school. There’s no convincing evidence of any lasting benefit or detrimental effect of enrolling a child of this age in a day program, so it’s more a matter of individual needs and family situations. Certainly, if a child is enjoying school, that’s a good reason to do it. But if you don’t really have good reasons for having her in school, this might be a good time to think about it again.

If you’d like to proceed with a plan to at least try to help her get used to school, here are some ideas:

  • Do “play therapy”: act out little routines and plays with her stuffed animals, going to school and having a good time. This is a great, indirect way of communicating with a toddler.
  • Have a quick, short, no-lingering drop off. “Bye, see you later!” are good last words. Don’t hang around. You must hide your own anxiety and ambivalence. Kids pick up on that stuff, believe me!
  • Have her bring something very special, like a blanket, or make a little pin she can wear with a picture of you on it.
  • Don’t go check on her, and don’t call.
  • Expect that drop off and pick up will be the worst times for both of you. But also expect that within a few more weeks that she’ll be enjoying herself, most of the time, after you’ve gone. If she isn’t, set a time-limit on how long to keep trying: something like “If there isn’t any improvement in two weeks, I’m going to withdraw her from school. But I’m going to keep trying until then.”

Anyone else have any good ideas? Post a comment!

Best of luck! Let us know how it goes, and if you come up with any other good ideas to help her!

What’s kindergarten for?

October 1, 2008

Kelly posted a question about academic expectations in kindergarten: “We have son born in July that just started Kindergarten. We made the decision to not hold him back. (Bucking that trend) Now, we are faced with reports that he needs help focusing and staying on task. What is realistic at this age? I worry that since we did not hold him back that he is being judged against kids that are 1+ years older than him (reference trend of holding boys back). Wonder if this has paved the way for more ADD diagnosis. Thoughts on what is correct expectations at this age? Also, any tips for us to use to try to get him to focus.”

First, let me thank you for “bucking that trend” and starting your son in kindergarten. I’ve written before about how routinely holding kids back is going to lead to problems for many children, both the held-back and their younger peers. Unless a child has a specific delay in intellectual or social development, it is almost always a good idea to get children started in kindergarten when they’re supposed to start. As you’ve seen, though, so many parents are holding especially boys back that the ones who are placed appropriately are often compared with children a year or so older. This is helping nobody. You’ve got an interesting idea about how this might be increasing the rates of ADD diagnoses—I have not seen any studies about how a child’s exact age compared to grade affects the rate of ADD diagnosis, but it’s a plausible thought that ought to be explored.

The silent treatment snit

August 2, 2008

“I’ve read about toddlers throwing temper tantrums, do you have any advice on how to handle a toddler who refuses to talk to you? I picked my 2 1/2 year old up from preschool today and she wouldn’t look at me or talk to me. I tried talking to her a few times but then just gave up and drove home in silence. When I tried to get her out of the car she threw a temper tantrum. Once she finally calmed down I asked her why she wouldn’t talk, if something happened at school, etc. and she said nothing happened. This is not the first time she has refused to talk (she has done the same thing to her dad and grandma before but she seemed to be doing better lately). Is this normal behavior, and is it best to not try to talk to her when she behaves like this?”

A “silent treatment” is a kind of snit—a different species, perhaps, from a temper tantrum, but certainly a close relative. As with all snits, the only thing you ought to do during a toddler-aged snit itself is ignore. How you best deal with snits otherwise has more to do with what you do before and after the snit than what you do during the snit itself.


What should we be teaching our preschoolers?

May 22, 2008

Holly posted, “In today’s media-rich, standardized academic world, it is easy as a parent to get pulled into the frenzy of preparing kids for the future and to lose sight of what is appropriate and natural development. My philosophy has been to let my 22-month-old twins explore the world through discovery play and not to drill them on ABC’s and 123’s. But it is definitely a challenge to maintain this philosophy when I hear stories of other toddlers ‘counting’ and doing other school-readiness activities before age 3. So the question becomes — how do we as parents know the right time to work on numbers and letters with our children? Do we wait for natural interest to show up after a certain age, or do we incorporate number/letter concepts into activities from the beginning?”

The pendulum in the United States has really swung towards more academics at an earlier age. (more…)

Holding Junior back

May 19, 2008

Kelly posted, “Can you talk about the thoughts on holding back boys from Kindergarten with late birthdays? I have a son born in July. I am seeing several families in our preschool holding kids back a year. What are your thoughts?”

Holding kids back does seem to be a trend these days, especially boys, and especially boys with summer birthdays. Though it may be a good idea for certain individuals to be held back, in the long run this trend is going to be a problem for all of us and all of our children.


TV + bedroom = bad idea.

April 15, 2008

Putting a television in your child’s bedroom is a bad idea.

That’s the conclusion of a study published in the April, 2008 issue of Pediatrics, the journal of the American Academy of Pediatrics (AAP). The authors studied 781 adolescents to determine the differences between kids who have access to a TV in their bedroom versus those who do not. The results are eye-opening. 62% of the children reported having a TV in their bedroom. The kids with TVs reported not only more time watching television, but also less time exercising, poorer dietary habits, fewer family meals, and poorer school performance. Other studies have found similarly concerning results in younger children.

The AAP recommends that children not have TVs in their bedrooms. I would take this a step further, and recommend that all TVs be kept out of all bedrooms. Parents: for a better night’s sleep and better adult relationships, use your bed only for sleeping and one other thing—but not watching television.

Should twins have separate classrooms?

April 6, 2008

In the suggestions thread, Allison posted: “I was wondering if there was any good information out there with regard to twins and whether they should be separated or kept together in school. Mine are almost 4 and we have the opportunity to separate them next year in pre-k. In their current class, they mostly just play with each other, with one following and modeling the behavior of the other. I would really like the follower to branch out on his own, and for them both to make other friends. But they are each others’ best friends and part of me hates to break that up.”

Studies of the effects of separation of twins for school have shown conflicting results. (more…)