Up to 1 in 10 American children may be affected by Attention Deficit Hyperactivity Disorder (ADHD), and even more when including other learning and behavioral issues or Learning Disabilities (LD) like Dyslexia. This can be greatly frustrating for both the children affected and their parents. Managing these issues can be complicated by the fact that children often are affected by more than one condition simultaneously. It is important for caregivers to know that these conditions can indeed be treated and that the quality of learning can be improved. To maximize the effectiveness of treatment, learning and behavioral conditions should be evaluated early and treatment started as soon as possible. The first step is for parents to understand the basics of ADHD and learning disabilities so that they can identify the warning signs in their children. Below is an interview with pediatric neurologist Dr. Pascal Saremsky.
What signs might indicate that a child has learning issues?
Dr. Saremsky: Typically, parents first notice signs of learning issues in their child at home or in their child’s performance in school. At home, parents may notice that their child’s room is frequently very messy, that their child is forgetful, easily distracted, and constantly misplaces things. While many children may occasionally be messy or irresponsible, it is the frequency and severity that may raise a parent’s concern. At school, teachers or counselors may notice that the child has difficulty focusing in class, acts out, or frequently fails to complete or submit assignments in a timely fashion. A common scenario is when an intelligent child is consistently receiving grades far below their abilities. When these problems constitute a pattern, parents should consider having their child evaluated for underlying conditions like ADHD and learning disabilities.
Can a child have ADHD even though they are not hyperactive or can sometimes focus?
Dr. Saremsky: Children with ADHD can exhibit a trait called hyperfocusing. They are able to focus intently for long period of time on a subject or activity that interests them, but they tune out responsibilities and are unable to focus in other contexts, like the classroom. Attention deficit issues come in many forms, sometimes with hyperactivity (ADHD) and sometimes without (ADD). Generally speaking, girls tend to be less hyperactive which can detract from making a prompt diagnosis, while boys more frequently exhibit hyperactivity.
What other conditions can affect a child’s ability to learn?
Dr. Saremsky: Learning disabilities come in a number of forms, affecting each child differently. Dyslexia can greatly hinder a child’s ability to read and to understand written expression effectively. A child may understand the rules of grammar and spelling, but nonetheless have great difficulty with reading fluency, speed, and comprehension as well as writing. Difficulties with math reasoning and number manipulation can indicate dyscalculia. A high proportion of children with ADHD and learning disabilities may also have issues stemming from other underlying comorbid disorders. Psychological conditions like depression and anxiety can impair learning - for instance a child with severe social anxiety is likely to encounter issues in the classroom regardless of a learning disability - if they suffer from both, then performance will be that much worse. Other neurological issues must be considered. One example is a condition called Childhood Absence Epilepsy in which a child appears to “space out” many times throughout the day. These episodes are actually a type of seizure that should be evaluated and treated as soon as possible. Brain trauma and conditions like anemia, Lyme disease, thyroid disorder, and vitamin D deficiency can also result in behavioral and learning symptoms.
What are benefits of a consultation with a pediatric neurologist?
Dr. Saremsky: First and foremost, a consultation with a pediatric neurologist can help to rule out any underlying psychological, neurological, or physical issues in a child. Secondarily, a significant difficulty is obtaining needed services from bureaucracies like those of school districts. A pediatric neurologist should not only be able to give an accurate diagnosis and prescribe a treatment plan, but also work together with parents, teachers, counselors, and therapists to formulate the best approach for each child. The provision of special services for children with learning issues is often conditional on a physician’s diagnosis and a compelling letter advocating on behalf of the child. A pediatric neurologist can also help secure a neuropsychological evaluation from the school district. Once these initial hurdles are cleared, a child can then be eligible for special services such as 504 accommodations or individualized educational plan. 504 accommodations can include: extra time on tests, separate testing location, preferential seating (at the front of the class), assistance with understanding test questions, and being provided with assistive technologies. An individualized educational plan is more elaborate and can include personalized instruction in certain subjects, extra teachers in the classroom, or even a separate specialized classroom in severe cases.
What do diagnosis and treatment entail?
Dr Saremsky: I believe the evaluation should be multidisciplinary and thorough. In sudden or severe cases of behavioral or learning problems, metabolic and physical conditions should be first ruled out. Blood tests can help to show whether there is any evidence of Lyme disease, vitamin deficiencies, anemia, or thyroid problems. Brain imaging and electroencephalograms (EEGs) can determine structural or functional deficits such as brain lesions or epilepsy. If any of these are present, their treatment is a priority. If a child has seizures, then they should be treated for epilepsy alongside any learning issues. I work with child therapists and psychiatrists to ensure that any significant psychological or psychiatric problems are under control. When a child is diagnosed with ADHD or a learning disability, it is best to follow a conservative treatment plan. First, I work together with a child’s caregivers to make optimal lifestyle and environmental changes. Modest changes in a child’s schedule, diet, and surroundings can have a positive effect on learning. Second, I help to coach parents on a variety of specialized parental techniques suited for children with learning issues. Third, I help to secure special school services like 504 accommodations or an individualized educational plan. Lastly, in more severe cases, certain medications may be considered - and these come in a variety of forms (not just stimulants) and dosing regimes. If a medication treatment approach is chosen, then regular and prompt follow-ups are conducted to ensure optimal medication choice and dosage, while minimizing negative side effects.
Do you have any final words of advice for parents of children with learning issues?
Dr. Saremsky: It is important to know that ADHD and learning disabilities have a multifactorial origin - both nature and nurture play a role. A child’s body and mind must be addressed alongside their environment and the pedagogical techniques used by their parents and teachers. The earlier you treat, the more aggressively you treat, and the more holistic your approach, the more effective you will be in improving your child’s learning.
Dr. Pascal Saremsky is a board-certified pediatric neurologist and pediatric epileptologist. He completed a fellowship in pediatric neurology at the Albert Einstein College of Medicine and a fellowship in pediatric epilepsy and neurophysiology at New York Presbyterian Hospital. He specializes in treating patients from newborns to early adulthood with a personalized and friendly approach that helps his young patients and their parents feel comfortable under his care.
If you believe your child may have ADHD or a learning disability, schedule a consultation with a pediatric neurologist today by calling (646) 679-6609 or booking online below.
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