February 18, 2022 • 17 mins
The pandemic has made school difficult for most children—but some kids may be facing extra challenges because of undiagnosed ADHD or a learning disability. Dr. Saltz tells parents what to look for and how to help—and reveals the unexpected silver linings.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. With so many children
zooming to school and missing in persons school, the number
of children who have undiagnosed attention deficit hyperactivity disorder amongst
the most common of childhood mental health issues, and dyslexia,
(00:50):
and really struggling to stay engaged with school work and
feeling frustrated and falling behind. Those numbers have all risen
with the emphasis for children in school being on staying
safe from COVID, which is understandable, The ability for teachers
to spot when a child is struggling, to recognize what
(01:13):
the struggle might indicate, and to suggest testing to pinpoint
what might be going on is diminished. Parents may well
assume that their struggling child is having difficulty due to
the social isolation, the loss of in school time, and
the general difficulties of the pandemic. And this may well
(01:37):
be true, but that can make it easy to miss
an emerging mental health diagnosis that requires specific diagnosis and
treatment to support the child. Most parents find it difficult
to even acknowledge to themselves that indeed their child could
(01:57):
have a d h D or a learning disability because
the idea is painful, and because we still stigmatize, and
because they don't want it to be true. And that
is the reason why diagnosis is so often delayed by
as much as two to five years from the beginning
(02:18):
of symptoms for children who then only slip farther behind.
Early intervention helps a child to stay on track and
not lose self esteem because they don't find themselves lost
and a wash with their school work if they have recognition, treatment,
(02:39):
and support. Today, I am answering a listener's question about
her child's slipping performance in school and what to do
about it. In addition, when a child is diagnosed with
a learning disability or with attention deficit disorder, might they
(02:59):
only have difficulty in school? Could they also have a
potential strength? About ten of school aged children have a
d D and ten to fift have dyslexia the most
common of the learning disabilities. Attention deficit hyperactivity disorder affect
(03:21):
the child's ability to regulate when they are attending to something.
This results in difficulty concentrating on subject matter that the
child does not find especially compelling, but also hyper focusing
on material that is of great interest to them. It includes,
(03:42):
for many, difficulty with being disorganized, misplacing or forgetting things,
being impulsive, and, for those with a d h D,
hyperactivity or a physical restlessness the child experiences. In addition
to the other symptoms, dyslexia affects a child's ability to
(04:05):
process written language correctly. Certainly, both of these differences in
a child's brain can make aspects of school and home
life more difficult. Many parents are reticent to pursue a diagnosis,
even when they have a visibly struggling child, because the
(04:26):
very idea of any mental illness or learning disability feels
so distressing and stigmatizing. Delaying diagnosis has two significant drawbacks.
One is that the longer a child stays off track
with regard to school ability and overall development, the more
(04:47):
difficult it is to get them back on track. Children's
brains are very plastic, meaning they keep changing, and the
earlier you treat them, the more quick really brain changes
can happen. This can result in fewer symptoms or the
development of coping skills that enable your child to work
(05:10):
around their symptoms. The second drawback of delaying diagnosis is
that along with the brain differences that cause symptoms such
as distractability and difficulty reading, come particular strengths that, if nurtured,
could make all the difference in terms of your child's
actual potential and future self esteem. So with that, let's
(05:36):
get to our listeners question and see how can I help.
Dear doctor Salts, My twelve year old is having an
increasingly difficult time with school. He has always been a
good student, high energy, but able to perform well in
the classroom. This past school year has seen the school
(06:01):
move to some remote time, some in class time with masks,
and less time with friends after school due to COVID concerns,
and it has all been a struggle emotionally, but his
grades have been slipping. He has had more difficulty concentrating
and studying for tests that are coming up. On the
(06:23):
one hand, he seems very unfocused and distracted forgetting assignments,
missing questions on a test. But on the other hand,
he is able to play a video game he likes
endlessly with razor sharp focus, and in fact I have
difficulty getting him to stop. So this doesn't seem like
(06:45):
attention deficit disorder to me. But I'm not sure, and
I'm worried that academically he is heading south. And actually
he feels very anxious about this himself. What can I
do to help him? These past two years have been
very difficult for many school children for a whole host
(07:09):
of reasons that you allude to. The Loss of time
at school has set some children behind in terms of
learning and has made it difficult to catch up, to
stay focused and feel happy at school. Kids who have
any attentional issues were amongst the most affected because Zoom
(07:31):
school was especially difficult for them. Staring at a screen
all day is hard enough for most adults, it was
pretty excruciating for many kids. Emotional state affects attention, and
so kids without an attentional diagnosis had more difficulty these
(07:51):
past two years if they were highly anxious, feeling sad,
are overall quite stressed. As any of these issues affects
one's ability to attend and concentrate. So discussing your son's
emotional state with him and helping him with his stress,
anxiety or mood could go a long way towards helping
(08:15):
him to be able to attend in school again. But
attention deficit hyperactivity disorder is an even more common diagnosis
than depression or an anxiety disorder in this age group.
How can I help with? Dr Gale Salts will be
back after the short brain back to my listeners question
(08:50):
about her son with school issues. The main symptoms of
attention deficit hyperactivity disorder are impulsiveness, disorganization, and problems prioritizing,
poor time management skills, problems focusing on a task, trouble multitasking,
(09:11):
excessive activity or restlessness, and poor planning, as well as
having a low frustration tolerance. So, Mom, you need to
ask yourself are several of these issues visible to you?
Or you should call his teachers and ask is this
(09:31):
visible to them? You don't need to have all of them,
just a couple most commonly actually is impulsivity and disorganization
and trouble attending to a task that they don't like.
You mentioned his focus on video games, another element of
(09:52):
a d h D is something called hyper focus, the
ability to attend in a super focused and can tenuous
way on content that you like. Sometimes, due to hyper focus,
it is difficult to stop. The reason for this is
that a d h D is not a wiring issue
(10:14):
that prevents you from being able to focus. It is
a wiring issue that has to do with what's called
a faulty switch in an area of the brain called
the default network. This is the area that has to
do with fantasy, thought, imagination, just free thinking, and one's
(10:35):
ability to regulate that switch determines when you will consciously
focus and when you choose not to focus. But if
the faulty switch is there, as it is in a
d h D, it means one's ability to consciously decide
when to focus is not consciously under your control. So
(10:58):
sometimes it will be on and sometimes it will be off,
and it's mostly going to be regulated by what is
enjoyable and really interesting to you, because enjoyable and interesting
turns on the neurotransmitter dopamine, and that neurotransmitter is the
neurotransmitter of reward. And so the outcome is that it
(11:23):
is hard to concentrate on things that you find boring
or difficult, or at least not engaging, because you can't
just turn on your switch. But it is easy, too
easy to focus when something is really absorbing. So hyper
focus only tends to apply to things that you find
(11:44):
highly engaging. And it sounds like you're questioning whether he
may have an intentional issue. If this is the issue,
then early diagnosis and intervention is key. Testing can often
be arranged through your school, especially if the teacher has
noted his struggle and refers him you can discuss this
(12:08):
with his teacher, but also outside neuropsychological testing can be
done instead to determine whether a d h D is present,
and either way, behavioral interventions to help him with developing
what I would call workarounds or behavioral methods of improving
his ability to organize, to follow directions, to show what
(12:32):
he knows on tests, to create better study methods that
can make a big difference in school performance and thereby
his self esteem. Sometimes, in cases that don't respond adequately
to behavioral training, medication maybe an option. This is something
(12:53):
best to discuss with a child psychiatrist. Some children have
a little trouble attending but really don't meet the criteria
for a d h D. They can still benefit from
learning organizational strategies for doing and keeping school work. Either way,
I'd advise you to rule in or rule out what
(13:15):
might be causing what you clearly see as a change
for your son to help set him back on track
for future years of emotional, academic, and social well being
in school. I hope that was helpful. It is getting
a diagnosis of a d h D or dyslexia all
(13:38):
bad news and a child no. Actually, there are unique
hardwired potentials for strengths and children who have a d
h D and dyslexia. Case in point is somebody I've
spoken to. Dr Beryl Benserrat, a radiologist who discovered the
method of using ultrasound to do pre natal screening for
(14:01):
Down syndrome. Dr Benisirath has dyslexia, and though school was
challenging for her due to difficulty reading, her uniquely wired
brain also helped her make breakthroughs medically that eluded others.
This was no doubt due at least in part, to
(14:21):
heighten the ability to spot patterns on X rays and
think creatively. These are known strengths for people with dyslexia.
Data also support a connection between a d h D
and exceptional originality and creativity, high energy, and an ability
to take risks that can pay off. When a child
(14:44):
is diagnosed with a d h D, one of the
first things I advise parents is to be aware of
the particular types of strengths that often accompany these disorders.
I tell parents to expose their children to subject matter
and experience is that allow for that strength to be
discovered and to manifest itself. For example, introduce your child
(15:09):
to puzzles in various three dimensional mazes and blocks to
explore their visual spatial aptitude. To art projects and music
of various types to gauge their interests in creative aptitude
in that arena, And to subject matter from astronomy to
(15:29):
coding to jazz to allow a spark to catch that
will engage both their strengths and perhaps their passion. Discuss
with your child their ideas for solving problems that exist
in these different arenas to allow them to generate creative
solutions and mollover what might work and what might not.
(15:54):
Allow space in their day for imaginative play, since unstructured
time is needed to allow creative thought to blossom. It's
also important to speak to your school and teachers about
allowing for methods of completing work that do play to
your child's strengths. That way, they can show what they
(16:17):
know and build confidence in their capabilities. Parents can and
should balance getting diagnosis and treatment with searching for and
nurturing strengths in their child. The earlier parents do this,
the better. Many of the world's most creative and successful
(16:38):
people also have a mental health diagnosis or a learning disability.
Do you have a problem I can help with? If so,
email me yet? How can I help? At Seneca women
dot com, all centers remain anonymous and listen every Friday too.
How can I help with me? Doctor Gail Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. With so many children
zooming to school and missing in persons school, the number
of children who have undiagnosed attention deficit hyperactivity disorder amongst
the most common of childhood mental health issues, and dyslexia,
(00:50):
and really struggling to stay engaged with school work and
feeling frustrated and falling behind. Those numbers have all risen
with the emphasis for children in school being on staying
safe from COVID, which is understandable, The ability for teachers
to spot when a child is struggling, to recognize what
(01:13):
the struggle might indicate, and to suggest testing to pinpoint
what might be going on is diminished. Parents may well
assume that their struggling child is having difficulty due to
the social isolation, the loss of in school time, and
the general difficulties of the pandemic. And this may well
(01:37):
be true, but that can make it easy to miss
an emerging mental health diagnosis that requires specific diagnosis and
treatment to support the child. Most parents find it difficult
to even acknowledge to themselves that indeed their child could
(01:57):
have a d h D or a learning disability because
the idea is painful, and because we still stigmatize, and
because they don't want it to be true. And that
is the reason why diagnosis is so often delayed by
as much as two to five years from the beginning
(02:18):
of symptoms for children who then only slip farther behind.
Early intervention helps a child to stay on track and
not lose self esteem because they don't find themselves lost
and a wash with their school work if they have recognition, treatment,
(02:39):
and support. Today, I am answering a listener's question about
her child's slipping performance in school and what to do
about it. In addition, when a child is diagnosed with
a learning disability or with attention deficit disorder, might they
(02:59):
only have difficulty in school? Could they also have a
potential strength? About ten of school aged children have a
d D and ten to fift have dyslexia the most
common of the learning disabilities. Attention deficit hyperactivity disorder affect
(03:21):
the child's ability to regulate when they are attending to something.
This results in difficulty concentrating on subject matter that the
child does not find especially compelling, but also hyper focusing
on material that is of great interest to them. It includes,
(03:42):
for many, difficulty with being disorganized, misplacing or forgetting things,
being impulsive, and, for those with a d h D,
hyperactivity or a physical restlessness the child experiences. In addition
to the other symptoms, dyslexia affects a child's ability to
(04:05):
process written language correctly. Certainly, both of these differences in
a child's brain can make aspects of school and home
life more difficult. Many parents are reticent to pursue a diagnosis,
even when they have a visibly struggling child, because the
(04:26):
very idea of any mental illness or learning disability feels
so distressing and stigmatizing. Delaying diagnosis has two significant drawbacks.
One is that the longer a child stays off track
with regard to school ability and overall development, the more
(04:47):
difficult it is to get them back on track. Children's
brains are very plastic, meaning they keep changing, and the
earlier you treat them, the more quick really brain changes
can happen. This can result in fewer symptoms or the
development of coping skills that enable your child to work
(05:10):
around their symptoms. The second drawback of delaying diagnosis is
that along with the brain differences that cause symptoms such
as distractability and difficulty reading, come particular strengths that, if nurtured,
could make all the difference in terms of your child's
actual potential and future self esteem. So with that, let's
(05:36):
get to our listeners question and see how can I help.
Dear doctor Salts, My twelve year old is having an
increasingly difficult time with school. He has always been a
good student, high energy, but able to perform well in
the classroom. This past school year has seen the school
(06:01):
move to some remote time, some in class time with masks,
and less time with friends after school due to COVID concerns,
and it has all been a struggle emotionally, but his
grades have been slipping. He has had more difficulty concentrating
and studying for tests that are coming up. On the
(06:23):
one hand, he seems very unfocused and distracted forgetting assignments,
missing questions on a test. But on the other hand,
he is able to play a video game he likes
endlessly with razor sharp focus, and in fact I have
difficulty getting him to stop. So this doesn't seem like
(06:45):
attention deficit disorder to me. But I'm not sure, and
I'm worried that academically he is heading south. And actually
he feels very anxious about this himself. What can I
do to help him? These past two years have been
very difficult for many school children for a whole host
(07:09):
of reasons that you allude to. The Loss of time
at school has set some children behind in terms of
learning and has made it difficult to catch up, to
stay focused and feel happy at school. Kids who have
any attentional issues were amongst the most affected because Zoom
(07:31):
school was especially difficult for them. Staring at a screen
all day is hard enough for most adults, it was
pretty excruciating for many kids. Emotional state affects attention, and
so kids without an attentional diagnosis had more difficulty these
(07:51):
past two years if they were highly anxious, feeling sad,
are overall quite stressed. As any of these issues affects
one's ability to attend and concentrate. So discussing your son's
emotional state with him and helping him with his stress,
anxiety or mood could go a long way towards helping
(08:15):
him to be able to attend in school again. But
attention deficit hyperactivity disorder is an even more common diagnosis
than depression or an anxiety disorder in this age group.
How can I help with? Dr Gale Salts will be
back after the short brain back to my listeners question
(08:50):
about her son with school issues. The main symptoms of
attention deficit hyperactivity disorder are impulsiveness, disorganization, and problems prioritizing,
poor time management skills, problems focusing on a task, trouble multitasking,
(09:11):
excessive activity or restlessness, and poor planning, as well as
having a low frustration tolerance. So, Mom, you need to
ask yourself are several of these issues visible to you?
Or you should call his teachers and ask is this
(09:31):
visible to them? You don't need to have all of them,
just a couple most commonly actually is impulsivity and disorganization
and trouble attending to a task that they don't like.
You mentioned his focus on video games, another element of
(09:52):
a d h D is something called hyper focus, the
ability to attend in a super focused and can tenuous
way on content that you like. Sometimes, due to hyper focus,
it is difficult to stop. The reason for this is
that a d h D is not a wiring issue
(10:14):
that prevents you from being able to focus. It is
a wiring issue that has to do with what's called
a faulty switch in an area of the brain called
the default network. This is the area that has to
do with fantasy, thought, imagination, just free thinking, and one's
(10:35):
ability to regulate that switch determines when you will consciously
focus and when you choose not to focus. But if
the faulty switch is there, as it is in a
d h D, it means one's ability to consciously decide
when to focus is not consciously under your control. So
(10:58):
sometimes it will be on and sometimes it will be off,
and it's mostly going to be regulated by what is
enjoyable and really interesting to you, because enjoyable and interesting
turns on the neurotransmitter dopamine, and that neurotransmitter is the
neurotransmitter of reward. And so the outcome is that it
(11:23):
is hard to concentrate on things that you find boring
or difficult, or at least not engaging, because you can't
just turn on your switch. But it is easy, too
easy to focus when something is really absorbing. So hyper
focus only tends to apply to things that you find
(11:44):
highly engaging. And it sounds like you're questioning whether he
may have an intentional issue. If this is the issue,
then early diagnosis and intervention is key. Testing can often
be arranged through your school, especially if the teacher has
noted his struggle and refers him you can discuss this
(12:08):
with his teacher, but also outside neuropsychological testing can be
done instead to determine whether a d h D is present,
and either way, behavioral interventions to help him with developing
what I would call workarounds or behavioral methods of improving
his ability to organize, to follow directions, to show what
(12:32):
he knows on tests, to create better study methods that
can make a big difference in school performance and thereby
his self esteem. Sometimes, in cases that don't respond adequately
to behavioral training, medication maybe an option. This is something
(12:53):
best to discuss with a child psychiatrist. Some children have
a little trouble attending but really don't meet the criteria
for a d h D. They can still benefit from
learning organizational strategies for doing and keeping school work. Either way,
I'd advise you to rule in or rule out what
(13:15):
might be causing what you clearly see as a change
for your son to help set him back on track
for future years of emotional, academic, and social well being
in school. I hope that was helpful. It is getting
a diagnosis of a d h D or dyslexia all
(13:38):
bad news and a child no. Actually, there are unique
hardwired potentials for strengths and children who have a d
h D and dyslexia. Case in point is somebody I've
spoken to. Dr Beryl Benserrat, a radiologist who discovered the
method of using ultrasound to do pre natal screening for
(14:01):
Down syndrome. Dr Benisirath has dyslexia, and though school was
challenging for her due to difficulty reading, her uniquely wired
brain also helped her make breakthroughs medically that eluded others.
This was no doubt due at least in part, to
(14:21):
heighten the ability to spot patterns on X rays and
think creatively. These are known strengths for people with dyslexia.
Data also support a connection between a d h D
and exceptional originality and creativity, high energy, and an ability
to take risks that can pay off. When a child
(14:44):
is diagnosed with a d h D, one of the
first things I advise parents is to be aware of
the particular types of strengths that often accompany these disorders.
I tell parents to expose their children to subject matter
and experience is that allow for that strength to be
discovered and to manifest itself. For example, introduce your child
(15:09):
to puzzles in various three dimensional mazes and blocks to
explore their visual spatial aptitude. To art projects and music
of various types to gauge their interests in creative aptitude
in that arena, And to subject matter from astronomy to
(15:29):
coding to jazz to allow a spark to catch that
will engage both their strengths and perhaps their passion. Discuss
with your child their ideas for solving problems that exist
in these different arenas to allow them to generate creative
solutions and mollover what might work and what might not.
(15:54):
Allow space in their day for imaginative play, since unstructured
time is needed to allow creative thought to blossom. It's
also important to speak to your school and teachers about
allowing for methods of completing work that do play to
your child's strengths. That way, they can show what they
(16:17):
know and build confidence in their capabilities. Parents can and
should balance getting diagnosis and treatment with searching for and
nurturing strengths in their child. The earlier parents do this,
the better. Many of the world's most creative and successful
(16:38):
people also have a mental health diagnosis or a learning disability.
Do you have a problem I can help with? If so,
email me yet? How can I help? At Seneca women
dot com, all centers remain anonymous and listen every Friday too.
How can I help with me? Doctor Gail Salts
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